Last month, I had the opportunity to attend Gartner Research’s Digital Marketing Conference in San Diego. It was packed with great information, including a keynote from Tali Sharot, a leading behavioral neuroscientist and author of The Influential Mind: What the Brain Reveals About Our Power to Change Others. For me, her research immediately highlights the challenges we all face in healthcare today around patient engagement and lasting behavior change.
Most patient engagement strategies fail
We’ve all heard it before, countless times. Exercise more. Take your vitamins. Take your medications. Eat less sugar. Eat less fat. Eat less take-out. Eat less.
Remember to floss. Remember to breathe. Get up early. Go to bed early. Buy organic.
Stop smoking. Stop drinking. Stop stressing. Just stop.
Let’s face it – lifestyle change is hard. And the advice above we often get from physicians, nutritionists, coaches, our families, our friends are directives, not effective strategies for creating lasting change in behavior, lifestyle and ultimately health status. Sometimes Just Do It (with apologies to Nike), doesn’t cut it.
How do we help patients (ourselves) succeed?
By understanding and applying how the brain works. By using tactics that align with brain function and known biases to change behavior and outcomes.
Sharot’s keynote discussed what is known as the confirmation bias, which is our natural drive to seek out and believe information that conforms to our opinions and beliefs and to ignore or discount evidence that is contrary to our beliefs.
There is a biological basis for this. The brain encodes information differently, depending on whether it aligns or contradicts what we believe or want to believe. When we encounter information that reaffirms our beliefs, our confidence in those beliefs goes up. When we encounter information that contradicts our beliefs, our confidence in ourselves changes only slightly.
In other words, we see what we want to see regardless of the evidence, which is why facts rarely work to change opinion and behavior. The brain distorts a situation until it finds one it is happy with.
However, if we apply what we know about confirmation bias to healthcare situations, we can begin to see how it’s possible to impact behavior, increase engagement and help patients achieve lasting change. Below are six strategies Sharot describes and examples of how they factor into improving patient engagement and outcomes.
Start with common ground. Don’t tell patients they’re wrong. This seems obvious, but it is amazing how many healthcare providers seem to forget this in discussions about health information and behavior change. Patients aren’t receptive to information that contradicts what they believe, so you can’t effectively communicate unless you start from a place of mutual agreement and understanding.
Highlight opportunities for progress instead of decline. Positive messages work better than negative ones. This also seems obvious, yet so many of us who work in healthcare focus on the negative and ignore what Sharot calls, the Optimism Bias. People over-estimate their likelihood of positive outcomes and underestimate their risk for negative outcomes, for example their risk of dying from smoking or getting cancer. This is the reason why public policies like mandatory passenger restraint systems and DUI/DWI laws have been more effective at reducing motor vehicle fatalities than education about the dangers of drunk driving or not wearing a seatbelt.
Offer immediate rewards. This is based on another cognitive brain principle called temporal discounting and is why long-term incentives are much less effective than short-term rewards. Patients might know and even agree they should adopt a healthier diet because they have high blood pressure and high cholesterol. Yet telling patients they will benefit five or 10 years from now is a weak motivator for change.
Use social incentives. The more activated a person’s amygdala (the emotion center of the brain), the more likely they are to accept other information and opinions. Therefore highlighting what others do and how others succeed is an effective way to change behavior. Think about the abundance of fitness, diet and other community-based apps and social platforms available today, where people can track their own progress and that of their family and friends. Humans are social creatures. Being held accountable for and being able to compare performance and receive recognition from others is rewarding and motivating.
Expand agency. The brain always seeks control over its environment to gain reward and avoid harm. When people have the opportunity for control, it’s coded as a reward itself. Too often in healthcare, we’re asking patients to give up something or stop doing something or refrain from doing something, all of which the brain interprets as a lack of control and therefore threatening.
Consider mental state. The brain changes and reacts differently, depending on its state, for example when it’s under stress or anticipating an outcome, positive or negative. Healthcare providers must consider other factors when evaluating a patient’s likelihood to engage and how socioeconomic factors, job-related stress, financial responsibilities, caregiver responsibilities and more may play a role in successful lifestyle change.
Even when we acknowledge and understand the need for change in our own lives, the biological construct of our cognitive brains can sometimes get in the way. This doesn’t mean it can’t be done and isn’t the only reason why patient engagement strategies fail. However, as Sharot stated in her keynote, understanding how the brain impacts motivation and behavior will make us more acutely aware of it in ourselves and others.
In healthcare, my hope is that it will allow for more effective communication and coordinated care between providers and patients, and arm patients with better strategies to help them succeed on their journey to improved health, higher quality of life and personalized care.