In global health we hear the word champion often. Champions can open minds and doors for innovation. They mobilize communities and advocate for change. They can reduce stigmas by providing accurate information and putting faces to silent struggles and years of discrimination. Global health champions helped eradicate smallpox and have given voice and legitimacy to HIV/aids in communities across the world. Champions can be survivors with their own stories to tell, empathetic allies and opinion or community leaders, or even relatable fictional characters. A Cohrene study (2007 as cited in NCCMT, 2011) suggests that using champions is effective approach to promoting change.
According to The National Collaborating Center for Methods and Tools or NCCMT (2011), “A champion is a charismatic advocate of a belief, practice, program, policy and/or technology.”
So how does one go about cultivating champions?
My answer is that there is not a single right answer. It depends on where you are, what you want to do and whose involved. Like anything you have to match the answer to the question. Do some formative research and decipher who is your audience and who and what influence and move them (see some of our previous blog posts about social marketing). Programs around the world depend on various types of champions: some engage communities and local people, some engage survivors and those with personal stories and struggles and some engage or create opinion leaders both real and fictional. In some situations champions can emerge on there own without being involved in a formal program or policy.
For example the dark, humorous but incredibly insightful blog author “Allie’ of Hyperbole and a Half posted “Depression part 2” explaining her experience with depression and strangely enough a piece of corn under her fridge. This single blog post began conversations about mental and depression by simply telling a story and explaining what it was like in a creating and captivating way. It has 5000 comments from the day it was posted, and is referenced by numerous blogs and popular websites including jezebel and reddit. If you need more proof simple google ” depression corn under the fridge”
For those of you who want a more theoretical or evidence based approach you can look into the “champion advocacy model” as outlined by NCCMT. This model looks at the likelihood that a idea or practice is adopted by the population of interest (relates to the diffusion of innovation model). Using a project by Family Health International (FHI) called ‘Network of Champions’ of (NOC which is detailed here), NCCMT argues that aligning individuals whom are already perceived as opinion leaders is more effective in promoting change than less influential individuals who are already aligned with your cause. They also conclude that:
- The influence of a single influence may be limited to a certain level or sphere. Therefore multiple champions should be engaged at multiple ‘points of influence’ to maximize their combined influence while avoiding bottlenecks.
- Any new advocacy effort demands a significant buy in and support from a wide range of stakeholders.
- Incentives and supports for champions can increase likelihood of success, including formal recognition and acknowledgement, technical and financial supports including transport stipends, capacity-building opportunities and skills certificates” (FHI, 2011)
- It is essential that strategies to prevent or address champion fatigue are developed and implemented.
- Any external inter-country networking of a various number of champion based initiatives should be established and maintained on an individual bases.
In addition to these lessons, FHI’s own report on NOC also recommends that you match your champion to the specific activity you want them to do being mindful of their position, influence, time frames and feasibility. You should also encourage champions to build local support networks and internalize the program’s vision to avoid micro managing them (FHI, 2011).
(Stomping out Mental Health Stigma, NHS)
In his 2010 TED Talk, Andrew Steward describes his experience with schizophrenia stating, “when someone breaks an arm we write all over their cast, but when someone suffers from mental problems we run the other way.” According to the Canadian Mental Health Association (CMHA), one in five people under the age of 65 will experience some sort of mental illness. Enormous stigma, judgment and discrimination are associated with mental illness. Despite the fact that mental illness is so widespread the public appears to have very little understanding about mental illness. CMHA lists and dispute the top 10 myths Canadians hold surrounding mental illnesses. All of the following are incorrect and do not take into account the complexity of mental illness (please see the CMHA website for more details).
Myth #1: Mental illness means that guy is crazy; he isn’t really sick.
Myth #2: Addictions to drugs and alcohol are the result of a lack of willpower.
Myth #3: Mentally ill people have lower intelligence and are poorer than the rest of the population.
Myth #4: Bad parenting causes mental illness.
Myth #5: People with mental illnesses are violent and dangerous.
Myth #6: If a person has schizophrenia, they have multiple personalities.
Myth #7: Electrical shock therapy is like torture. It is inhumane, outdated and completely ineffective.
Myth #8: Once you are diagnosed with a mental illness, you are crazy for the rest of your life.
Myth #9: All people get depressed, as they grow older; it is part of the aging process.
Myth #10: People with a mental illness cannot hold down a job.
Where do all these misunderstandings stem from?
One answer is the media. A recent Canadian review of a number of academic studies concluded five powerful things:
- The mass media is the public’s main source of information about mental illness.
- The information presented by the media about mental illness are often stereotypes that are negative and wrong.
- Negative public attitudes of mental health are connected to negative media portrayals.
- Negative media portrayals directly and negatively affect those living with mental illness.
- Government responses to mental health issues are connected to negative media portrayals of mental illness.
Media has also been using its power for good.
Various ad campaigns, tv shows movies, and film have begun addressing the stigma of mental illness by presenting realistic portrayals of mental illness. Below are a couple of British advertisements addressing the stigma surrounding mental illness and these types of public myths in humorous ways.
United Kingdom Government Public Service Announcement (60 sec):
Time to Change (61 sec):
In TV, an approach called Entertainment Education (EE) has begun to be used to portray mental illness and its treatment in realistic ways. EE is described as “entertainment with social benefits” by its creator Miguel Sabido (Baker, 2005) and has been outlined in a number previous blog posts within this blog by my colleagues.
There has been limited research linking the positive effects of the media on a public beliefs and attitudes about mental illness. However, a 2009 study demonstrated the positive effects of a “multimedia outreach effort to youth dealing with bi-polar disorder” using an EE in a series of episodes on the popular show 902010.
This success suggests that EE can be effectively used to combat the negative impact of media on the public’s understandings of mental illness. In 2005, an American organization called the Substance Abuse and Mental Health Service Administration (SAMHSA) began recognizing “consumer/peer leaders and TV and film professionals who educate the public about the real experiences of people [struggling with mental health conditions]” with their Voice Award program. The 902010 bi-polar story line referred to above won a SAMHSA Voice award in 2009. The following TV shows were recipients of SAMHSA Voice Awards in 2012 for their realistic portrayals of mental illness showing us that media can be part of the solution in the fight against mental health stigma
- Castle – Season 4 Episode 9 “ Kill Shot”
- Glee – Season 3 Episode 14 “On My Way”
- Homeland – Season 1 Episode 11 “ The Vest”
- Law & Order: SVU – Season 13 Episode 1 “Personal Fouls”
- Necessary Roughness – (The entire series)
- Parenthood – Season 3 Episodes 5-9
References not linked to:
Barker K. Sex, soap, and social change: The Sabido methodology. Haider, M., ed. In: Global Public Health Communication: Challenges, Perspectives, and Strategies. Sudbury, Massachusetts, Jones and Bartlett Publishers, 2005. p. 113-154.
Mental health and mental well-being are more than a lack of mental illness. Our mental well-being is impacted by a range of factors ranging from individual level psychology to wider societal determinants. In their Mental Well-being Impact Assessment (MWIA) Toolkit (2011), the National MWIA Collaborative outline an evidence-based model of metal well-being (as seen in the figure below).
MWIA’s Dynamic Model of Mental Well-being
Using this model, the MWIA toolkit walks individuals and community stakeholders through a screening and assessment process examining a proposal’s impacts on mental well-being. It then allows stakeholders to develop monitoring indicators and make evidence-based recommendations aimed at maximizing the proposal’s positive impacts on mental well-being while minimizing its negative impacts.
After hearing and reading so much about the Transtheoretical Model and the Stages of Change, I wanted to supplement Tara’s lovely presentation and this week’s readings with an exploration of motivational interviewing. So this post will talk about how motivational interviewing is related to our readings, what exactly it is, how it’s related to public health in general and I’ll leave you with a question to ponder or discuss in the comment section.
How is this related to our readings?
Parvanta mentions motivational interviewing in the text when she differs theory-base methods (stage-based behavioral adoption) from practice strategies (motivational interviewing) and activities/channels (counseling sessions). What this means is that Motivational interviewing or MI, is an intervention that delivers an adaptation of stages of change theory to actually change an individual’s behaviour. MI is not the only way of delivering an adaptation of the stages of change theory. Click here to see another way to deliver a practice strategy informed by the Transtheoretical model.
What is Motivational Interviewing?
MI is an evidence-based counseling intervention that has shown to be effective in treating people with addictions issues (for those interested in the evidence here is an open access journal article full of psychology jargon about MI).
MI is used to ‘move’ people in one stage of change to another by directing the conversation in such a way so that the client (and not the clinician) is the one coming up with the reasons (motivation) to change. Like my title suggests a quick and dirty way to understand MI is that it is remarkably similar to the “reverse psychology” our parents (or at least TV parents) used on us when we were kids.
A foundational concept to MI is that people often get defensive when someone else is telling them why their behaviour is bad and they need to change it. This results in the person putting more effort into justifying their behaviour and why they shouldn’t change than why they should. For this reason, MI places the burden of explaining why a behaviour is bad on the person who is doing it. It is argued that this allows the person to own the behaviour change and their own personal reasons for change. This ownership increases the likelihood of follow through and maintenance of the behaviour change. MI can be compared to traditional ‘intervention’ style, which use confrontation to attempt to motivate people into changing in their problematic behaviours.
Below is a video of Dr. Bill Miller, the creator of motivational interview, talking about traditional addictions approaches, the background and basics of MI.
This is public health course not a course in addictions. Why should I know about motivational interviewing?
MI is now being used for individual behavior change for behaviors like physical inactivity and healthy eating. The Public Health Agency of Canada is now promoting the use of MI techniques by physicians for supporting behaviour change in their patients (as seen in the video overview below). See their website for more videos on using MI techniques for specific behaviours (eg. physical inactivity).
A question for your consideration:
Motivational interviewing claims to be client driven but can also be portrayed as quite manipulative. What ethical considerations do you think are important to be aware of before using MI or any other change theories on the behaviour of others?