Ulterior Motives

How goals, both seen and unseen, drive behavior

Identity and Disease Prevention

Disease prevention is made harder by threats to identity.

Pink Ribbon
A gender-identity based symbol of breast cancer.
Some diseases strike at random, but others are directly related to some core aspect of a person's identitySmoking is a dangerous activity that can lead to lung cancer and heart disease.  But, smoking becomes a part of a person's identity, which can make it hard for a person to stop smoking.  Diseases like breast and ovarian cancer strike women.  They have a deep connection to women's self-identity, both because of the role of breasts in appearance and sexual attractiveness, and because of the role of both the breasts and ovaries in reproduction.

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This connection between disease and identity is important, because it can influence the effectiveness of methods of disease prevention.  In the case of breast cancer, for example, many organizations have developed huge public-relations campaigns to promote breast self-examinations and mammograms for women over 40.  These campaigns have met with mixed success.

A new study in the June, 2011 issue of the Journal of Consumer Research by Stefano Puntoni, Steven Sweldens, and Nader Tavassoli suggests that this relationship between identity and disease may limit the effectiveness of these campaigns.

A breast cancer ad with gender cues.
In one set of studies, they had women read an ad about breast cancer.  One version of the ad highlighted women's self-identity.  The ad started by saying, "Hey, Woman! Yes, you!"  It also had images of women and pictures of pink ribbons.  The other version of the ad did not highlight women's self-identity.  It just started by saying "Hey You!" and it did not have any pictures of women in the ad.  After reading these ads, people rated their risk of a variety of diseases including breast cancer.  Specifically for breast cancer, the women who read the ad targeted at women rated their risk as lower than the women who read the ad that was not targeted specifically at women.  In another study using an ad for ovarian cancer, women donated less money to fight ovarian cancer after reading an ad that was targeted at women than at an ad that was not specifically targeted.

The idea here is that when a person's identity is threatened, she wants to remove the threat by not paying attention to the information that makes her uncomfortable.  Consistent with this idea, in another study, women showed better memory for a breast cancer ad when it was not targeted specifically at women than when it was. 

So, what can be done?  The authors suggest that threats to identity are most effective when the person does not connect the feeling of threat to their identity specifically.  That is, when reading an ad like a breast cancer ad, a woman might find that the ad makes her uncomfortable, and might just choose to skip it to avoid feeling bad.

The authors suggest that acknowledging that a subject is fearful up front can make messages relating to that fear effective.  To demonstrate this point, they did one additional study in which women saw either an ad that highlighted gender or one that did not.  In this case, though, before rating their risk of diseases, they stated their fear of a variety of diseases.  Women who saw an ad that highlighted gender, but first rated their degree of fear of breast cancer showed about the same level of belief about the risk of breast cancer as women who saw the ads that did not highlight gender.

That is, expressing that breast cancer is threatening helped women to acknowledge that it also poses a risk.

These studies demonstrate why it is so difficult to help people engage in behaviors that would help to prevent diseases.  Many diseases are threatening to a person's identity.  We do not like to pay attention to information that threatens our sense of self.  So, we ignore that information. 

There are two lessons here.  If you are trying to convince others about the importance of preventative behaviors, try to do it in a way that minimizes the relationship between disease and identity.  On the other side of the coin, if you see information about prevention behaviors that feels threatening, start by acknowledging that disease is scary.  That will help you to recognize that the fear need not be the guiding force in your beliefs and behavior.

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Art Markman, Ph.D., is a cognitive scientist at the University of Texas whose research spans a range of topics in the way people think.

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