Showing scan images to motivate healthy behaviors in patients provides mixed results

Can showing patients ultrasounds and X-rays of their bodies to point out existing health damage make patients change their risky behavior?

Getting patients to change their behavior is a big challenge for doctors, but critical for public health. A new systematic review looked at whether showing patients medical scan images would motivate them to change their behavior to reduce risks to their health. However, the results were less than clear.

"Behavior is very difficult to change, and many interventions which on a common-sense level would be thought likely to be effective in changing behavior, are not shown to be," said lead author Gareth Hollands, of the health psychology section at King's College in London. "Given the difficulty of changing behavior, we would not say we were greatly surprised by the results."

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

Medical imaging, such as ultrasound, X-ray and magnetic resonance imaging (MRI), allows doctors to determine whether patients have any bodily damage and to assess their patients' level of future disease risk based on the results.

The Cochrane reviewers evaluated nine studies involving 1,371 adults. Participants in each study were shown their medical scan images — typically arterial scans for assessing cardiovascular risk and skin photography for assessing skin damage. Participants were then educated about any risks to their health and how they could change behavior to help lower these risks.

The reviewers found mixed results. Because of the small number of studies and the different interventions used, they could not find strong evidence that this approach was effective in changing behavior.

Hollands and his colleagues did find that with smoking cessation, showing and explaining arterial scanning images was more effective than not showing them. In three studies that evaluated smoking cessation after participants were shown arterial scans, the odds of participants who were shown the scans giving up smoking or attempting to quit were 2.8 times higher than for those who were not shown scans.

Moreover, one study that measured the number of participants who performed skin self-examinations in the four months following being shown their skin photography found that the odds of those shown the scans doing self-exams were 4.86 times higher those in the control group.

On the other hand, a variety of studies — using arterial scans or skin photographs — all found no significant difference in participants in the intervention and control groups. Such studies look at these health behaviors: (1) increased use of cholesterol and blood pressure medications, (2) increase in fiber consumption, (3) changes in physical activity, (4) changes in hours spent in the sun and (5) changes in the use of sun protection.

"I would not expect that just seeing one's medical imaging results would change their behavior," said Jennifer McClure, Ph.D., associate director for research at the Group Health Center for Health Studies in Seattle.

"The hope is that seeing these images increases one's understanding of their health risks, which in turn increases their motivation to change, but sustained behavior change requires more than simply knowing one's risk," McClure said. "It is dependent on a number of other individual-level factors which influence motivation, as well as whether one has the requisite skills, knowledge or resources necessary to make and maintain behavior change. So the mixed results are not at all surprising."

Hollands and his fellow reviewers concluded that new techniques are needed to give patients visual evidence of how certain behaviors damage their body — and motivate them to change.

"The feedback of medical imaging results may be one such approach," Hollands said. "Medical imaging methods are continually evolving and the results produced are increasing in detail and clarity… as medical imaging becomes ever cheaper and more widely available, there will likely be increasing opportunities for feeding back results to individuals, and a corresponding opportunity to assess whether this is a viable intervention strategy."