Health Psychology and Behavior Change in Healthcare
Behavior change is hard — and changing health behaviors is no exception. Whether it's stopping smoking, getting more exercise, or taking your medication as prescribed, individuals with chronic illness face a range of behavior modifications recommended by their HCP. Studies like one from the National Conference of State Legislatures (see http://www.ncsl.org/research/health/medication-adherence-taking-pills-as-ordered.aspx) show that up to 50% of American adults are nonadherent in one of the most common requests — taking their medication. Why?
Health psychology experts urge us to look more closely at the why behind patient behavior.
In fact, health psychology theory tells us that all behaviors are driven by sets of personal beliefs. In order to change such behaviors as nonadherence, you must first identify and address the beliefs that support and guide that behavior.
Here are four guiding principles I've learned from health psychology colleagues that provide critical perspective for designing patient-support programs that seek to support health-related behaviors like treatment adherence.
There is a reason nonadherence continues to be a significant challenge in healthcare. There is no single approach that will solve the problem for everyone. You may have a well-designed website or app but, regardless of the channel, it's the relevance of the content that is key.
When a pharma client engages us to design a patient-support program, the first step involves rigorous research by our health psychology experts, including insights mining, literature review, social listening, and interviews across the healthcare ecosystem. It's precisely because there is no magic bullet that we need to work diligently at the beginning to understand the barriers and motivators (the why) behind behaviors across the target population.
What works for one individual may not work for another. Behavior change is personal. If a person skips taking a medication because he or she is asymptomatic and doesn't believe it's helping, reminders won't help. That person isn't forgetting to take the medication — he or she is choosing not to take the medication.
Related to this point, it's important to understand the difference between segmentation and personalization. Segmentation groups people by demographics, stage of disease, and geography as well as attitudinal traits. But two people of the same age on the same medication may have radically different beliefs that drive their nonadherence. You wouldn't automatically assume that two 25-year-old women in the same town like the same music. Why should patients be any different? Personalization is the opposite of one size fits all. It's about delivering the right message to the right person at the right time in the right framework.
Many people are surprised to learn there are actually more than 100 behavior change techniques (BCTs) supported by health psychology theory.
After assessing the challenges of a population, our health psychology experts decide which BCTs are the right ones to leverage in specific patient communications. Some strategies used in motivational interviewing may play a role — or they may not. We may decide that email messages about medication adherence should use a problem-solving BCT, whereas outreach on lifestyle changes may use personal goal setting.
Simply educating someone about a prescribed treatment doesn't mean he or she will activate on that information. Education is important but only goes so far. To be effective in changing behaviors, communications tools need to provide both relevant content and meaningful engagement over time.
In the end, pharma and payers alike would do well to engage with experts who understand how to address the why behind nonadherent behaviors. Only then can they develop personalized interventions that support each patient to stay on track for the long haul.