The knowing-doing gap

Curiosity and a sense on incredulity occurred when I first read the statistics that essentially said that it takes on average 17 years before evidence of what works makes it into practice and that those that do are merely a slither from the tip of the iceberg – so many great things, things with potential to deliver positive change get lost down the abyss between knowing and doing. Why is that?

But hang on ‘Helen’, this isn’t just about the translation of academia into health and care practice, oh no, no, no…… this goes much deeper into the human psyche. Public health and government campaigns across the globe exhort the virtues and long-term benefits of ‘healthy living’ whether that relates to healthy eating, safe sex, increases in exercise, not smoking or taking recreational substances and limiting alcohol intake etc, however in many cases their words fall on deaf ears with people making a conscious choice to behave in the ways that they do, those behaviours seemingly being far more rewarding, at least in the short term, than the effort of making the required change – even when the pay off is much greater in the long term. What is this all about and what can we do about it?

I was assessing a new HOPE facilitator the other day on their maiden-voyage , sitting quietly at the back of the room, witnessing the delivery and experiencing first hand the impact that the programme was having on real people, when I was struck by the group discussion the developed in front of me.

It was started off from a seemingly simple statement made by one individual, innocently setting the scene for others to chip in. “We are all familiar with the words, we all know what we should do………. but it’s only since starting this course that I’ve been able to start to do these things“.

The person was right of course, all of the people in the room had been through the ‘NHS sheep dip’ of investigations, diagnosis, treatment etc and had all been given the same or similar information in the form of ‘professional advice’, leaflets and video’s etc, but clearly the messages that the NHS is so keen to relay to the public, with the belief that they should soak these messages up, somehow combining them with their DNA, to enact a permanent change in behaviour clearly simply does not work for many people.

The Everett Rogers model of attributes of a successful innovation demonstrates 5 key components to consider if you want the odds of your innovation or behaviour change sticking to be in your favour.

So what is it about the HOPE programme that helps people who for far too long feel that they have been stuck on an inescapable hamster wheel of struggling to overcome physical or mental health challenges, but never really getting anywhere? I suspect that the lesson’s shared by Roger’s can shed much light on the difference that this particular programme offers.

For a start across Devon and Cornwall people are seeing the ‘social proof’ from others, like them, who have tried and not only survived but have thrived as a result of the programme, this offers a sense of hope that things can be better. Relative advantage (tick)

The programme works particularly well when you bring people who share similar experiences together, whether that be health conditions or symptoms, such as chronic pain, fatigue, anxiety etc = Compatability (tick)

When you bring people together with shared experiences or purpose, providing them with a safe and non-judgemental space, you never know what will pop up in conversation!

It is simple and gentle in its format, scooping people up from week one when they embark on their own personal journey, but one that is shared with others treading the same path. The power of the programme is in its simplicity. = Complexity (tick)

we have even had some unexpected guests.

The programme is offered free across the community and although we actively target those people who describe themselves as having lower levels of knowledge, skills and confidence in managing their current health and wellbeing concerns, the programme is inclusive – all who desire HOPE are very welcome to give it a go. We have found that in the main when people join on week one, they stay the whole 6 week course. We have even had a small number of people come back for second helpings! = Triability (tick)

The last of Roger’s attributes for innovation is slightly more difficult to evidence for HOPE. People who attend the programmes are not ‘observable’ – we do not encourage onlookers to peep, reminiscent of a bygone era in Victorian entertainment, however we do offer HOPE to the workforce members of our system wide health, care and wider partners: after all those who care for others often require that same compassionate care, time and understanding for themselves – it is what makes us human. We also share the programmes reported outcomes, letters of HOPE and in the near future plan on recording podcasts where we can hear from participants directly, while maintaining their anonymity. = Observability (oh go on then, let’s have a final tick)

One of the 6 components of Personalised Care is “Building my knowledge, skills and confidence“. On its own it seems barely enough to turn the tide of poor health outcomes that are plaguing many in our society. Across the western world we may be blessed with increasing life expectancy, but without the accompanying health expectancy those extended years of life can be miserable and frustrating for all concerned.

Add “working in partnership with care team” and “connecting with help and support in my community” into the mix and we start to witness phenomenal positive changes, based on building relationships, human to human, where individuals believe that they can create a future that is meaningful to them.

From what I have witnessed in person, the strength in the HOPE programme, where people build knowledge, skills and confidence around their own health and well-being alongside others in similar situations, is in its ability to bridge that gap between knowing and doing while developing long lasting human connections.

A final couple of questions for you to consider as we end this blog;

  • How many of Roger’s attributes does your change work encompass and what can you do to build more of these into your work?
  • How can you incorporated all or some of the elements of Personalised Care into your change work, taking us one step closer towards flourishing lives and communities?

If this seems daunting don’t fret, we are here to help……. if you need to mull over any of the above, feel free to get in touch and we will assist where we can; after all when we combine forces, anything is possible..

Published by change unlocked today

Helen Davies-Cox and Chris Edworthy are 'Architects of Extraordinary Change' , having over 60 years of experience in the NHS between them, leading and engaging in change projects throughout their careers. email:

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