Target the Ready and the Willing
Change isn't always an exercise in behavioral engineering; it's often unplanned. In addition, while healthcare focuses on the "numbers" related to change-blood pressure, weight and blood glucose, to name three-indirect effects such as improved confidence and better mood can't be quantified.
In other words, it's hard to convince patients to change their behavior. The hardest to motivate, when pushed, will likely fail, while the easiest to motivate don't need a push. That's why Dr. David Sobel, medical director of patient education and health promotion at Kaiser Permanente, suggests that providers focus on those in the "middle of the curve."
To "prescribe" success, he says, a patient's care plan needs to be personal, specific, easy, rapid and pleasurable. If patients need to exercise, for example, ask them what activities they enjoy and build an action plan around that. Take the time to discover solutions by asking patients what they think might work best for them. (In one case, Sobel says, such questioning helped a patient decide t put her "take my medicine" notes on her detergent, since she did laundry every day. It worked.) Finally, don't forget to celebrate successes-positive reinforcement never hurts.
Learn From Video Games
The gamification concept is more than just scoring points and earning badges and plaudits, Cueva points out; it also involves understanding the psychological triggers that keep people engaged. This means focusing on motivation that's intrinsic (what individual patients care about) and not extrinsic (what a health insurer or healthcare delivery organization thinks they care about).
Jane McGonigal, a game designer and author who developed SuperBetter to help counteract the symptoms of her own post-concussion syndrome, says empowered patients benefit from positive reappraisal, a perception of social support and a willingness to engage with their stressors, among other factors.
A game such as SuperBetter, which helps users set goals as they recover from injury or illness or focus on living a healthier life, can turn stress into "post-traumatic growth" and act as a "springboard to unleash our best qualities," McGonigal says. When this happens, she adds, people avoid a life that's filled with the top five regrets of the dying.
Support Measurement-Based Medicine
The evidence-based medicine concept suggests that information from many sources-from EHR systems to medical devices and, yes, games-can help physicians make care decisions. But Jamie Heywood, cofounder and chairman of the research and peer care site Patients Like Me, says that's a misnomer, since there's really no evidence that the decisions will work.
It's better, then, to focus on measurement-based medicine, he says. This tracks the severity and impact of a condition to support patients (who make life choices), physicians (who make care choices) and researchers (who determine what works). "You have to solve all three together," Heywood says. "That's when you really learn something."
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