Behavior change is a process, not an event.  Encouraging people to take action often takes repeated exposure and contacts — particularly if that action relates to health.

People flagged at risk of stroke in a community stroke screening are more likely to see a doctor within three months if they get a personalized pep talk via phone, including advice on how to get to a doctor's office,  than those who received standard information on risk factors but no motivational help.

This study in the July-August 2011 issue of the Journal of Stroke and Cerebrovascular Diseases continues to refine work I was involved in during the 1990s as a PR consultant to the National Stroke Association.

Behavior change– especially in health — can require a five step process:

* Creating awareness of a issue

* Generating interest to learn more

* A triggering event that makes it personally relevant

* Follow-up to provide motivation

* Action to address the health risk.

Getting someone to attend a stroke screening requires the individual to be aware of stroke risk and the event where they can be assessed.  The blood pressure and health history checks at a stroke screening make it possible to have a "teachable moment" when a health care professional can say to that person, "you have double the risk of stroke because of your blood pressure."  Unfortunately, studies show that even when people in screenings are told they are at high risk of stroke, they rarely go to a doctor for care.

We know that fear of acute stroke can be immobilizing. Doctors at the University of Michigan, who conducted the new study, used a brief phone call, known as the Health Belief Model, to offer specific health advice and discuss barriers to seeing a primary care physician.  These patients were twice as likely (56%)  to visit their primary care physician and discuss stroke screening results as the group that did not get a call (38%).

An effective behavior change campaign has multiple steps — including education, an interpersonal component (if practical) and follow-up to make sure the person has the tools and resources  to get the medical help they need.