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Applying Behavior Change Principles
to Remote Care Management
To effectively manage chronic conditions, people must make significant changes in daily life, which
can be especially difficult for older adults who are even more set in their ways than most. Many of the
behavioral shifts that improve health outcomes—reducing calories, increasing exercise, or weighing
oneself daily—are simple. The challenge lies in persuading people to initiate and sustain changes that
contradict habit, culture, convenience and immediate gratification. We call this behavior change and it
is key to the success of remote care management (RCM).
The Science of Behavior Change
The science of behavior change identifies methods of motivating people to make difficult changes.
A broad range of behavior change principles have emerged from the fields of health psychology,
psychotherapy, behavioral economics and the study of influence. These principles are commonly used
in clinical interventions; others, which have been applied primarily in marketing, hold promise for
persuasive health messaging. A translation of these techniques to remote care management can help
unlock some simple principles with significant impact.
Health Psychology
The first major category of
principles, loosely categorized
as Health Psychology, includes
approaches from Learning
Theory, Behaviorism and several
areas of Clinical Psychology.
Many of the techniques in this
category have typically been
applied in clinical interventions,
often in combination, to
help people reduce alcohol
intake, stop smoking and
make other health changes.1
The outcome measures of
these types of clinical trials are
typically behaviors that can
be measured separately from
other health factors (e.g., the
completion of a breast exam
or the cessation of smoking).
In contrast, the most relevant
behaviors for chronic disease
management are more difficult
to measure because they are
ongoing behaviors, such as
improving diet, not one-time
events. Despite this challenge,
there is promise for theorybased interventions that
combine multiple techniques
and delivery methods for
contextual prompting.
Educational feedback can be
provided verbally as well as
in visualizations that specify
healthy and unhealthy ranges.
An example is a newsletter
article titled “Avoid salt
because it leads to fluid
retention” that is coupled with
a picture of a saltshaker with a
red line through it.
Cognitive Behavioral
Therapy
The second major category
of principles emerges from
Cognitive Behavioral Therapy
(CBT), a style of therapy that
emphasizes evaluating one’s
thought patterns and practicing
alternative interpretations and
behaviors.2 Well evidenced to
treat depression and an array
of mental health problems,3,4
CBT is now being studied to
help people improve physical
health and cope with illness5
by monitoring one’s thoughts,
emotions and reactions.
People learn to replace
negative thoughts with more
constructive interpretations. For
example, someone who reacts
to overeating with the thought,
Behavior change draws from several fields, and the principles of each may be used in RCM.
Science of
behavior change
Effective message
Health Psychology
“Avoid salt because it leads to fluid retention”; couple with
a picture of a saltshaker with a red line through it.
Cognitive Behavioral
Therapy
“Today was challenging because my daughter brought
over dinner; I’ll get back on track tomorrow.”
Behavioral Economics
“I agree to follow my plan for a healthy diet because it will
help me live the way I want to in the long term.”
Persuasion and Influence
“I agree to limit my salt intake because it will help me manage
my heart condition and spend more time with my grandchildren.”
Technology not only allows the messages to be tailored for each user, but also allows the timing
of the messages to be programmed to have the biggest impact as well. Protocols should be
structured to include three major touch points:
A morning session including an assessment
of vital signs and mood, and a recommitment to the
primary behavioral goal
Contextual prompting for meals and medications taken throughout the day
An end of the day review for self-reflection and coping skill development
2
“I blew it. I might as well give
up on my intention of losing
weight,” might instead practice
a thought such as, “Today
was challenging because my
daughter brought over dinner;
I’ll get back on track tomorrow.”
Technology integrated into the
daily lives of people can be
used to suggest this type of
alternative thinking and coping
style to people who experience
such setbacks or need to
develop better problem solving
skills.
Behavioral Economics
A third category of principles
draws from Behavioral
Economics, a field that describes
errors in human decisionmaking and strategies to
counteract those errors. One
error concerns forecasting and
the tendency to undervalue
long-term investments in favor
of immediate gratification. This
tendency accounts for some
of the reasons why people
don’t manage their finances or
physical health in a way that is in
keeping with previous intentions
and long-term interests.6 For
example, a woman who on
January 1 resolves that weight
loss is her highest priority
decides the next evening, in
the face of a restaurant menu,
that dessert is more valuable.
Technology can provide the
reminders, encouragement and
focus on the long-term value
that would allow better decisionmaking.
Persuasion and Influence
The fourth and last category of
principles is based on a body of
work related to Influence, which
includes findings from Social
Psychology and Marketing.
One particularly applicable
set of principles relates to
commitment and consistency.
Using technology, a person with
heart failure might recommit
to a goal of reducing salt each
day after reading a reminder
of how that behavior relates to
longer-term health goals and life
values like, “I agree to limit my
salt intake because it will help
me manage my heart condition
and spend more time with my
grandchildren.”
Conclusion
Effective management of
chronic conditions hinges on
lifestyle change. Most people
with chronic conditions face
this challenge with little daily
support. To help succeed
in making sustainable
lifestyle change, remote care
management (RCM) programs
are a cost-effective way to apply
well-evidenced principles of
behavior change. When people
have RCM technologies in
the home, they are supported
in two ways. First, people
get daily access to clinicians
and care providers who are
trained in promoting healthy
behavior change. Second, RCM
technologies are an effective
vehicle to deliver pertinent,
near real-time information to
people with chronic conditions
based on their specific status
and challenges. The benefit
is people supported by RCM
programs have been shown to
become more proficient and
involved in the self-management
of their health.
For More Information
Learn how Intel-GE Care InnovationsTM Guide remote care management solutions can help your company apply
behavior change principles to help manage members with chronic conditions. Visit careinnovations.com/Guide to
see an online overview of our remote care management platform.
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References Consulted
Glanz, K., Rimer, B.K., & Viswanath, K. (Eds.). (2008). Health behavior and health education: Theory, research and practice (4th
ed.). San Francisco, CA: Jossey-Bass Publishers.
1
Leahy, R.L., & Holland, S.J. (2000). Treatment plans and interventions for depression and anxiety disorders. New York, NY:
Guilford
2
DeRubeis, R. J., Siegle G. J., & Hollon, S. D. (2008). Cognitive therapy versus medication for depression: Treatment outcomes
and neural mechanisms. Nature Reviews Neuroscience, 9, 788-796.
3
Butler, A.C., Chapman, J.E., Forman, E.M., & Beck, A.T. (2006). The empirical status of cognitive-behavioral therapy: A review
of meta-analyses. Clinical Psychology Review, 26 (1), 17–31.
4
Beck, J. S. (2007). The Beck diet solution: Train your brain to think like a thin person. Des Moines, IA: Oxmoor House.
5
Ainslie, G. (2001). Breakdown of will. Cambridge, UK: Cambridge University Press.
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The Care Innovations™ Guide requires an internet connection to enable communications with the patient’s care team and back-end data
hosting. The Guide is intended for use by patients who are able to operate the Guide in accordance with its instructions for use and are
under the guidance of a healthcare professional. The Guide is not intended for emergency medical communications or real-time patient
monitoring. Available for over the counter use.
Copyright © 2013 Intel-GE Care Innovations LLC. All rights reserved. Care Innovations, the Care Innovations logo, and the Caring Icon logo
are trademarks of Intel-GE Care Innovations LLC. Intel and the Intel corporate logo are trademarks of Intel Corporation in the United States
and/or other countries, used under license. GE and the GE Monogram are trademarks of General Electric Company in the United States and/
or other countries, used under license. *All other third-party trademarks are the properties of their respective owners.
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