Technology is shaping the future of healthcare, providing massive breakthroughs in precision medicines, diagnostics, pharmaceuticals, and healthcare delivery. But despite these innovations, one in every five Indians below 45 years of age is exposed to at least one morbid condition. According to the first Longitudinal Ageing Study in India (LASI) released by the Union Ministry of Family and Health Welfare in 2020, the percentage of people without morbidity consistently declined with age.
Most of the chronic illnesses in India attributes to cardiovascular disease, hypertension, bone/joint diseases, diabetes mellitus, chronic lung diseases and psychiatric conditions. Behavioural patterns such as behavioural excesses and deficits significantly contribute to these chronic health conditions. Hence, behavioural interventions are the most effective approach to countering the rising chronic illness in India.
Behavioural deficits are those behaviours that are under-performed, such as physical activity, healthcare-seeking behaviours, and adherence to prescribed medical regimes. In contrast, behavioural excesses are behaviours performed too often, such as eating unhealthy diets, smoking, and substance use. Behavioural science, which merges psychological theories with economics, can resolve the paradox of irrational choices adopted by humans.
However, the very challenge in making behavioural interventions work is information asymmetry. Individuals choosing unhealthy over healthy options often do so because of the high immediate satisfaction compared to more probabilistic benefits after an uncertain delay. For instance, opting to eat unhealthy junk foods for immediate gratification compared to eating healthy foods whose benefits can be realised in an uncertain future.
Such skewed and irrational decision-making occurs due to exogenous variables such as motivation, quality, urgency, personal tastes and preferences, lifestyle, etc. One way to overcome these behavioural barriers is health literacy.
Health literacy refers to the level of literacy that individuals possess to understand and translate health information to protect, maintain and improve one’s health by making the right choices. Indeed many studies have shown an improvement in health behaviour in chronic illness due to health literacy resulting in desirable health outcomes.
The behavioural intervention framework is one such potential and cost-effective approach to augment health literacy among the growing population of India. The intervention involves constructing health messages and communication strategies tailored to match personal characteristics and delivered by trusted authorities. Though there are several practices for achieving this, using the COM-B model of behaviour is the most robust behavioural framework.
The COM-B model proposes that a specific behaviour occurs due to the interaction between Capability, Opportunity and Motivation. Thus, each of these individual components drives behaviour and targets altogether to promote the desired behaviour.
Capability in COM-B Model
Capability refers to the individual’s knowledge and skills to promote behaviour. It aims to reduce information asymmetry by comprehensively providing appropriate information to avoid misinterpretation. Health messages should be simple, lucid and engaging because individuals are less likely to engage with complex information.
The messages should provide information on possible risks and benefits of health behaviours. It is essential to gauge the existing literacy levels, socio-cultural factors, dissemination platforms, and local practices to achieve this. For instance, motivating individuals to follow a healthy diet and regular exercise requires organising a training session to inform the learning of that behaviour that may augment their capabilities.
Opportunity in COM-B Model
Opportunity refers to all the external factors that facilitate a behaviour. It includes physical opportunity, social opportunity and opportunity within the environment. Just focusing on providing information alone may not achieve the desired behaviour. There could be social norms or physical resources that could hinder the practice of desired behaviour. For instance, an individual may be aware of the benefits of regular exercise. Still, monetary issues or lack of companionship, i.e. social opportunity, could be a barrier to their participation. In such cases, free exercise classes can encourage people to attend, overriding these barriers.
Motivation in COM-B Model
Motivation refers to all the internal factors that drive behaviour. If capability and opportunity exist to influence one’s behaviour, their motivation to adopt the desired behaviour increases. Motivation could be either reflective or automatic. Reflective motivation involves making plans and evaluating the outcomes, whereas automatic motivation depends on desires, wants and impulses. For instance, to instil the behaviour of adopting a healthy diet, the health message can use reflective motivation to highlight the benefits of performing that behaviour.
Behaviour in COM-B Model
If all the above individual components are successfully implemented, the individual’s behaviour will change to the desired behaviour. Thus, the COM-B model shows how a robust behavioural science framework can link knowledge, attitude and practices into a new behaviour of healthy lifestyle practices. It will reduce the chronic illness burden among Indians, and they may experience a range of health and social benefits.
Health behaviour is an ongoing problem and will not be resolved in the short run. It is not wise to rely only on technology to reduce the chronic disease burden. Instead, we all need to acknowledge the significant role of health literacy in the coming years and work to counter irrational health behaviours at every level, from individual to societal. It will not be an overnight task but would require collaboration and investments among stakeholders to achieve the desired behaviour in the long run.
