How to Better Communicate Health Risks and Improve Health Outcomes: Self-Affirmation and Feeling Good

St. Louis, MO (January 17, 2018) –  We’re running a three-part blog series about health risks and communication in health, walking through psychological pitfalls, and offering behavioral science solutions. In Part II, we’re discussing self-affirmation techniques.

Part II ─ Self-Affirmation and Feeling Good

“If we don’t intervene, then you’ll die. If we do intervene, the risk of complications is very low.”

As we discussed in Part 1 of this series, changing the format and presentation of risk information to make it easier to understand is a good first step. Using absolute numbers and visual aids can improve how people calculate risk likelihood.

Unfortunately, people also struggle with managing their emotional reaction to risk information. In fact, those most at risk are often the ones most likely to respond poorly to health information or to ignore it altogether. Understanding these emotional pitfalls can help us rethink when and how we deliver risk information to people.

Sometimes decisions about health risks are easy. Administering CPR to save a life makes sense. But sometimes the risks result from behaviors a person is taking or a complicated combination of factors, as with diabetes or a heart attack. How do people think about and respond to these risks?

What if you could reduce the risk of getting diabetes by 50 percent by losing weight? What sort of trade-offs would you be willing to make? What other information would you want before making that decision? How would you feel? Understanding risk matters for decisions about medication, surgery, and our everyday behaviors when it comes to our health.

Understanding risk, probabilities, and percentages can be difficult. This difficulty is compounded when the risks are related to outcomes like death or serious health complications at some point in the future that result from a number of different factors that accumulate over time. What does it mean to halve risk when the baseline rate is low? People may struggle to process risk information the way it is normally presented. Here’s why:

Psychological pitfalls of risk communication

Getting information about a health risk can be scary. Trying to figure out how to feel and what to do can be overwhelming. People must balance their immediate emotions to the threat (fear, worry) and their anticipated emotions if the bad event comes to pass (regret, guilt). Together, these emotions can get in the way of listening – as a result, risk communication often results in no behavior change or poor decision-making.

The Ostrich Effect – Sometimes it’s easier to just ignore threatening information.

People may also try to discredit the threatening information and its sources, or seek out and cling to dubious sources of reassuring information.

For example, when presented with information about the dangers of cigarettes, smokers tune out that information to avoid dealing with it, and continue smoking.

It’s not always easy to know how to address a health risk.

Risk appeals can be effective when presented with a clear next step and a person feels capable. But, people are often unsure where to start making changes, or they may feel that the changes are out of their hands. In the healthcare system, where insurance can influence the treatments available, people may feel particularly helpless. Presenting risk information without the opportunity for actionable change may leave people with good intentions but no difference in behaviors, or it might even backfire, leaving them anxious and afraid with no recourse.

Solutions to help people respond better to risk information

how to Improve Health Outcomes

 Help people “self-affirm” before presenting risk information so they have an emotional buffer.

A brief self-affirmation exercise can bolster people’s emotional resources so they are better equipped to receive and process negative or threatening information. In a self-affirmation, people think about their cherished values and the things they like about themselves. A self-affirmation might be something like, “I am never too busy to help my friends,” or “I successfully adapt to challenges at work.”

In one study, two groups of women were all given dietary advice. When people were given the diet advice by itself, nothing changed; people ate the exact same amount of fruits and vegetables the next week. But, women who walked through a brief affirmation before receiving dietary advice ate four additional servings of fruits and vegetables during the next week! Self-affirmation makes it easier for people to respond to threatening health information and take the next step.

If people self-affirm before receiving risk information, they may be less likely to ignore advice or to have negative emotional reactions that get in the way of action.


Translating research into the real world.

The Envolve Center for Health Behavior Change is a partnership between the Brown School at Washington University in St. Louis, The Center for Advanced Hindsight at Duke University and Centene Corporation. The Envolve Center projects use behavioral science insights to improve health outcomes, working for evidence-based changes at every stage in the process.

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Lindsay Juarez – Senior Behavioral Scientist

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.

Julia O’Brien – Principal Behavioral Scientist

Julia O’Brien is a principal behavioral scientist and leads the Better Living and Health Group at the Center for Advanced Hindsight at Duke University. She has a Ph.D. in social psychology and a background in product research. Julia loves behavioral science and believes it has the potential to solve lots of the world’s problems – especially when paired with technology and bold ideas.