People often say one thing and do another.

This came home clearly to me with a nutrition project conducted with fifth and sixth grade students over the course of two consecutive semesters. We taught them nutrition and fitness and assorted various nutrition and fitness concepts (nutrient density, empty calories, food groups, energy requirements, etc.). We asked them at the beginning to identify which snack they would choose if they were with their friends (apple, carrots, peanut butter crackers, chocolate chip cookie, potato chips). We asked them at the end of the project the same question. They said they would choose an apple both pre and post. On the pretest, in descending order, the  students would choose carrots, potato chips, chocolate chip cookies, and peanut butter crackers. On the post test, in descending order, the students would choose chocolate chip cookies, carrots, potato chips, and peanut butter crackers. (Although the sample sizes were reasonable [i.e., greater than 30], I’m not sure that the difference between 13.0% [potato chips] and 12.7% [peanut butter crackers] was significant. I do not have those data.) Then, we also asked them to choose one real snack. What they said and what they did was not the same, even at the end of the project. Cookies won, hands down in both the treatment and control groups. Discouraging to say the least; disappointing to be sure. What they said they would do and what they actually did were different.

Although this program ran from September through April, and is much longer than the typical professional development conference of a half day (or even a day), what the students said was different from what the students did. We attempted to measure knowledge, attitude, and behavior. We did not measure intention to change.

That experience reminded me of a finding of Paul Mazmanian . (I know I’ve talked about him and his work before; his work bears repeating.) He did a randomized controlled trial involving continuing medical education and commitment to change. After all, any program worth its salt will result in behavior change, right? So Paul Mazmanian set up this experiment involving doctors, the world’s worst folks with whom to try to change behavior.

He found that “…physicians in both the study and the control groups were significantly more likely to change (47% vs 7%, p<0.001) IF they indicated an INTENT (emphasis added in both cases) to change immediately following the lecture ” (i.e., the continuing education program).  He did a further study and found that a signature stating that they would change didn’t increase the likelihood that they would change.

Bottom line, measure intention to change in evaluating your programs.

References:

Mazmanian, P. E., Daffron, S. R., Johnson, R. E., Davis, D. A., & Kantrowitz, M. P. (August 1998). Information about barriers to planned change: A randomized controlled trial involving continuing medical education lectures and commitment to change. Academic Medicine, 73(8), 882-886.

Mazmanian, P. E., Johnson, R. E., Zhang, A., Boothby, J. & Yeatts, E. J. (June, 2001). Effects of a signature on rates of change: A randomized controlled trial involving continuing education and the commitment-to-change model. Academic Medicine, 76(6), 642-646.