Focusing on our health is not new. We all want to live a long and healthy life. But what we say is often different from what we do. Indeed, one of the biggest say-do gaps is on healthy behaviors such as exercising, eating right, keep up with our medical appointments, and so on.
Being in the pandemic for the past 2 years, however, has brought self-care front and center. More than ever before, people have had the time and opportunity to really reflect on what matters, and to think about how they want to shift their lives. With that, people are becoming more and more aware of the fact that they need to more proactively take care of themselves.
This shift in mindset about health has brought about a rapid change to the already growing trend away from standard health care models towards a new standard of care that is centered on preventative healthcare.
That is, the current approach of the healthcare system is predominantly reactive or curative in nature, responding to disease and illness once already present and progressing. This current approach is unfortunately “too-little-too-late,” resulting in poorer long-term health outcomes as well as a greater economic burden on society.
With increasing access to valuable health data and readily available technologies, the sizeable opportunity for a dramatic shift towards preventative and predictive healthcare is becoming abundantly clear. Moreover, the benefits of preventative health are abundantly clear: preventative health measures are cost-effective and reduce negative health outcomes in the long-term.
As a consequence, this opportunity to permanently shift towards preventative health is an objective that many in the public health, digital health, health insurance, and pharmaceutical spaces have their eyes on.
Despite our collective desire to shift to the standard mode of care to preventative health, this shift nevertheless faces strong headwinds.
The biggest problem is that implementing effective strategies to prevent chronic illness and disease before it happens has largely not been incorporated into mainstream medical practices. There are several reasons for the lag in a shift to preventative care.
First, the decision of where and how to allocate resources has traditionally been focused on reactive care. These decision-making processes will need to change along with healthcare services to keep up with this paradigm shift.
Second, a need for updated health metrics is in order. In the standard model, health metrics of concern are based on measures pertinent to treatment response. A shift to preventative care requires that we apply learnings from predictive models to current health metrics as well as introduce and utilize less popular markers that are correlated with a pre-disease state.
Another important factor is the financial incentives for healthcare providers - transitioning healthcare reimbursement models from volume-based to value-based reimbursement to improve the uptake of preventative care.
These largely logistical factors all influence the speed at which we can shift to a preventative system, however, this challenge is also largely a behavioural one. For preventative care to work long-term, patient and provider behaviour will be paramount to ensuring sustained success and positive health outcomes.
When thinking of preventative care at the individual level, psychological and behavioural barriers are one of the most critical challenges to adopting preventative health measures.
There are several psychological barriers that we face for lasting behaviour change:
Bounded rationality: Healthcare is complex, and the information surrounding it is often dense and difficult to navigate. This creates challenges for both patient and care provider to communicate effectively and ensure that the most relevant information with respect to behavioural change is received, absorbed, and retained.
Intention-action gap: Another challenge inherent to preventative health is the ‘say-do-gap’, or in other words, our human tendency to struggle with following through on an intended behaviour due to loss of salience and motivation over time, forgetfulness, loss of motivation, extrinsic barriers, and other factors.
Health extrinsic locus of control: Another set of challenges lies with the nature of the healthcare system and our interaction with it. Healthcare has traditionally been one-sided, resulting in a perceived lack of control over a patient’s health outcomes. Further, patients can perceive that all the power lies in the health care providers’ hands.
Opacity: Positive patient interaction with their healthcare provider is critical. A lack of transparency and support can contribute to mistrust in health advice, preventing behaviour change.
Present bias: Patients can easily lose sight of the long-term outcomes. Within a complicated and overwhelming healthcare system, patients that are not attended to right away may feel as though waiting months in advance, going for checkups, getting a test, or exercising regularly in the face of their present day challenges is far too much effort, with little to no perceived reward.
How can organizations innovate to overcome these barriers to preventative health? Here are 5 key behavioural strategies that can help navigate this shift to preventative care and ensure long-term success.
1. Combat Uncertainty with Concrete and Achievable Goals
The healthcare system is a complex and uncertain environment for many seeking care. Uncertainty prevents us from being able to learn and expect certain outcomes from our behaviour. The more certain our objectives, approach, and environment, the more quickly we can learn a new behaviour and sustain it. A proven strategy to reduce uncertainty is the setting of smaller, more achievable goals that are time-bound. This allows us to see the results of our efforts faster, and experience the reward associated with accomplishing a goal more quickly. Building upon this, momentum is built, making it easier to establish lasting behaviour change.
2. Make the Behaviour Obvious and Rewarding
The ‘say-do-gap’ affects us almost every day. How often have you created a New Year’s Resolution to eat healthier or to floss more, only to give-up a month or two later? One way to overcome this is to place cues in the environment that help facilitate the desired action. By doing this, we make it easier for a cue to ‘trigger a response,’ leading to habit formation. Another effective strategy is to associate preventative health behaviours with a rewarding outcome, otherwise known as temptation bundling. This is, after all, the basis of how we as humans reinforce habits. One example of temptation bundling could be: “every time I eat healthy, I get to watch my favorite tv show at the same time”. The behaviour-reward association teaches us to anticipate and look forward to our preventative behaviours, rather than dread doing them.
3. Involve Patients in the Discussion to Improve Collaboration
Feeling like your health is out of your control can be disempowering and lead to inaction. Health care providers and digital health companies can stand to benefit from allowing patients a say in their preventative health strategies. Research shows that when an individual is involved in creating a plan for themselves, their sense of autonomy and ownership leads to an increased perceived value. Healthcare personalization can have a similar effect, increasing our trust and satisfaction in healthcare services. Further, having some choice in our healthcare can improve overall well-being.
4. Increase Transparency in the Healthcare Process
Patients seeking care, especially in a digital setting may lack trust in the services or information provided. Preventative strategies can also be opaque, and the evidence of positive outcomes are less tangible and more future facing. Increasing transparency in the process and outlining key information in a clear and direct way, as well as making that information accesible to patients after their appointments, can help them rebuild trust and receptivity to preventative health protocols. Transparency can also help to reduce friction: by clearly outlining what needs to be done and why, patients can more easily maintain healthy or preventative behaviors.
5. Emphasize Positive Outcomes with ‘Big-Picture’ Thinking
Engaging in preventative health care measures like regularly making and attending appointments with a healthcare provider, getting medical tests, and living a healthy lifestyle may seem a daunting and grueling task. The associations we have with healthcare are not always positive, and this can lead to fear, avoidance, and a lack of engagement. One way to mitigate this issue is to place the emphasis of care on future, ‘big-picture’ outcomes, which encourage visualization of the impacts of our efforts. Shifting our thinking to how sustained changes in our present behavior would result in a positive future outcome can dramatically increase the likelihood of engaging with preventative health strategies and sustaining behavior change long-term.
These 5 behavioral strategies are only a few of the many ways to help integrate and maintain preventative health care into mainstream practice. These tactics act as a great starting point to help navigate the shift from reactive to preventative health in a variety of healthcare contexts.
The next major step in the transition to preventative thinking will be to refine and tailor specific strategies to healthcare goals and settings to optimize their impact. Behavioral audits conducted in specific healthcare sectors can both boost awareness of barriers to preventative care adoption as well as complimentary solutions.
As technology continues to advance and personalized medicine comes to the forefront of healthcare, understanding how to incorporate a behavioral science approach into healthcare practices will be critical to the success of preventative medicine.