Please note, this article contains references to Ashfield Engage which has now become Inizio Engage
Step 3– Changing behaviour to drive adherence
When designing a Patient Engagement Programme you want to avoid the major pitfall of underestimating how difficult it is to change behaviour, and as a consequence, fail to deliver proper medication usage and adherence. To do so, your objective should be to change people’s behaviour, dealing with their complex and context-driven human psychology, so that outcomes are optimised.
Establishing your performance objectives and measurement systems as discussed in Setting up your Patient Engagement Programme for success, and learning to work with internal and external stakeholders are important first steps to establishing a successful Patient Engagement Programme. However, these steps are futile if the program design fails to take into account the patient as a whole.
Consider the whole patient
It’s easy to assume that non-adherent behaviour is caused by drivers common to the population as a whole. For example, forgetfulness or side effects are often touted as reasons for patient non-adherence. However, there can be a whole range of factors and nuances specific to each individual patient causing the behavior. Perhaps, patients may see the medication as a constant reminder of their condition, or believe that if they skip a few doses, the treatment will still work but the side effects won’t be as bad.
To understand the drivers of behaviour, you need to think about patients as individuals with needs and backgrounds as unique as your own. Each patient has unique clinical and functional needs in their disease journey as well as behavioural and psychosocial needs.
Clinical and functional needs might include fatigue, pain, insomnia, the rate of progression, the level of disability, or transportation to and from medical appointments. While behavioural and psychosocial needs range from confidence in seeking support, coping and managing side effects, dialogue with the care team and caregiver, Illness and treatment perceptions, inadequate knowledge/understanding, to emotional wellbeing (disease or non-disease specific).
Support the whole patient with a behavioural science approach
Despite the tendency to think that interventions based on education approaches will address the issues leading to non-adherence, only 5-20% of people change their behaviour based on being reminded and educated.
One needs to go beyond such approaches and work within behavioural science to truly effect change. Behavioural science examines how psychosocial and behavioural factors, combined with clinical and functional needs, contribute to people’s physical health and illness. As such, behavioural science helps provide a more holistic view of the patient and can be used to enhance a Patient Support Programme from the early insight and design stages, to training clinical educators/nurses to help patients cope.
Behavioural health psychology works to enhance your Patient Engagement Programme design and execution in several areas:
Research – Get a better understanding of the what, why and how for patients. Look beyond their actions to understand thoughts, feelings and motivations that underpin behaviour.
Informed design – Use scientific evidence combined with clinical practice to develop your Patient Engagement Programme.
Interventions – Design care plans and materials which promote self-management and adherence by empowering patients to better manage physical and psychological aspects of self-care.
Teaching and training – Enhance the nurse/patient relationship.
Empower and motivate patients with a behavioural science approach.
In any communication with patients, one should take into consideration answers to such key questions as –
- “What might get in the way of taking your medicine as prescribed?”,
- “ How can you avoid or overcome these challenges?”,
- “Once you have tried a solution, think about how well it worked for you.”
In addition, clinical educators should be trained in health psychology methodologies, giving them the tools to do motivational interviewing to uncover patients’ illness perceptions and personal goals, to offer positive coping techniques such as mindfulness, and provide cognitive behavioural techniques to help patients identify and change negative thoughts and behaviours. These approaches can help patients cope; and reduce anxiety, fatigue and depression.
Now that you understand the importance of a patient behaviour’s effect on adherence and the key role that behavioural science plays in designing and executing your programme, you are ready to move to the next step in creating a successful Patient Engagement Programme – Meeting patients where they are.
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