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White Paper 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. 3 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. 6 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. 0713/SV/DHF-6364 CI2106-002US 4