One of the enduring issues in mHealth adoption is the challenge of affecting behavior change. Clinicians may see great success in using mobile technology to connect with patients outside the office, but how can they sustain any momentum over time?
What happens when the novelty wears off?
With the help of B.J. Fogg and the Persuasive Technology Lab at Stanford University, GenerationOne, a Southfield, Mich.-based developer of collaborative mobile health and management tools, has compiled a Top 10 list telling providers what they should be avoiding.
Titled "Top 10 Mistakes in Behavior Change," the list is as follows:
1. Relying on willpower for long-term change. "Willpower" is a tricky word, Stanford's researchers warn, and it's generally not that strong in people who need the most help. Any mHealth programs that rely solely on willpower without reward or reinforcement are doomed to fail. For providers, it's best to simply ignore the idea that willpower exists.
2. Attempting big leaps instead of baby steps. Many an mHealth project has big ambitions, but getting there should be a slow and steady process. Providers who focus too much on the eventual outcome might lose their way before they reach that goal. The idea, researchers say, is to build up a series of small successes. For example, when asking a patient to give up on carbs, start by eliminating pasta, and once that's accomplished, move on to other foods.
3. Ignoring how environment shapes behaviors. Compliance is different for each patient, researchers say. Someone who is homebound has different challenges than someone who commutes to work each day. Providers need to look at the patient's environment before developing an mHealth strategy.
4. Trying to stop old behaviors instead of creating new ones. Focus on action, not avoidance, researchers say, because it's easier to do something than to avoid doing something. Instead of telling a patient to stop sitting around the house so much, a provider should suggest walking, perhaps around the neighborhood or a nearby park or mall.
5. Blaming failures on lack of motivation. Make the behavior easier to do, researchers say. And this is where mHealth technology really comes into play. Patients may have a hard time remembering to test their blood glucose level or blood pressure every time. Providers need to establish a means of reminding them, such as via e-mail or text messaging.
6. Underestimating the power of triggers. Behaviors don't happen in a vaccum – one bad behavior has its roots in another behavior. Instead of encouraging a patient to eat less, for instance, a provider should first examine why the patient is eating so much.
7. Believing that information leads to action. A patient can be armed with all sorts of data – and yet still not be motivated to act. Physicians often get caught up in that data, and forget that their patients don't have the same motivations as they do to change. Reward, pleasure and a sense of progress or achievement work better to prompt action.
8. Focusing on abstract goals more than concrete behaviors. Make it real for patients, rather than hypothetical. A physician may tell a patient to get in shape, but not suggest how to do so – such as walking 15 minutes a day.
9. Seeking to change behavior forever, not for a short time. This harkens back to the "baby steps" idea. Establish goals for a fixed period of time, rather than forever. Physicians should talk to their patients about reaching one goal – losing a pound or two, cutting down on carbs, bringing down one's blood pressure – then develop another goal.
10. Assuming that behavior change is difficult. In order to affect behavior change in patients, physicians themselves need to have the right attitude, researchers say. Patients need support and a positive outlook, and they'll be looking to their doctor for that.
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