Behaviour change, dual processing-models and the ethics of health promotion

Abstract

Background Research suggests health-related behaviours are strongly influenced by non-conscious processes. Dual-processing models describe this in terms of system I (impulsive) and system II (reflective) mechanisms of behavioural control. System I-targeted behaviour change interventions may promote healthy behaviour whilst bypassing conscious processes. Such interventions are sometimes thought to be ethically suspect, often due to a concern that they undermine autonom; system II-targeted interventions are generally prefered. This paper questions the justifiability of this preference. Methods In this conceptual analysis, we use psychological theory regarding dual-processing models of behavioural control to inform a philosophical analysis of the ethical permissibility of behaviour change interventions targeting reflective and impulsive systems. Findings Dual-processing models show a large proportion of behaviour to be under non-conscious control. A concept of autonomy that requires significant conscious awareness and control over one’s behaviour is therefore unrealistic and unhelpful for guiding ethical intervention development. A useful concept of autonomy must accommodate the routine influence of non-conscious processes. Further, health promotion via conscious, system II processes encourages false beliefs about the extent to which behaviour is subject to conscious control, rationalising the stigmatisation of those with ‘unhealthy’ behaviour. Additionaly, system I-targeted interventions can be effective at promoting health and demand less effort from the individual. Discussion A psychologically informed analysis of system I-targeted behaviour change interventions suggests they are less ethically problematic than often assumed, and may have distinct advantages over system II-targeted interventions.