The Current State and Future of Multiple Health Behavior Change: An Interview with Dr. Bonnie Spring

Jean M. Reading, PhD, Tyler B, Mason, PhD, Peter Giacobbi, PhD, Tammy Stump, PhD; Multiple Health Behavior Change and Multi-morbidities SIG

Dr. Jean Reading (left); Dr. Bonnie Spring (right)

The Multiple Health Behavior Change and Multi-morbidities (MHBCM) SIG is relatively new to SBM. We talked to Dr. Bonnie Spring, an esteemed professor at Northwestern University, to learn about the current state of MHBCM research and the future importance of our SIG.

Dr. Jean Reading:  What are some examples of important research contributions in MHBCM in the last 20 years?

Dr. Bonnie Spring: There have been certain practical issues that have needed to be tackled. One of which is because you're combining across multiple behaviors; each of which has its own metrics, just the question of how you quantify improvement across behaviors has been a huge issue. There have been various approaches proposed, and I don’t think there's a clear winner. But the fact that it's been tackled and there are options is a good thing. I think the other practical questions have had to do with just how many behaviors can people change at once? I don't think we have the answer to it yet, but we're getting closer. The other is related to the question of how many things can you change at once? Can you do this simultaneously? Or, is it better to do it sequentially? And there has been a fair amount of research on that. Not entirely consistent. But I have to say, I think that the evidence has moved in the direction of saying we can do an awful lot more simultaneously than we thought. On the issue of simultaneous versus sequential behavior change, I think the push towards pragmatism says simultaneous, because it's so much more efficient. I think let's not try to figure out for the next 10 years what the answer is to this, let's try to build something that can actually fit into systems and be scalable, usable, and practical.

JR: What are the pressing research issues for MHBCM, particularly when thinking about digital health?

BS: In one of our recent papers, we really hoped that we would find that a technology solution alone would be non-inferior to offering a coach because it's much less expensive. It wasn't non-inferior. There are people for whom it worked, about a third of the sample. But we don't know what that third is. Not only do we not know who that third is, but if we're wrong, we can't rescue people. We don't know what the step care options are that would fix this. So at a population level, we need a mix of treatments that are population scale, not all that costly, and we need to know who at the outset will benefit from them, who needs more, and in what sequence.

JR: Do you have any advice for students and early career researchers as they begin to establish a research program in MHBCM?

BS: I think one of the fundamental choices is whether they orient towards a public health approach or a clinical approach. They are quite different, and they both have real advantages. I came from a background in severe psychopathology, and so clinical was the arena that I was familiar with. I learned how to do intensive behavioral treatments. The concept that every clinical psychologist could sit in their office till doomsday and treat every person and we wouldn't have a dent is a very slow to dawn realization for a clinical psychologist. Another is the issue of cost and the importance of costs, particularly in a healthcare system like ours. When you talk about these issues with clinicians and physicians, they see cost as a trivial problem. They say, if you develop something and it works, somebody will find a way to pay for it. I don't think we have that luxury any longer. This is where the public health population approaches make a very important point and bring us down to reality. We need to be working at both ends: developing the expensive stuff for the people who really need it and giving people what they need, not less but also not more. This will spread resources across the population equitably.

JR: What activities or contributions would you like to see from the MHBCM SIG over the next couple of years?

BS: I think there's a lot of interface there that could be productive, which could mean strategically partnering with other SIGs on problems. There's a lot of overlap with the Optimization SIG. Many multiple health behavior change people have found those methods really valuable. Also, we tend to forget about theory. We tend to do one thing or another, and we need to recognize we can't be all things. But we do need to be addressing those issues of mechanism and why.