Easier Read Than Done: Knowledge Alone Isn’t Enough to Change Behavior

This post initially appeared on the Envolve Blog.

How many fruits and vegetables should you eat every day for better health? Many public health food campaigns hinge on providing information to help people make better choices. These campaigns, such as the “5 A Day,” are good at raising awareness or improving people’s attitudes toward fruits and vegetables.1 However, there is little evidence that these campaigns then increase actual fruit and vegetable consumption.1, 2, 3, 4

Although most people would agree that eating a healthy diet and exercising can improve health and help prevent chronic diseases, only one in 10 Americans eats the recommended five servings of fruits and vegetables per day.5 And despite clear guidelines for physical activity, only one in five Americans meets the recommended levels for aerobic and anaerobic exercise.6

Why is there this disconnect? It may be that the time it takes for individuals to see the positive health effects of these behaviors seems too long and the outcomes too indirect. Perhaps people are better at carrying out healthy behaviors when the effect is more immediate, such as controlling one’s blood sugar to manage diabetes or taking a daily medication to address a chronic disease.

In collaboration with the Envolve Center for Health Behavior Change™, researchers from Duke University surveyed 1,000 adults with Type II diabetes and found that being well-informed about diabetes self-care does not translate into healthier behaviors or better disease management. Survey participants were asked to report on their knowledge and attitudes toward diabetes self-management behaviors, including diet, exercise and following other medical recommendations. Participants were asked about their motivation to control their disease, the dangers it presented to their short- and long-term health, and their actual disease management. Despite two-thirds of ­the sample reporting extremely high knowledge of what to do to manage their disease and almost all agreeing that following those recommendations was “very important,” there was little to no relationship between those measures and the likelihood that individuals were successfully managing their diabetes and reaching their HbA1c targets. Whether it’s eating more veggies or managing diabetes, healthcare providers and policymakers need to question assumptions that being informed about healthy behaviors means people actually engage in those healthy behaviors.

 If information alone doesn’t change behavior, what works?

Once people know what to do, the most effective ways to increase the likelihood of action are to make it easy or fun and to make unhealthy behaviors more difficult. We’re great at doing this for children: accompanying vaccinations with lollipops, blending extra greens into a smoothie to make “monster juice,” or replacing screen-time with outdoor playtime. We overlook that adults like doing easy and fun things too!

Adults can also harness the power of social connections. Exercising with a friend makes working out more fun and creates accountability; knowing that your “accountabilibuddy” is waiting for you makes it much harder to decide that you’re too tired for the gym. Getting others involved in your health goals can also create a culture of wellness in your network. For example, an office could hold “Salad Club” during a weekday lunch, making healthy eating the default norm. Even more complicated behaviors, such as checking blood sugar or adhering to a medication regimen, can benefit from accountabilibuddies, as app developers have learned.

So, grab a friend, get out there and eat your veggies!


[1] https://www.ncbi.nlm.nih.gov/pubmed/16672211

[2] https://www.sciencedirect.com/science/article/pii/S0749379706004934

[3] https://www.bbc.com/news/health-20858809

[4] http://www.who.int/dietphysicalactivity/media/en/gs_fv_ppt_lorelei.pdf

[5] https://www.cdc.gov/media/releases/2017/p1116-fruit-vegetable-consumption.html

[6] https://www.cdc.gov/nchs/fastats/exercise.htm


About the Author

Lindsay Juarez is a senior behavioral scientist in the Center for Advanced Hindsight at Duke University. She has a Ph.D. in social psychology and specializes in goal pursuit and self-control. She works with the Envolve Center’s Behavioral Economics (BE) team, which incorporates BE and social science into health-related behavioral modification programs.