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.

  • last week, I asked a director of the NIH,s Behavioral branch if education (in terms of such things as “Breast Cancer Awareness, Prostate Awareness, etc) has been effective in changing outcome. Her answer, in general was there is not a lot of data to support that it does.

    I believe this is because changing behavior- a principle driver of health - is so difficult, particularly when you are aligned against industries who specialize in driving unhealth behaviors.

    I mean, let’s face it- the key article which showed that smoking caused cancer was 1964, but no substantial positive change was made until decades later in smoking. Knowledge is simply not sufficient to change behavior.

    My thought is we need to advocate for passive mechanisms of behavior change, independent of education, similar say, to passive organ donation rather than active organ donation, or automatic default 491k deposits.

  • Matt, I completely understand where you are coming from and agree with your statements; However, I don’t believe behavioral change can occur independent of education. Even in passive organ donation they showed positive results using the IIFF model which basically burns down to motivational education with an opportunity to act. I infer from your post that awareness and information alone isn’t enough to promote behavioral change and I agree. Motivation to change and an opportunity to act are indeed important.

    CH’s Humantiv app and dynamic health score can be thought of as an opportunity to act. One would hope that healthcare professionals are providing patients the education they need to make decisions and act. But I believe many are merely providing recommendations mostly devoid of helpful information and not educating the patient on the importance and the why of their recommendations.

    I’m of course speaking of an extreme but for instance let’s say a person walks into a room and there is a big shiny red button attached to box sitting on a desk by the wall. There is a card sitting next to the box that says “You shouldn’t press the button”. There is no one else there. The person loves pushing red buttons because of the huge dopamine release he gets. He understands the that he shouldn’t according to the card’s recommendation, but why not and who could it hurt? He pushes the button and the room explodes. Hours later among the burning ash an examiner finds more cards that seem to have fallen off of the desk and are lying inbetween the ashen desk and the wall. The cards say the following: “because the button is attached to a bomb”, “the bomb is in this room,” “if the button is pressed, the bomb will explode,” “if the bomb explodes it will destroy the room.” “ if you are in the room, you will die,” etc.

    That was probably a little too hyperbolic on my part, but that in essence was what I was getting at in my previous post.

    I wish I had an answer as to what other ways we could promote behavioral change. All I know is to try by educating patients as much as I can in my clinical encounters. I think the Humantiv app will help many patients, but it is still probably an incomplete solution. What recommendations do you have for me or for CH?

  • Great analogy!

    Regarding education and motivation, I do wonder if education via digital form is substantially different from education face to face - even with something as simple as telemedicine, let alone tools like chat bots, and virtual AI docs. (Different, by the way, may not mean less effective...).

  • @mattrmd interesting thought. @Grady and myself were speaking with @BrennenHodge a little over a year ago about having a physician assign educational modules for patients to complete using a CH resource library. Completion of the module could affect their health score or medit or some other immediate benefit in addition to educating them on their health and/or disease process. Do you have any thoughts on that?

  • Having an education module for physicians could work if you could get CME approval - H heck you could even charge for it). A reasonalbe example is the Mayo Clinics social media course developed in conjunction with Hootsuite. Its also an entry point to their social media network.

    I have laways thought an education module for physicians about advanced technolgies (AI, Deep Learning, NAtural Language Processing, etc) could be valuable but to make it work finacially one ould have ro jump through the CME hoops.