opportunities in behavior change
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© 2011 Institute for the Future. All rights reserved. | SR-1407
Building for Jane DoeOpportunities in Behavior Change
BayCHIMary Cain, MPHMay 8, 2012
Transforming Health Through Technology
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
Agenda
• Current Context
• Motivation, Capacity and Environment
– What is it?– How do health plans and employers
approach it?– Where are there opportunities to
improve?
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
My Background
• IFTF
– Consumers and technology • LifeMasters and StayWell
– Building behavior change programs for the chronically ill
• Co-founded a consulting firm, HT3
– Trained motivational interviewing to case management
– Writing about behavior change
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
Current Context for Behavior Change
• Personal view of health
• Technology changes
• Who is paying for products and services?
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
Personal Health Ecology
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
Carma’s PHE
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
Technology Opportunities
• Smartphones as personal data collection and network tools
• Multiple data streams in our PHEs (EHR, PHR, real-time flows)
• Blended reality, geospatial web, data layers and feedback loops
• Sensors, monitoring and social nudging
• Internet of Things
• Virtual reality, avatars and a future you
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
Population SegmentationAc
tivati
on
Level of illness/declining functionHealthy Sick
Low
Hig
h
QS
Chro
nica
lly il
lTrying to stay well
Pre diagnosis
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
QS
Chro
nica
lly il
lTrying to stay well
Pre diagnosis
Health insurance
DTC
Employers
PaymentAc
tivati
on
Level of IllnessHealthy Sick
Low
Hig
h
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
QS
Chro
nica
lly il
lTrying to stay well
Pre diagnosis
Emotional StatesAc
tivati
on
Level of IllnessHealthy Sick
Low
Hig
h
Overwhelmed
Working to get a handle on it
Unaware
Maintaining control
© 2011 Institute for the Future. All rights reserved. | SR-1407
Behavior Change
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
Who is good at behavior change?
• Consumer packaged goods companies
• Game developers
• Military and organized religion
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
What drives behavior?
• Motivation, Capacity, Environment
– What is it?– How do health plans and employers
approach it?– Where are the opportunities to improve?
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
Motivation: Why am I behaving this way?
• Spectrum of motivation from extrinsic to intrinsic
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
Motivation Spectrum
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
Motivation: Why am I behaving this way?
• Spectrum of motivation from extrinsic to intrinsic
• Most behavior change programs are designed for highly motivated individuals
• Badges, points and money provide extrinsic motivation
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
Motivation: Health Plan/Employer Approach
• Carve out the chronically ill and focus on changing/motivating them while offering generic (crappy) lifestyle programs for everyone else
• Acquire a few innovative but fragmented offerings
• Focus on extrinsic motivation with the expectation that intrinsic will come using financial incentives
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
Motivation Opportunities
• Opportunity 1: Focus on the more intrinsic end of motivation spectrum
• Opportunity 2: Focus on discrepancy between today and what you want. Build mindfulness and self-reflection.
– Challenge: make MI or cognitive behavioral therapy DIY and scalable
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
Capacity: What am I able to do?
• Health information (each is a spectrum)
– Self-knowledge, comparing self to others, personal ability and skills
– Health behaviors, what to do to be healthy, link between behavior and health
– Purchasing decisions, what’s the right product, service, treatment for each individual
– Health risks, awareness of environment and genetic risks as well as risks related to decisions and lifestyle
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
Capacity: What am I able to do?
• Self regulation: Do something now for long term gain
• Self efficacy: belief in ability to achieve goal
• Resilience and persistence: ability to maintain and come back from stress and setback
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
Capacity: Health Plan/Employer Approach
• Think knowledge is power and use the foie gras method of creating awareness
• Offer one-size-fits-all information that the consumer must seek out
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
Capacity Opportunities
• Opportunity 1: Provide context-specific information
• Opportunity 2: Filtering based on profile(s)
• Opportunity 3: Games for skill development, self-efficacy and resilience. Examples of teaching someone how to do the right thing in a safe environment
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
Environment: What support surrounds me?
• Social and physical environments
• Cue (or trigger) causes behavior to happen
– A habit = No thinking involved• Ability to program our environments to
support us
– Delegating/cognitive offloading to our devices
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
digitalpotato
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
Environment: Health Plan/Employer Approach
• Health Plans: Not my problem
• ACOs: It will become my problem
• Employers
– Create a culture of health – Physical plant communications and health
infrastructure
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
Environment Opportunities
• Opportunity 1: Activate the social network and focus on social norms
• Opportunity 2: Create context-specific triggers
• Opportunity 3: Consider the flow of Jane Doe’s day and her PHE
© 2011 Institute for the Future. All rights reserved. | SR-1407
Thank You
Mary Cain, MPH mcain@ht3.com
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
Social Learning/Social Cognitive Model
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
Theory of Reasoned Action/Planned Behavior
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
Health Belief Model
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
Learning Theory
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
Transtheoretical Model
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
Ecological Model
© 2011 Institute for the Future. All rights reserved. | SR-1407
Transforming Health Through Technology
Patient Activation Model
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