When people are entrenched in a belief, education isn’t enough.
Philip Fernbach, PhD, coauthor of the book The Knowledge Illu-
sion: Why We Never Think Alone, has noted, “Our research shows
that you need to add something else to the equation. ... Extremists
think they understand this stuff already, so they are not going to be
very receptive to education. You first need to get them to appreci-
ate the gaps in their knowledge.”^5
This quote highlights one reason that focusing on the critical
thinking dimension of Diligent Clarification may not be enough:
When people feel they don’t need further education, simply pro-
viding additional information won’t help.
Conversion messages, such as testimonials from people
who have changed their mind on an issue, may be one effec-
tive way to help people understand their own knowledge gap. A
recent study found that people’s attitudes were more strongly
influenced by a video clip of environmentalist Mark Lynas talk-
ing about his change from being opposed to genetically modi-
fied crops to favoring them than by a clip in which he discussed
only being in favor of them.^6
This technique of conversion messages may be useful to
warm people up to the possibility that they don’t know as much
about something as they think they do. Public health campaigns,
such as the American Heart Association’s Go Red for Women,
often feature stories of people discuss-
ing how they were once unaware of their
disease risk and have since changed their
outlook and habits.
Many dietitians use this technique in
group programs, where participants can be
prompted to describe how they changed their
perception of their ability to adjust certain
eating habits. In one-on-one counseling or
in the media, RDs may use a story-telling
approach to discuss how they, or a patient,
had one thought about a particular food or
eating habit, but learned that it was inac-
curate and found a more effective way to
address a problem.
Logical Reasoning
and Risk Tradeoffs
Of course, while some education is
essential, we would argue, however, that
education should focus more on thought
processes and the evidence process
rather than simply sharing information.
This leads to our second dimension, Logi-
cal Reasoning. It’s commonly understood
that human emotion sometimes gets in
the way of logical reasoning. Behavioral
science research shows that people have
enormous difficulty understanding basic
probability, a nonemotional evaluation
that’s fundamental in the understand-
ing of risk.
This shows up in many places in nutrition science, and the survey
asked about three specific examples. First, people often confuse
relative risk, the increased likelihood of an event, with absolute
risk, the overall likelihood of the event. People also often confuse
hazard, something that can cause harm, like a specific chemical,
with risk, the likelihood that this hazard will cause harm with an
expected exposure. Finally, people often confuse correlation, two
things that have a linear relationship, as strong evidence of cau-
sation, one thing causing the other.
We asked RDs two questions about these concepts: 1) How
would you describe the average dietitian’s comfort level in
discussing these concepts with patients or other audiences?
2) How often do you think the average dietitian appropriately clari-
fies these concepts to patients or other audiences? Tables 3a and
3b show the responses.
Overall, responses suggest that dietitians aren’t fully comfort-
able discussing these concepts and, therefore, don’t often address
them when talking with people. There are no quick fixes for this, and
we think some useful continuing education programming could be
developed for these concepts. For now, we address some of the chal-
lenges in talking about absolute vs relative risk through an exam-
ple. Here, we will characterize the dietitian’s role using a Logical
Reasoning tactic from Table 2b: Help people understand tradeoffsTABLE 3A
Percentage of Respondents Indicating That the Average
Dietitian Was Either “Extremely Comfortable” or
“Somewhat Comfortable” in Discussing These Concepts
With Patients or Other Audiences68% Discussing the difference between “correlation” and “causation”
46% Discussing the difference between “risk” and “hazard”
43%
Discussing the difference between “relative risk”
and “absolute risk”TABLE 3B
Percentage of Respondents Indicating That the Average Dietitian
Either “Most of the Time” or “Always” Appropriately Clarifies
These Concepts to Patients or Other Audiences28%
Discussing the difference between “correlation” and
“causation”19% Discussing the difference between “risk” and “hazard”
18%
Discussing the difference between “relative risk” and
“absolute risk”august 2019 http://www.todaysdietitian.com 39