New Year, New Compliance Program?
What can we learn from the psychology of New Years resolution-making, and keeping, which could be practically applied to improving patient compliance?
Companies with smoking cessation and weight loss products will know the importance of tapping into the New Years resolution tradition. But having observed a volume of activity in these areas over the last few weeks, Di Stafford of The Patient Practice suggests there are relevant learnings for all companies interested in encouraging patients to make positive health behaviour changes.
Its thought that the tradition of making New Years resolutions originated from the Babylonians, and people all over the world have been making them ever since. The early Christians believed that the first day of the New Year should be spent reflecting on past mistakes and resolving to make improvements in the coming twelve months. These days, more than 60% of us admit to making New Years resolutions, but one month into the New Year how many of those New Years resolutions are still being adhered to? Unfortunately an overwhelming majority are forgotten within the first few weeks of the year, and some studies suggest as few as 10% are still being followed after twelve months.
However social psychologist Richard Wiseman(1) of the University of Hertfordshire, UK believes he has found the formula to ensure a New Years resolution is both made and achieved. He has just published findings from a year-long study of more than 3,000 people in the UK and US who were trying to stick to their resolutions throughout 2007.
His general tips for success include a number of suggestions based on solid behavioural change principles that are highly relevant to the development of patient support and compliance programs.
First, he suggests timing and planning are key, and the period leading up to any behaviour change is critical for a person to think about what they really are committed to achieving. Spur of the moment resolutions made at 11:59pm on December 31st are unlikely to succeed!
Certainly, there seems to be a growing consensus that it is pointless to try to encourage a person to make changes unless they have demonstrated a degree of readiness and commitment. In the transtheoretical model of change, Prochaska(2) outlines three stages prior to the actual Action stage. The model shows that, for most people, a change in behaviour occurs gradually, with the patient moving from being uninterested, unaware or unwilling to make a change (precontemplation), to considering a change (contemplation), and finally to deciding and preparing to make a change (preparation).
In patient programs, this readiness to change can be assessed using simple online questionnaires, or by asking people to identify where they would place themselves on a scale. The concept of the readiness ruler (developed by Stephen Rollnick) asks patients to identify how important they feel is it for them to make the change (i.e. take the medicine) and how confident they are that they can do what is needed. If a satisfactory level of readiness is not apparent, it is probably pointless to enroll a patient into any kind of patient support program. Instead, resources might be used to help move them through the contemplation and preparation stages.
Wiseman also recommends focusing on just one resolution rather than trying to make multiple changes. His findings suggest that people have a greater chance of success when they focus on changing just one specific habit or behavior. Leading UK pharmacy chain, Boots, has clearly recognised this and points to the success of its three year-old Change One Thing programme (www.bootschangeonething.com) as proof that concentrating on just one thing really works. Making grand plans to lose weight, stop smoking and exercise more is a recipe for failure to do any of these.
In the context of patient compliance, this means it could be helpful to work with patients to identify one area of their medicine-taking which may be most problematic perhaps due to time of day or social factors and concentrate on developing strategies to overcome these hurdles. Or, in the case of polypharmacy, it may prove beneficial to concentrate on resolving problems one medicine at a time.
This links to another of Wisemans recommendations make goals specific. He offers the well-known example of SMART (Specific, Measurable, Achievable, Realistic and Time-based) objective setting as a tool to facilitate this. Several patient programs already do this by offering paper and online patient diaries which can be used to set goals and record achievements. Interestingly, Wiseman says this approach works particularly well for men, who are more likely to stay on track if they focus on how much better life will be when they achieve their goal, and use visual reminders to remind them of their desired endpoint.
Chris Venn, Pfizers European Brand Manager for smoking-cessation product Champix, agrees that support programs should have a variety of tools available to help patients track their progress. Champix users have access to Pfizers LifeREWARDS behavioral support program, which Venn says offers a virtual coach providing one-to-one advice and helpful tips 24/7. The site has a number of tools, including a daily diary, and a progress monitor for key measures such as smoke-free days, body benefits and monetary savings made.
After analyzing different approaches by gender, Wiseman claims that women are more likely to be successful if they go public, telling their friends and family about their resolutions, and asking for their support in helping them to achieve their goals. The UK public health smoking cessation site http://gosmokefree.nhs.uk also offers users a number of quit tools, including a Make a Promise function, which allows users to publicly declare their resolution to quit, and to dedicate it and e-mail it to friends and family. Of course these days, friends are increasingly found through online, shared-interest communities too, and these are proving to have an important influence in success or failure with health behavior changes.
A 2001 study by Brown University Medical School in the US reported that people who dieted with the help of a structured online community program lost three times more weight in six months than those who just sourced diet and exercise information from the web.
The study suggested that regular e-mail advice from qualified practitioners and peer support through chat forums are the most important services that websites can offer to those trying to make health changes.
Patient discussion forums and chat rooms are beginning to appear on pharmaceutical patient support sites, but across Europe in particular, there is still uncertainly about whether, and how, these should be moderated, in addition to concerns about the associated ethical and legal issues. These tools seem particularly suited to weight loss, smoking cessation and exercise advice, but are already being used successfully for long-term conditions, as demonstrated by Bayer-Scherings multiple sclerosis portal, MS-Gateway (www.ms-gateway.com).
Regular online community support can be particularly helpful when motivation begins to fade, and old behaviors return. Friends at different stages of the change curve may be able to persuade patients to get back on track. Regular e-mail updates and messages from patient support sites also can provide gentle reminders of progress towards the end goal.
The New Year may be a popular time for deciding to change habits, but of course motivation can come from all sorts of factors throughout the year, too. A sudden wake-up call may occur; a critical point in life may be reached, or a personal emotional response to an event can act as a trigger, all resulting in a resolution to make changes. By recognizing and responding to these patient reactions, and deploying some of the techniques above, companies can build more engaging and effective patient support and medicine compliance programs.
Author: Di Stafford is Director of The Patient Practice Ltd, a consultancy specialising in patient marketing, communications and relationship management. www.thepatientpractice.com
(1)See www.richardwiseman.com for more information
(2)Prochaska & DiClemente, 1983; Prochaska, DiClemente, & Norcross, 1992; Prochaska & Velicer, 1997