Messages about Diabetes: A Mind Genomics Exploration of Communicating for Medicine & Public Health

Abstract

Awareness to risks of type II diabetes, the epidemic of the 21st century, is low. We present an investigation into the messages about diabetes which resonate with respondents. The approach uses experimentally designed combinations of messages, unique for each respondent, with the property that the messages appear in a way that prevents the respondent from ‘gaming’ the experiment. Each respondent generates a unique pattern of coefficients for both important of messages, and response time to messages. The study suggests three mind-sets (Focus on the sufferer alone; The doctor is the source of knowledge; Focus on management with the help of others.) We present the PVI, personal viewpoint identifier, allowing the researcher to identify the appropriate convincing message for each respondent, who is first assigned to one of the three mind-sets by the PVI. The Mind Genomics study provides the health community with an easy-to-use system for understanding and deploying convincing messages in health-relevant situations, and may serve as an ongoing, working tool, for health maintenance among the general population. Introduction One only needs to open any medical journal to read about the medical issues involved in one or another aspect of diabetes. The popular press, and especially the web, are filled with stories about the issues of diabetes, the newspapers filled with latest information about specific issues involved with diabetes as a looming disaster for society, the magazines filled with stories about personal encounters with diabetes, and to those on the web innumerable advertisements about what to do and what not to do to forestall diabetes. The sheer popularity of diabetes as an issue of discussion is witness to the growing recognition of this developing scourge of society. Type II diabetes has been recognized as a global epidemic of the 21st century [1]. Diabetes is the seventh leading cause of death and disability worldwide [2]. Disability resulting from diabetes has grown substantially between 1990 to 2013 particularly among ages 15–69 years; age-standardized prevalence among adult men doubled from 4.3% to 9% and agestandardized prevalence among adult women increased by 60% from 5% to 8% [3]. People suffering from diabetes are at risk of developing a range of complications endangering their health, functionality and survival. Diabetes has increased across countries [4]. In 2013, 382 million people in 130 countries had diabetes [5]. It is estimated that by 2030 the number of people with Diabetes will rise to 552 million by 2030, and that by 2035 the number of people with diabetes will rise to 592 million (5–7). Despite these concerning data, only a few countries, mostly in Western Europe, seem to have a chance of halting the rise in diabetes by 2030 [4]. Health expenditures associated with diabetes create an economic burden [8]. Epidemiological and economic data for 184 countries suggest that direct global costs accounted for $1.31 trillion, based on WHO’s general health expenditure figures and data from the 2015 [9]. Furthermore, indirect costs of premature mortality and comorbidity due to diabetes accounted for 35% of the total burden with America being the largest contributor to global costs of diabetes [10]. Type II diabetes is caused by factors such as obesity, sedentary lifestyle, diet, smoking, physical and emotional stress which are modifiable [11,12]. Interventions to target modifiable risk factors can prevent or delay the onset of diabetes, but awareness of risks of diabetes is low [10]. The human suffering in diabetes and the economic burden of diabetes on health systems of every country, make diabetes an urgent matter to combat the disease [4]. Education, and especially effective communication, are critical. When people can be effectively educated about the risk and the modifiable factors that can be changed, there is the possibility that the effects of Diabetes can be reduced. One consequence of education is that those individuals who perceive themselves to be at risk of diabetes may be more conscious about what to do, and more likely to follow up on efforts which reduce their risk of developing diabetes [8]. Sadly, little attention was paid to creating effective messages which raise the awareness diabetes risks [1,12]. To be sensitive and effective, messages about risk awareness need proper shaping through framing, narrative impact or visual imagery [11]. These messages should Howard Moskowitz (2019) Messages about Diabetes: A Mind Genomics Exploration of Communicating for Medicine & Public Health Endocrinol Diabetes Metab J, Volume 3(5): 2–13, 2019 acknowledge the role of individuals in adopting healthy behaviors, and consciously avoid activating negative stereotypes or arousing anger at the message source [13]. Effective messaging will enable health professionals and health policy makers to identify and to use the most effective message for each person in the population by mindset segments of the sample. How do we understand the mind, and enhance risk awareness effectively? Formal statistics provide no sense of how people ‘feel’, and to what people ‘react’. Softer yet quantitative methods provide other points of view. Mind-Genomics is an approach best described a ‘cartography of the mind’ which studies responses to different aspects of daily life experience [14–16]. Mind-Genomics maps an experience, identifies its different facets, determines to what facets the person attends, and how important each facet is for each person [14,17–22] By dealing with responses to elements of everyday experience, as they are reacted to by people, Mind-Genomics reveals how people react to the specifics of experience, looking at the nuances, and thus taking into account the richness of experience. Mind-Genomics is an empirical science, mapping aspects of experience by importance, and segmenting different groups of people by their different viewpoints, so-called mind-sets. This Mind-Genomics study identifies effective messaging to raise awareness to risk of diabetes, looking at the general population by the different mind-sets, and what will work (as well as what will fail) for each mind-set. At the very practical level, in both the medical and non-medical worlds, what does one say to alert the population to the potential problems of diabetes? What does one say to direct people to the proper behaviors, and encourage them, in order to forestall diabetes? And, if one puts the current messaging to the test, do the content of today’s messages strike a resonant chord in the mind of the average consumer? Must we frighten people into a better lifestyle? [23–26]. Finally, as part of this introduction, can we identify different types of people, responding to various messages. We know from the popular press that there is a plethora of choice and the corresponding paradox of choice [27]. In the world of food, for example, we now know both from science and from the marketplace that people have different preferences for products, and will gravitate to what they like, rejecting what they dislike. Prego, for example, is just such a phenomenon, of a product once appearing in one SKU (shop-keeping unit), but now proliferating into more than a dozen, with varieties coming in and out of the market every year. Do we have the same distribution of preferences, not for a physical food product, but rather for a message, such as the type of message to warn us about diabetes? Method The approach used is known as Mind Genomics, a form of experimental design in which messages are combined into short, easy-to-read vignettes, such as that shown in Figure 1 for this study. The messages are developed by a Socratic method of choosing a topic, asking four related questions which ‘tell a story,’ providing four answers to each question, and testing combinations of these answers. Mind Genomics, based upon the statistical rigor of experimental design [28] combined with simple testing of combinations by the web, creates a method which is fast, easy, affordable, iterative, and scalable. The objective is to work with small, cost-effective groups of respondents, members of a large on-line panel, and explore different messages in an iterative fashion, to discover what ‘works’, to discover possibly ‘newto-the-world’ mind-sets, and when possible iterate rapidly across a series of studies to fine tune messages [14,29,30.] Figure 1. Example of a vignette for the diabetes study The methods of Mind Genomics enjoy a long history. Psychologists and marketers have known for decades that the everyday experience of people is not easily uncovered by the conventional scientific method of isolate and then study. For some phenomenon, such isolation works very well to help the researcher understand the phenomenon. The everyday experience of people, the world of normal behavior where Howard Moskowitz (2019) Messages about Diabetes: A Mind Genomics Exploration of Communicating for Medicine & Public Health Endocrinol Diabetes Metab J, Volume 3(5): 3–13, 2019 diabetes is a relevant issue, cannot be easily understood by isolating variables in a clinical way. Rather, it is important to simulate the compound and complex nature of experience, where an individual is presented with many stimuli of different types, all competing for attention. To this end, experimental design of ideas was promoted by pioneer researchers in the world of marketing, Professors Paul Green and Jerry Wind, at the Wharton School of the University of Pennsylvania [31,32] It is their pioneering which has stimulated the research in this paper, albeit the topic has changed from issues in marketing to issues in public health, namely diabetes. It is important to keep in mind that Mind Genomics studies do not purport to be the ultimate in terms of what works in communication of a topic. Rather, each Mind Genomics study provides a wealth of information in and of itself, as well as a platform both for archiving scie