Opportunities in Behavior change

© 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



Agenda

• Current Context

• Motivation, Capacity and Environment

– What is it?– How do health plans and employers

approach it?– Where are there opportunities to

improve?



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



Current Context for Behavior Change

• Personal view of health

• Technology changes

• Who is paying for products and services?



Personal Health Ecology



Carma’s PHE



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



Population SegmentationAc

tivati

on

Level of illness/declining functionHealthy Sick

Low

Hig

h

QS

Chro

nica

lly il

lTrying to stay well

Pre diagnosis



QS

Chro

nica

lly il


Pre diagnosis

Health insurance

DTC

Employers

PaymentAc

tivati

on

Level of IllnessHealthy Sick

Low

Hig

h



QS

Chro

nica

lly il


Pre diagnosis

Emotional StatesAc

tivati

on

Level of IllnessHealthy Sick

Low

Hig

h

Overwhelmed

Working to get a handle on it

Unaware

Maintaining control


Behavior Change



Who is good at behavior change?

• Consumer packaged goods companies

• Game developers

• Military and organized religion



What drives behavior?

• Motivation, Capacity, Environment

– What is it?– How do health plans and employers

approach it?– Where are the opportunities to improve?



Motivation: Why am I behaving this way?

• Spectrum of motivation from extrinsic to intrinsic



Motivation Spectrum



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



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



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



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



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



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



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



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



digitalpotato



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



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


Thank You

Mary Cain, MPH [email protected]



Social Learning/Social Cognitive Model



Theory of Reasoned Action/Planned Behavior



Health Belief Model



Learning Theory



Transtheoretical Model



Ecological Model



Patient Activation Model

Opportunities in Behavior change

Health & Medicine

transforming health

health plans

health information

technology capacity

technology motivation

technology lifemasters

individual health risks

health planemployer