We need to stop trying to change people’s minds!

I am looking forward to the 4th International Dog Health Workshop (IDHW) co-hosted by the Kennel Club and International Partnership for dogs in Windsor at the end of May. I have been helping to organise one of the themes, Breed Specific Health Strategies, which is the subject of a series of workshop sessions. I will also be making a short presentation on this topic in the Day 1 plenary session.

When I spoke at the 3rd IDHW in 2017, I started by saying that the challenge we face is not a veterinary one, nor even a scientific one. My view was that the challenge we faced was a change management one and how to drive continuous improvement in breed health. This year, I will be saying the challenge is not “are you improving?” but “how fast are you improving?” and “can you prove it?”. Frankly, describing all the actions that are being taken is no longer good enough. If we can’t measure the impact on breed health, we can’t demonstrate that any of those actions were of value.

Prof. Åke Hedhammar, who is leading the theme on extremes and exaggerations in dog conformation, has said something similar in his briefing note to participants:

“We propose to once more focus on the health issues related to a brachycephalic constitution as the highest profile and worst with relation to exaggerations and extremes. In an introductory talk in plenum I will admit that we – despite the magnitude of attention, the raising of awareness across several stakeholder groups, and many actions taken – have failed, so far, to make significant changes in the health status of these breeds. Perhaps many initiatives have not been designed to fully evaluate impacts. There has certainly been a failure to impact the public perception of, and desire for brachycephalics.”

From a change management perspective, it boils down to one thing: if there is no change in (human) behaviour, there will be no improvement in (canine) health.

When I worked with the late Philippa Robinson, as part of our Dog-ED initiative we put together a model describing the elements needed to link health improvement activities with measurable benefits:

As Åke pointed out, we’ve seen lots of projects and new processes that have created outputs such as reports, websites, guidance, educational resources and even new legislation. There has been collaboration to generate support but, in my view, there just haven’t been enough new behaviours to result in rapid enough improvements in dog health. Given the wide range of people interested in dog health, there are lots of people among whom we might need to see new behaviours. Primarily, though, it falls to buyers, breeders and owners to start doing things differently.

Lots of the outputs generated have been focused on changing people’s minds in the belief that they will then change their behaviour. Provide more information, educate them, help them see the error of their ways, stigmatise them; how many of these have caused people to change their behaviour at all, or fast enough, to make a difference for dogs?

One-size-fits-all solutions rarely work

My very first “Best of Health” article described canine health improvement as what is known in business as a “Wicked Problem”. It’s complex and needs to be viewed as a system. Simple, one-size fits all solutions (e.g. change the Breed Standards; introduce more regulation), rarely work and often have unintended consequences. The scale of the challenge can seem daunting but it has parallels in the world of human health where issues such as obesity and crime are being addressed using a systems approach (sometimes!). There is lots of practical work being done, based on good research, in the field of behavioural change.

One of my favourite models for human behaviour change is Dr Susan Michie’s Behavioural Change Wheel. She created the COM-B model from a 2011 study of peer-reviewed papers on behaviour change. She concluded: “Interventions and policies to change behaviour can be usefully characterised by means of a Behaviour Change Wheel comprising: a ‘behaviour system’ at the hub, encircled by intervention functions and then by policy categories.

In the COM-B model, Capability, Opportunity and Motivation interact to generate behaviour. Capability and Opportunity address the question of whether a person can or can’t adopt a particular behaviour while Motivation addresses will they or won’t they adopt it. Both capability and opportunity can influence motivation; for example (but VERY simplistically), if a breeder understands the importance of a particular health screening programme and it is available nearby, they may be more motivated to participate in it.

Coercion vs. incentives

COM-B provides a way to design interventions aimed at changing behaviour. Michie’s work has created a taxonomy of 93 behaviour change techniques, drawn (primarily) from work in public health. The model also differentiates between “interventions” (activities aimed at changing behaviour) and “policies” (actions taken by authorities to enable interventions). So, for example, introducing new canine legislation is a policy approach with the intervention typically being focused on coercion or restriction. This approach to restrict breeding relies on the behavioural change technique of “future punishment” (if you don’t comply, you will be punished). Interestingly, a 2019 paper by Michie reported that coercion and restriction were the least cost-effective interventions in a public health setting, while use of incentives was more cost-effective.

Michie also points out that interventions operate within a social context and should be evaluated against 6 criteria (abbreviated to APEASE):

CriterionDescriptionExample questions to answer
AffordabilityAn intervention is affordable if it can be delivered within an acceptable budget to all those who should benefit.What is the budget to implement the proposed intervention and ensure it is working as intended?
PracticabilityAn intervention is practicable if it can be delivered and implemented as designed.Who will implement the proposal?
Effectiveness and cost-effectivenessEffectiveness refers to the effect size of the intervention in relation to its objectives. Cost-effectiveness is the ratio of an intervention’s effect to its cost.Does the evidence support the recommendations for the intervention?
AcceptabilityAcceptability refers to the extent to which an intervention is judged to be appropriate by relevant stakeholders (and this may differ for different stakeholders).What are the views of vets, KC, breeders, owners and have they all been considered?
Side-effectsAn intervention may have unwanted side-effects or unintended consequences.What might be the unintended consequences or displacement actions?
EquityAn intervention may reduce or increase the disparities between different potential beneficiaries.What will be the effect on other breeds or other owners?

The Quality Guru Joseph Juran said: “If you always do what you always did, you’ll always get what you always got”. Is it time we took a more behavioural and systems-oriented approach to look at why canine health improvement is not happening or not happening fast enough?