Helping Patients Help Themselves

Contributed by:

Jennifer Sigaud, Managing Director, Us, Atlantis Healthcare

NOTE: The content below contains the first few paragraphs of the printed article and the titles of the sidebars and boxes, if applicable.

pv1016_jennifersiguadOne of the biggest challenges in healthcare begins the moment a patient steps out of the doctor’s office or clinic. Suddenly, that individual assumes the bulk of responsibility for managing his or her condition on a daily basis — day after day, good mood or bad, on vacations, at work and at home.

Managing a chronic condition is not just about taking medication as prescribed; it often includes making changes to lifestyle, including diet and exercise. Complicating this is a range of factors, including degree and quality of social support, as well as access to healthy foods and activities.

Needless to say, some individuals are more successful at adhering to their prescribed treatment than others.  Among people with chronic conditions, 60% to 80% are nonadherent.

How can pharma marketers help patients help themselves? A good place to start is by applying the discipline of health psychology to understand the “why” behind nonadherent behavior.

Education Can’t Be a One Way Street

Change isn’t easy. Simply telling people what to do or providing them with a pamphlet about their medication is usually not enough to motivate long-term adherence. Information alone doesn’t guarantee any individual will do what you ask.  This isn’t just relevant in healthcare, we see it in many parts of our world. Coaches tell their teams to execute certain plays, to run fast, to win games.  But, without frequent practice, guidance, and honest feedback, how can any team expect to win?

A successful patient journey is supported with a two-way dialogue. Giving instructions isn’t a conversation.  Information delivered in a vacuum doesn’t allow patients to own the process, or set realistic expectations of what they need to do. Just as athletes need feedback and coaching, so do individuals trying to manage a chronic condition.

For those with unhealthy behaviors, changing behavior can be hard. It’s human nature that we don’t want to do things that are uncomfortable, or things we feel don’t bring value. For some, fear of side effects to a medication can lead them to take only half of their pills or bury the pill bottle at the back of the medicine cabinet until the next episode.

If you’re telling someone to do something that goes against the very bedrock of what they think — for example, these pills will make me sick — they aren’t going to do it until you can shift the bedrock.  This is where health psychology offers a key to unlock healthier behaviors.

Adopting Healthy Behaviors

How can pharma empower each patient to stay on track?

The first step is research.  Not just research to understand who is nonadherent, but research to understand why individuals are not following prescribed treatment, and which types of interventions are most suited to change those behaviors.

Leveraging health psychology models at the very beginning of the process — the research phase — sets up an effective framework to develop programs that address the barriers and motivators behind an individual’s nonadherent behaviors.

Designing successful patient interventions isn’t as simple as designing well-written patient education brochures. Applying the academic rigor of health psychology in the research phase creates a four-step blueprint for successful patient support:

Step 1. Identify beliefs driving behaviors

Health psychology dictates that individual behavior is determined by individual beliefs. This is true not just in healthcare, but for every decision we make during our day. Your choice of what to eat, what to read, and which TV shows to watch are all influenced by your personal beliefs.
In managing a chronic condition, each patient is influenced by their beliefs around their condition, their medication and their ability to follow their HCPs prescribed treatment. Through research, we can uncover a range of very different beliefs among patients with the same condition, on the same medication, in the same demographic:
The medication makes me feel bad, so how can it be helping?
I don’t feel any different when I skip a dose, and I’m saving money by delaying the refill
The doctor was confusing and I’m embarrassed to ask questions
The last time I self-injected it hurt; I think I’m doing it wrong

Step 2: Highlight the right behavior change technique

Research also identifies which behavior change technique will work best for an individual patient. Many marketers are familiar with motivational interviewing, but did you know there are more than 100 behavior change techniques?  Using motivational interviewing won’t be helpful in every case. Some patients might do better with goal setting. For others, time management support might be the key. A health psychology expert can identify the relevant technique that works best to address specific belief-driven behaviors in order to empower patients to improve and maintain good self-management.

Step 3: Design a personalized solution

Once research identifies the unhelpful beliefs and the relevant behavior change techniques for an individual, those insights then need to be integrated into interventions or solutions that provide the right context to address the issue. Education and support can be delivered in a variety of forms, including phone consultation with a nurse/pharmacist, printed materials, apps, or web-based activities.

Behavior change tools are not intended to be one size fits all.  The research should guide what messages will resonate with each individual, and identify the best approach. The intervention needs to mesh with an individual’s style of engagement, including channel preference, learning style, or type of behavior change technique.

Step 4: Guide patients to “own” a change in their behavior

A good way to impact behaviors long term is to connect with individuals in such a way that that the change appears to come from them. It’s about providing patients with tools and resources so they can embrace a different way of thinking and take a more active role in managing their health.

Smartly designed solutions can bring the patient along a continuum so, in the end, the change in behavior becomes endemic to them, something they authentically “own.”  When this shift happens, you don’t have to keep reinforcing a behavior or reminding an action. Once the patient adopts a new way of thinking, that will inherently drive sustained behavior change.

What Does Success Look Like?

Success looks and feels different for everyone involved in patient care, including the patient, the HCP, the pharmacist, the caregiver, and pharma. For some patients, success may be defined simply as being able to walk with their grandchildren without getting winded.  For other stakeholders, success can mean satisfaction with a program, decreased cost of care, improved lab results, on-time refills — the list goes on.

In order to define success, it’s critical that the goals from each stakeholder are aligned at the onset. This is a valuable step in acknowledging that, ultimately, this is the patient’s journey, and stakeholders must collaborate to decide how to best imprint on the journey to be successful.(PV)

Atlantis Healthcare uses health psychology frameworks to design and manage interventions that empower people to better self-manage their illness for the long term.
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