In today’s information age, knowledge has been democratized due to the prevalent “consumer-first” mentality and an increasing number of mobile devices and applications. People are exerting energy to make informed choices about the foods they eat, the clothes they buy, and the entertainment they pursue. The trend extends to healthcare as well, with patients seeking empowerment to become core members of their own care plans.
The rising number of patients with chronic diseases is a sad reality but one that lends itself particularly useful to the patient-consumer mindset. Unlike acute conditions, people suffering from chronic diseases like hypertension, type 2 diabetes, and obesity need to make long-term behavioral and lifestyle changes to improve their conditions. These changes, which include diet, exercise, and medication adherence – lend themselves very little to clinical control and can’t be achieved with sporadic office visits. Rather, they are changes which require individuals to make a concentrated effort to enact themselves, with constant guidance and self-reflection.
Mobile health coaching is the use of evidence-based clinical interventions and strategies to actively and safely engage patients in health behavior change. Mobile-enabled remote patient monitoring systems (mRPM), whether in the form of smartphone applications or medical wearables, are the ideal health coaching platform to encourage greater health engagement and patient adherence to care plans. Smartphone adoption has reached 77% of all Americans, including 46% of seniors. Moreover, smartphones and mobile devices are never far from reach with one report finding that Americans use their smartphone five hours a day on average. Healthcare providers, too, are turning to wearable devices according to a 2018 HIMSS Media report that found that 90 percent of those incorporating wearable devices in their workflow see it as a technology strategy that can positively impact chronic disease management. Health coaching can effectively stimulate positive patient behavioral change through “nudging,” optimize healthcare outcomes by grounding patient biometrics within a real-world context, and extend chronic disease management to encompass prevention as well as palliation.
“Nudge theory” & health coaching
Today, 25% of American adults own a wearable device, and nearly one third of these adults cease using their wearables six months after purchase. Health professionals must develop an incentive structure that helps integrate medical wearable use into patient care. One way to improve patient adherence is to develop a care plan that incorporates behavioral economics to influence patient action. The “nudge theory,” which won the Nobel Prize, contends that repetitive gentle reminders, indirect suggestions and positive reinforcement can influence people’s actions. The main principle behind the theory is that people tend to make decisions based on habit and whatever they interpret is the easiest option available. Contrary to popular opinion, “scare” tactics are not good motivators and do not encourage long-term patient behavioral change.
Telling patients they will die of a stroke if they don’t take their hypertension medication, for example, may scare patients enough to adhere to a care plan for a short time but they will quickly revert back to old habits. The implication for medical wearables is that physicians and organizations need to find a way to integrate medical wearables into patients’ lives conveniently, so that creating and following new healthy habits becomes easy.
Part of this objective falls incumbent upon designers and researchers to create a compelling user experience around the software components of medical wearables. For instance, once a care plan is developed for a patient taking hypertension medication, a physician can nudge new behavior by asking the patient to record each time he or she takes the medication, any experienced side effects and the ensuing blood pressure reading.
The patient should start seeing a positive trend that the prescribed medication is having on his or her blood pressure and this should in turn encourage adherence to the hypertension care plan. Immediate positive feedback and the act of inputting data can stimulate patients’ increased mindfulness about their health, while encouraging other positive and ancillary patient engagement behaviors such as reading nutrition labels on food packaging for sodium content.
This type of repetitive reminding falls under the label of health coaching, in which the experience of getting reminders, inputting data, and receiving feedback guides patients to actualize better health through long-term medication adherence and positive lifestyle choices.
Health coaching: The value of biometrics in a real-world context
Smartphones and mobile devices allow for real-time connectivity through wi-fi or cellular reception, enabling data collection and sharing anytime and anywhere. Precise patient biometrics collected and shared in real-time are especially effective because they reflect a real-world context. They can also provide physicians with valuable insights about their patient’s condition and how it fluctuates in response to social determinant factors. This, in turn, drives better management of chronic conditions and care transition in between face-to-face appointments. For instance, a patient who reports a high blood pressure measurement could simultaneously report a difficulty getting transportation to a pharmacy to refill a prescription.
The physician could then either help the patient arrange for delivery of the medication or locate available transportation services. If the physician was not privy to the real-world context, in this case the knowledge that a high blood pressure reading was a result of the patient’s difficulty in obtaining and taking hypertension medication, the physician or medical staff could have needlessly recommended that the patient visit the physician’s office or take a costly trip to the emergency department. Without contextual insight, biometrics alone cannot adequately help both patients and physicians manage conditions and develop effective care plans.
Medical wearable devices and applications can also integrate health coaching for chronic disease prevention, extending chronic disease management to encapsulate preventative as well as palliative medical care. The goal of preventative care is to help patients transform short-term behavioral health changes into long-term habits, staving off the onset of a chronic disease.
One 2017 study employed in-home and wearable health devices to successfully demonstrate the effective use of patient-generated health data (PGHD) to better manage and engage patients suffering from Type 1 and Type 2 diabetes. The results of the study demonstrated that patients found the devices and applications in their care program as an enhancement to their quality of life—enabling them to better self-manage their diabetes. Patients also found that the remote monitoring program strengthened their relationship with their care team (inclusive of the physician, nurse, and nutritionist) and eased the burden on them to manually record readings and attend weekly in-person visits. Health coaching can become a patient’s greatest ally, helping the patient build awareness, encouraging them to become their own health advocate and supporting them in developing the skills they need to sustain new behaviors.
Overcoming barriers with health coaching
Although both healthcare providers and patients see the value of PGHD, questions of feasibility and integration remain. The 2018 HIMSS Media report highlighted some of the hurdles providers face in deploying wearables and using PGHD, which included the cost to payers, providers, and patients; integrating data into the patient record; and data overload on providers. Health coaching can help overcome the barrier to a wider integration of wearables in healthcare, and can be viewed as an extension of care where a digital “coach” facilitates patient treatment and education on behalf of the physician. This is especially relevant today – when physician shortages are increasing each year.
Health coaching would not replace the need for physicians, rather, it would help re-organize physician workflow so that physicians could dedicate more time to complicated cases rather than to routine and redundant work. Health coaching also offers a solution to the data overload problem. Patient data has to be clinically relevant to the physician and to the patient’s condition, and health coaching combined with PGHD can focus data collection to those aspects that have direct clinical impact. Physicians can then control the quality, quantity, and type of data and information collected from patients. Patients benefit too, as health coaching helps fill in the gaps between appointments with adequate support and timely interventions, saving patients unnecessary money and driving better health outcomes.
Waqaas Al-Siddiq is founder and CEO of Biotricity, a biometric remote monitoring services company.