How can we encourage more patients to take care of themselves? What could incentivize the US population to adopt a healthy lifestyle?

  • In my opinion patient education is paramount.

    But it is much more complex than that.

    Education has to be accessible, relevant, and motivating.

    Accessibility of self-care education needs to be widespread. It doesn't matter whether the education comes from physicians, nurses, schools, television, magazines, internet, emails, mobile applications, billboards, or any other media outlet, it has to come from somewhere.

    In many cases it doesn't even come from the physician. A physician's title is "Doctor", which comes from the latin root docere, meaning, "to teach". But many physicians, for many reasons, only tell the patients what to do. This is largely due to the nature of the current healthcare system (reactive medicine, time constraints, demand > supply, profit motivated) and not due to the physician's desire, or lack thereof, to teach. Education in a physician's office has become, "what you need to do because of your problem is this". There is hardly time for emphasis on any other aspect of the problem, such as prevention. And I don't mean to say that physicians are the only ones that should be teaching. All healthcare workers are trained to educate patients, but like physicians most lack the time and availability to do so.

    Another problem with the accessibility of self-care education is funding. The person that would gain the most from good self care education is everybody and nobody. Everyone would benefit, but no one would make money. Pharmaceutical and Insurance companies spend large sums of money to educate people on the use of their product... so they can sell their product and make money. Where are the large sums of money to fund self care education?

    Self care should also be relevant. The message has to apply to the individual in order to motivate the individual. There is less of problem with relevancy of self care education than with accessibility or motivation. Self care applies to everyone and is mostly universal, but none-the-less, education must be relevant to the learner in order to motivate them.

    Finally, and most important in my opinion, is that self care education must be motivating. Motivation, like emotion, both come from the latin root motere, meaning, "to move." So self care education has to move someone to take care of themselves.

    Psychologist David McClelland was a major theorist in motivation. He described three primary motivators for people:

    1. The need for power in the sense of influencing or impacting other people. McClelland distinguished between two kinds of power. One is selfish, ego-centered power, without caring whether the impact is good or bad—the kind of power displayed by narcissists, for example. The other is more important to the healthcare, it is a socially beneficial power. This kind of power is where one takes pleasure in influencing people for the better or for the common good.

    2. The need to affiliate; taking pleasure in being with people. Those who are high in this affiliation motive, for instance, are motivated by the sheer pleasure of doing things together with people they like. When we're working toward a common goal, people motivated by affiliation find energy in how good we'll all feel when we reach that goal. Great team members may be driven by the affiliative motive. Having groups/teams of patients working together toward the same health goals is a worthwhile endeavor.

    3. The need for achievement, reaching toward a meaningful goal. Those high in the need for achievement love to keep score, to get feedback on how they are doing. People who are strong in the achievement drive continually strive to improve; they're relentless learners. No matter how good they are today, they're not satisfied with the status quo; they're always trying to do better. This is where objective feedback and goal setting for health can help a person be motivated.

    Using self care messages that service these primary motivators is important in order to MOVE people to focus on their health and wellness.

    One very good strategy could be to utilize the power of narrative. Patient accounts of hardship and recovery are good motivators since they appeal to a person's emotions and are relevant. But they need to be accessible also.

    Pharmaceutical companies are very good at this, and again, it is one reason they put lots of money into their patient education/advertisements. Their advertisements are usually relevant to their patient's health problem, motivating to the patient by showing a vision of change in a narrative format, and widely accessible due to the funding.

    Positive narratives can illustrate to the patient how their own story could change for the better.

    All of this is just speculation on my part. I'd love to hear someone else's opinions on different strategies to encourage self care among our patients.