IT Forefront

Beyond technology: How behavioral psychology and design thinking can help your patients change their behavior (and stick to it)

by Andrew Rebhan

Health care stakeholders need to rethink how they develop IT-enabled patient engagement strategies, particularly for chronic disease management. Currently, IT leaders are focused on unifying multiple technologies to aggregate and analyze various sources of patient data. Applying an analytics layer (e.g., classification and segmentation algorithms) to these data sources allows health providers to develop risk scores and stratify patient populations across multiple dimensions, such as age, chronic illnesses, online activity preferences, health-related behaviors, etc. This data-driven insight makes it possible to offer more effective interventions and customized content across the care continuum.

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However, technology is only part of the equation. Health care organizations should also augment their population segmentation by assessing patients' level of "activation," or awareness and engagement with their own health care.

The more engaged a patient is in his or her own care, the more likely he or she is to adhere to healthy behaviors and medical regimens, resulting in more effective chronic disease and population health management. Unfortunately, activating patients and sustaining health behaviors is notoriously difficult. An NEJM Catalyst Insights Council survey on patient engagement found that many approaches that help initiate positive behavior change may not be as effective at sustaining such change. The table below shows the highest ranking approaches in each category from the survey.

Many factors (e.g., education about preventable conditions, virtual social support, electronic reminders) perform disproportionally well in only one category, meaning that health care providers should be strategic about how they employ these tactics.

Another key finding: While technology offers many new opportunities to improve patient care, there are still basic human elements concerning social interaction and support that industry stakeholders cannot overlook. The top two factors leading to sustained behavior change have a social component—and "in-person social support" is the only method that was cited by the majority of respondents as effective for both initiating and sustaining change. At the same time, "personal technology devices" ranked fairly low across both categories.

Behavior change is complex, so approach it holistically

As many health care organizations start to build out a digital health strategy for sustaining healthy patient behavior and engagement, there is a risk of getting tunnel vision around the technology. Here are some tips on how to build a more comprehensive plan:

  1. Dissect patient motivation—Engaging patients in their own care requires tapping into their internal needs, and seeing how those needs can be fulfilled. If those needs can be met through a health and wellness program, then those patients should be willing to sustain positive behaviors (e.g., taking their medication as prescribed, sticking to a healthy diet). Of course, patient preferences will vary from person to person, but there are some fundamental factors that can appeal to a wide range of patients, including:
    • Having all the necessary information to make fully informed decisions (i.e., a sense of autonomy);

    • Setting personalized, meaningful health goals (i.e., goals that reflect their specific behaviors, priorities, and values); and

    • Continuously learning and progressing (e.g., consistent and timely coaching and feedback from a care team).
  2. Provide multiple modes of access to the health system—"Going digital" is not a silver bullet. Newer means of communication through telehealth, mobile apps, and virtual assistants have their benefits, but many patients still prefer to interact with their providers through face-to-face visits or other traditional means. Said another way: Build new platforms, but ensure you have access points to match the preferences or needs of all your patient groups to help sustain engagement.

  3. Mind the 'digital divide'—Given the exponential rise in technological capabilities and the various hype cycles the industry is susceptible to, health care providers must be cautious not to invest in initiatives that underserve their most vulnerable patient populations. We have seen through our research on the social determinants of health how income, language barriers, mental health, health literacy, and a host of other economic and social factors can significantly stunt both patient access and efforts that leverage technology to improve health outcomes.

  4. Adopt design thinking principles—Patients will increasingly demand their own health data, but effective use of that data to drive positive behaviors will depend on certain design and usability considerations. Health care stakeholders should take into account matters of format (e.g., communication methods, notifications), detail (e.g., health data granularity and context provided), and agency (e.g., descriptive data, supplemental advice, proactive recommendations). From a design-thinking perspective, a successful digital health program will incorporate technology into a patient's life in such a seamless way that any devices will become a normal part of life and wellness, rather than an "imposed" requirement to combat illness.
 

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