How we changed daily habits of diabetes patients

Case studies
2017 May 17
By Matej Sucha
The Slovak health insurer Dôvera has prepared for its diabetes patients a great program aimed at providing better health care and helping them remain healthy as long as possible.

One of the main pillars of the program is a series of eight two-hour long education sessions during which patients learn the most important information about different aspects of the illness. Research shows that up to 85% of patients’ health state is entirely in their own hands, through what they eat and how they move.

In this light, the program has a whole new aim – ensure behavior change. We all know, that for a successful behavior change, simply providing information is not enough. A clever behavior change strategy is needed. This is what brought Dôvera and MINDWORX together.

After a detailed analysis of the existing program we proposed a new behavioral strategy built around one main and four supportive pillars.

Main pillar – habit formation

Lasting behavior change must consist of building new habits. Lots of behavioral research concentrates on the problem of effective habit formation and it is exactly this research which is at the core of the newly designed strategy. Here are a few main rules which it follows.

New habits must be easy and gradual

The most common mistake people make when they want to change their behavior is that they set too ambitious goals. If I don’t do any sports and suddenly decide to start running 10km every day I am doomed to failure. The new behavior will be too difficult and I will subconsciously fight it.

Instead, it is better to start with an extremely simple goal (for example 3 squats every morning after brushing my teeth) and gradually, as I get used to it increase it.

Stimulus - behavior - reward

When building new habits, the sequence stimulus – behavior – reward is essential.

A stimulus is very important because it launches the desired behavior, it serves as a reminder. Stimulus should be an already existing activity which I link to my new behavior (for example: after brushing teeth, after watching evening news).

It is also important to reward the desired behavior. A reward is important because it helps to build a positive association with the new behavior. The reward can be a simple self-praise , watching a favorite TV series or having a cup of coffee.

The new behavior should be daily

In order to form an effective habit, the behavior in question should be performed daily. It is much easier to get used to doing something regularly every day, than doing it irregularly.

Supportive pillar – adopting the right identity

In order to effectively fight diabetes, I must accept the illness and recognize that I have the illness (which absolutely doesn’t mean I can’t have a fulfilling life).

Research also shows that this new identity (of a patient with diabetes) should be linked to the so called higher order goals – what do I want to do/be in 5, 10 years from now that I need to be in good shape for (“caring grandfather”, “successful manager”)? This serves as vision and additional motivation for the patient.

Supportive pillar – Peer pressure

Many times, peer pressure proved to be more effective at changing people’s behaviors than the desire to be healthy or look good. The fear of looking bad in the eyes of others is deeply and powerfully rooted in our minds.

We therefore decided to incorporate peer pressure into the program. Patients will share their progress with the other patients which will serve both as motivation for the others and the fear of sharing failure will nudge patients towards the desired behavior. Patients will also form pairs and check out on each other, call and support each other in the periods between education sessions.

Supportive pillar – Communication of information

Behavioral sciences claim that often the way an information is communicated is more important than the information itself. It is therefore crucial to closely audit how information are communicated to patients.

Behavioral economics for example studies a phenomenon called choice & information overload. It says that when people are swamped by too many information or too many options to choose from, they slide into action paralysis (resulting in delaying the decision or not deciding at all).

It is also important to be concrete and realistic especially when communicating to older people. That for instance means talking of foods which patients know or instead of saying how much sugar different foods contain, representing it with real sugar cubes.

Another think to bear in mind is the decision-making process of patients. It might be more effective to teach patients what they should buy or how to prepare shopping lists rather than what they should eat at home (if I buy a chocolate, there is great probability that I will eat it. If I don’t even have chocolate at home it is much more likely I won’t).

Supportive pillar – Gamification

The fourth pillar was designed in collaboration with experts on gamification from Luducrafts. It consists of implementing aspects of games into the educational program. Patients will for example collect points and attain ranks within the program.

With a new rank, patients will receive a sticker of different color on their health card. This will immediately indicate to the doctor that the patient in question is not a newbie anymore (aspect of pride for the patient).

Patients will also gain rewards for collected points and diplomas for attained ranks. All these and other gamification aspects will contribute to increasing patients’ motivation to stick to the desired behaviors and goals.

We believe that for a successful behavior change we need a clever behavior change strategy. We are convinced that, if implemented correctly, the approach described above has the potential to save hundreds of lives and help thousands of people live a healthier and happier life.

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