Traditional approaches haven’t stemmed the growth of lifestyle-related diseases, but digital therapeutics show a promising path forward.
The persistent rise of lifestyle-related diseases remains a troubling global health trend. Today, conditions like diabetes and cardiovascular disease account for roughly 70 percent of deaths and health care costs worldwide. The good news is these conditions are preventable, often with moderate changes in diet and physical activity. The proliferation of smartphones also makes it possible for billions of people to find reliable health resources instantly.
The challenge is traditional health information is not very engaging. Behavioral research suggests the “emotional” part of the brain governs most lifestyle choices, like what to eat. As such, appeals to the “rational” part of the brain, like black-and-white nutrition labels, often fall short. What’s more, nearly half of adults struggle with health literacy. While information is more available, it may not be accessible or actionable for everyone.
Dr. Tryggvi Thorgeirsson and Dr. Saemundur Oddsson are working to change that. As co-founders of the digital therapeutics company SidekickHealth, the Icelandic physicians are combining clinical expertise with behavioral economics and mobile technology to improve people’s health.
“As medical doctors, we had treated thousands of patients who had or were at risk of lifestyle diseases,” said Thorgeirsson. “Our clinical advice would be a familiar refrain: eat well, get active, be mindful of stress, and take medication as prescribed. But the better option would have been to help shape the lifestyle choices that led people to our clinic or hospital in the first place.”
“We hypothesized that a mobile health engagement platform could support people with lifestyle change at scale,” said Oddsson. “Smartphones are almost ubiquitous, so the channel for intervention was clear. The key was to make it engaging for as many people as possible – not just the folks who were already interested in managing their health.”
Working with universities in Europe and the U.S., and bringing together a team of experienced game developers, Thorgeirsson and Oddsson created the SidekickHealth platform. With a text-light design and game-like experience, SidekickHealth enables users of different ages, backgrounds and levels of health literacy to take a more active role in their health.
Over the past two years, employers and health care providers have used SidekickHealth to engage their employees and patients at work, at home and everywhere in between. Users complete individual health missions and team challenges focused on nutrition, physical activity and stress. As they accumulate points for their progress, they earn motivating altruistic rewards, such as clean water donations to help children in need.
Hlynur Hauksson, an airline employee based in Reykjavik, Iceland, joined a SidekickHealth challenge as part of a three-week workplace wellness initiative. “It was fun, I was always earning points for veggies, water, workouts and even housework,” said Hauksson. “I started doing mindfulness exercises with my four-year-old, which gave us great quality time together. Plus, I lost five kilos.” After the wellness challenge, Hauksson continued using SidekickHealth as part a four-month lifestyle change program with a local health provider. He kept up his healthy habits throughout the summer, culminating in the completion of his first 21km run in the Reykjavík marathon.
The use of smartphones and gaming has shown promise in helping people overcome potential barriers to change. In a diabetes prevention program with participants who were over age 65 and had never used an app, SidekickHealth users averaged seven exercises per day, with 84 percent continuing in their program after four months. A similar program with a predominantly Spanish-speaking population averaged six exercises per day, with 83 percent retention.
“We collaborated with SidekickHealth because it makes our program scalable, allowing us to provide more diabetes prevention programs to those in need,” said Marlayna Bollinger, Founder and Executive Director of the Skinny Gene Project, a non-profit organization with a Diabetes Prevention Program recognized by the U.S. Centers for Disease Control and Prevention. “We can modify the program to make it culturally relevant and ensure information is not just received; it’s understood. In groups that are at high risk for diabetes, like Hispanics and Native Americans, SidekickHealth has been especially effective in helping people lower their risk for diabetes.”
By taking a new perspective on health engagement and empowering people with technology, a key indicator of global health may start moving in the right direction.
This post originally appeared on the Vertical Blog.
In the most recent publication of Iceland’s SÍBS blaðið, SidekickHealth CEO and co-founder Dr. Tryggvi Thorgeirsson writes about health management, behavioral economics and the road to lifestyle change. Hinn beini og breiði…Read more
In an ideal scenario, corporate wellness programs will always lower health costs, enhance productivity, boost employee engagement and reduce employee absenteeism and turnover. But this state of workplace nirvana often feels out of reach. A significant barrier is the ability to motivate behavior change, which influences everything from employees’ daily health habits to their adoption of a wellness initiative. Fortunately, the field of behavioral economics offers new insights that can help address this challenge.
Unhealthy behaviors, such as physical inactivity and poor diet, have contributed to a staggering growth in lifestyle-related diseases, which can be particularly costly for employers. Type 2 diabetes, for example, affects about 30 million Americans, and another 84 million have prediabetes, a condition that increases a person’s risk for developing type 2. The total cost of these diseases tops $300 billion, including indirect costs in the form of lost work days and productive capacity.
With medical costs continuing to rise at a rate of 6 percent, and employers bearing much of the financial impact, many companies are implementing programs to reduce health risk factors and insurance premiums. Wellness offerings include weight loss initiatives, on-site screenings and vaccinations, exercise classes and gym membership reimbursement, as well as educational classes on health management, smoking cessation and stress reduction. Businesses are also leveraging technology to streamline and scale programs across their workforce, putting resources like fitness trackers or health management tools directly into their employees’ hands.
There is a veritable healthy buffet of options. So, how do you know which ones to choose? And how do you make them work for you? Organizations vary in terms of their wellness objectives, workplace environments and workforce demographics, but they can generally move employee well-being in the right direction by aiming for a mix of traditional programs and emerging methods and by taking a cue from behavioral economics.
Making workplace wellness work for your teams
The field of behavioral economics combines psychology and economics to explore how individuals actually behave, as opposed to how they would behave if they were perfectly rational, with unlimited willpower, and solely acting out of self-interest. It considers how people are influenced by the framing of information, their emotions, their identity and their environment.
Behavioral economics sheds light on the drivers behind people’s lifestyle choices, such as what to eat and whether to exercise. These insights can inform how we engage and motivate employees to make healthier choices, and in turn, how to make those healthy choices become healthy habits. And since the efficacy of workplace wellness depends largely upon employee participation rates, concepts from behavioral economics can go a long way towards incentivizing the adoption of a wellness program and ensuring its sustainability.
Framing health engagement as a positive experience
The framing of messages has a significant impact on people’s choices. Individuals make decisions in part based on how they perceive that information. Studies have revealed that the value of an objectively neutral experience can be interpreted differently depending on the way it is positioned.
Behavioral economist Dan Ariely conducted an experiment in which he told a class of students he would read poetry aloud to them. Half of the students were asked whether they would be willing to pay $10 to listen to the poetry recitation; the other half were asked whether they would accept compensation of $10 to listen.
The result? Students who received the positive frame were willing to pay, while those who received the negative frame wanted to be paid. Both groups indicated that for a longer reading, a greater sum of money should be paid. But the framing of the experience determined who should be compensated.
We see the impact of framing in lifestyle choices as well. Research suggests that two separate cognitive systems control our judgment. Another behavioral economist, Daniel Kahneman, describes these systems as fast thinking (emotional) and slow thinking (rational). Thought processes in the former system tend to be automatic, intuitive and impulsive. By contrast, thought processes in the latter system tend to be deliberate, reflective and effortful.
Most of our actions, like what we eat, are often governed by fast thinking. The advertising industry adroitly targets fast thinking with emotional appeals and colorful campaigns to sell products like soda and junk food. But many public health messages are framed through a lens of statistics, data, charts and warnings.
In a study, Frederick J. Zimmerman, Ph.D, analyzed how for-profit fitness companies promote healthy behavior through a positive frame (“Get Game! Have Fun”), whereas public health authorities tend to employ a frame of obligation (“Regular physical activity is important for good health”). According to Zimmerman, shifts in message framing may fundamentally alter our understanding of an activity from a burdensome duty to a rewarding experience.
These studies tell us that health messages should emphasize personal achievement, social interaction and fun. Corporate wellness programs should target fast thinking with positive framing and methods such as colorful graphics, humor, stories, games and instant gratification through rewards.
Living for the present
People tend to place a higher value on the present, discounting the impact of future costs and benefits. For example, the fun of enjoying a double cheeseburger is now, while the adverse effects on one’s health come later. This mentality also works against prevention efforts: flossing now might help avoid an unpleasant dentist visit, but not until sometime in the future. When time separates the costs and benefits from a behavior, lifestyle change becomes difficult.
The effects of financial incentives on weight loss were analyzed in one study where participants who met their goals became eligible for daily lottery prizes, with frequent small prizes and occasional large rewards. After four months, the incentive group had lost more than three times more weight than the control group (14 lb vs. 4 lb).
Workplace programs should bring the costs and benefits of lifestyle change closer together to counter the impact of “future discounting.” Providing instant rewards and frequent positive feedback can be helpful, as can highlighting the short-term benefits of healthy behaviors, such as improved energy levels, instead of longer-term benefits, such as reduced risk for diabetes.
Sharing the wellness
Behavioral economics models assume that people are motivated by more than pure self-interest. Altruism is an important motivator behind health-related behaviors, such as blood and organ donation, as well as many group- and peer-based interventions. In addition, incentives benefiting our friends can be several times more effective than standard, individually targeted incentives.
Workplace wellness programs can harness these concepts by enabling interaction and peer support among members in groups. Social network incentives, in which group members benefit from an individual’s efforts, and altruistic rewards, such as rewarding efforts with gifts that benefit a local charity, can motivate participants to continue their engagement in a program. In effect, teamwork, health promotion and corporate social responsibility can mutually reinforce one another to the benefit of an organization, its employees and society.
Adapting to employees
Programs to raise awareness and promote well-being must meet the needs and preferences of the workforce. In particular, wellness programs must take into account potential barriers such as health literacy – the ability to make informed decisions based on one’s understanding of health information.
The National Assessment of Adult Literacy found that nearly 90 percent of adults lack proficient health literacy. Low health literacy is associated with higher rates of chronic conditions, more frequent preventable hospital visits, and less use of preventive services. Each of these scenarios contributes to higher health care costs.
Programs that equip people of all health literacy levels with the knowledge and skills to manage their health can help employees change behaviors and avoid costly complications. By removing barriers to engagement in a wellness program, employers can increase participation and efficacy across the workforce.
The returns of wellness initiatives are evident in a healthier and happier workforce and can be measured in a variety of ways. Employers can see direct savings in the form of lower health costs as well as productivity gains. Lowering the risks of lifestyle-related disease and stress-related burnout can reduce absenteeism, presenteeism and, in the most serious cases, employee turnover. With regular evaluation of wellness programs, employers can also identify gaps and plan new strategies or interventions to improve efficiency and effectiveness.
Technology also has a role to play in measuring success. For example, giving employees access to mobile applications and web-based programs can both engage them and let them monitor their progress on the way to wellness. Putting the power of information directly into the hands of the workforce can encourage them to more actively manage and track their health status over time.
Ultimately, corporate wellness starts with your employees, and knowing them is the key to success for any initiative. Applying concepts from behavioral economics can help motivate them towards healthy habits and away from the signs of lifestyle disease and burnout. And with the right programs and tools in place, they can feel empowered on their journey to better health and wellness.
This article originally appeared in Human Resource Executive.
Organizations that want to reduce healthcare costs must first identify those drivers that are preventable and then determine the optimal path to avoid them. For lifestyle-related diseases like Type 2 diabetes, health promotion and lifestyle change programs present a real opportunity to lower healthcare costs while improving people’s health outcomes and care experience—all goals of the Institute for Healthcare Improvement’s Triple Aim.
In Iceland’s capital, Reykjavik, a combination of behavioral economics, big data and mobile technology is a promising way forward to identify individuals at increased risk of lifestyle-related diseases and reverse their condition.
What is behavioral economics? It combines lessons from psychology and economics to consider how people behave—as opposed to how they would behave if they were perfectly rational, with unlimited willpower, and solely acting out of self-interest. It considers how people are influenced by their emotions, identity, environment and the framing of information.
Behavioral economics can be applied to the prevention and management of diabetes, a disease that now costs an estimated $825 billion each year globally. A significant part of the economic burden stems from the number of people affected. About 422 million people have the disease, which equates to about 8.5% of the world’s population. In Iceland, where the population tends to be more physically active than the norm, the rate is 6.1%. However, it is experiencing an upward trend.
Because Type 2 diabetes develops slowly over months and years, the good news is the disease can often be delayed, prevented or even reversed. More than 1 in 3 adults are prediabetic—at higher risk for type 2 diabetes and cardiovascular disease—but a structured lifestyle change program focused on diet and physical activity can be an effective formula for achieving and maintaining a healthy weight and normal blood sugar level.
Large clinical trials, including the Centers for Disease Control and Prevention’s National Diabetes Prevention Program, have shown this type of program can cut the risk of progression from prediabetes to type 2 diabetes.
As a physician who has worked with thousands of patients with lifestyle diseases, I recognize that messages of behavior change—eating right, exercising more and managing stress—do not so easily translate to everyday life. People have priorities that demand their time and attention, from managing a career to raising a family, that often relegate lifestyle choices to an afterthought.
In addition, adult health literacy is a challenge, and many people may have a low motivation for lifestyle change until a medical episode brings new perspective to the effects of unhealthy habits. As the industry looks to combat the impact of diabetes and help people engage in their healthcare, two dynamics have emerged to encourage prevention efforts.
First, we are developing a better understanding for how individuals make their lifestyle choices, particularly when a behavioral economics model is applied. Lessons from behavioral economics can support public health because they help us guide people toward better choices. To date, the more traditional, “rational” appeals—such as black-and-white nutrition labels on the back of a food packages—have fallen short in steering people toward healthier habits. Since the more “emotional” part of our brain is responsible for most of our lifestyle choices, targeting decision-making with emotional appeals—such as games, instant gratification and rewards—can more effectively activate the triggers that motivate people.
That dovetails well with the fact that mobile devices are approaching ubiquity, providing a direct channel for preventive care. Not only are smartphones widely distributed, but people carry them at all times, spending several hours per day using apps that often deliver powerful emotional triggers in the brain. Mobile devices can increase provider-patient interaction for lifestyle interventions, as well as offer opportunities for primary prevention.
Combining behavioral economics with technology has applications for both providers and employers. By incorporating a digital layer to traditional lifestyle programs, clinicians and coaches can complement in-person sessions with tools that help people manage their health anywhere and open channels for support along their journey. Employers can integrate similar methods into workplace initiatives to promote employee wellness and reduce the risk lifestyle-related disease among the workforce.
One example of how this approach has been successfully deployed is in Reykjavik. Earlier this year, more than 2,000 municipal employees across the country’s capital participated in the first step of a new workplace wellness program. Using a health engagement platform on their smartphones, employees took part in health challenges in three focus areas.
The first was nutrition, enabling participants to set goals for consuming healthy meals, practicing mindful eating and avoiding sugary foods. The second was exercise, allowing participants to count steps, log workouts and record activities like household chores. The last was stress reduction, such as relaxation, mindfulness and meditation exercises.
Over the course of three weeks, employees who took part in the initiative completed more than 500,000 health-improving activities, including stair-walking the equivalent of 100 trips up Mount Everest.
In addition to the health advantages, the “Reykjavik Health Games” encouraged competition and teamwork across the organization as participants worked to earn the most points for their group or department. Further motivating participants, the points they were earning accumulated towards a charity water donation, which the City of Reykjavik provided to an organization focused on helping children in need.
Participants were also offered a simple, seven-question prediabetes screening through their phone as part of the initiative. Of the employees who completed the questionnaire, more than 200 were determined to be at increased risk for diabetes and were referred to a 16-week, structured lifestyle change program administered through a digital platform in association with a local healthcare provider.
This approach can support efforts by insurers, providers and employers to reduce health costs. The Agency for Healthcare Research and Quality found diabetes with complications ranked at the top for hospitalizations covered by Medicare and Medicaid and those who were uninsured. Reducing the number of diabetes patients requiring inpatient admissions can help lower this expenditure.
Second, diabetes prevention programs that can effectively motivate their participants to lose weight and adhere to their program can improve the health of their populations and achieve quality metrics for reimbursement.
While cutting healthcare costs is a daunting challenge on its face, lifestyle-related diseases present a clear opportunity for progress. Helping people recognize their potential risk for diabetes, empowering them to make lifestyle change and engaging the triggers that motivate their behaviors and are the keys to keeping them healthy and out of the hospital.
This article originally appeared at FierceHealthcare.