Patient Engagement
Clip
If It’s Designed Well, They’ll Want It (06:10)

A number of proposed interventions to improve patients’ health behavior appear cumbersome, or require additional people and time, notes Scott Halpern, Deputy Director of the University of Pennsylvania’s Center for Health Incentives and Behavioral Economics. What are the key components to designing programs that ultimately have the potential for scale?

Dartmouth College marketing expert Punam Keller emphasizes “segments of one” in helping patients overcome barriers to changing their health behavior, such as in the example of her heart study. “You are identifying people’s barriers and you’re tailoring solutions right there on the spot, based on the information that you have in your toolkit,” she says.

In another example, a study on voluntary medical male circumcision to reduce the acquisition and spread of HIV/AIDS virus in southern Africa faced a “long list” of barriers, such as issues of masculinity and a perceived license to cheat on one’s partner. But the study persisted, and in less than four years, the market for voluntary male circumcision grew from almost zero to 1 million. How did the program scale? “You create demand for it,” says Keller. “You make it legitimate. You make it pervasive. It’s no longer taboo.” Then, she says, you let others take over the market while you “go create demand for resolving another health issue somewhere else.”

Harvard economist David Laibson highlights three effective tools for creating low-cost scalability in health care: automaticity, active choice, and logistical simplification.

  1. Automaticity: “By and large, people go with the flow if you’re creating something that they want,” Laibson says. “Typically, if it’s well designed, it is something that they want.” Automatic processes typically lift participation by about 70 or 80%, according to Laibson.
  2. Active choice: If automating a process is inefficient, compel people to make an active decision instead, advises Laibson. “Do you want to have an appointment? Yes or no. You force the choice,” says Laibson. “Now they’re actively engaged, they’re making an active decision.” Active choice can result in a 40 or 50% lift in participation.
  3. Logistical simplification: This involves stripping the forms for your processes down to their most basic elements. “If you have a five-page form, often you can shrink it to a half-page form,” says Laibson. Logistical simplification typically only results in 10% extra participation, but, as Laibson reminds us, 10% is still progress.

From the NEJM Catalyst event Patient Engagement: Behavioral Strategies for Better Health at the University of Pennsylvania, February 25, 2016.

More From Patient Engagement

Shared Decision-Making for Good Clinical Care: Better, but Not Easier

Active patient involvement and patient autonomy can be burdensome to patients, especially when they are faced with serious illness. The primary goal of shared decision-making is not autonomy, but good care that fits patients’ lives.

The Patient as Consumer and the Measurement of Bedside Manner

Many physicians do not believe patient satisfaction is a legitimate pursuit. Yet they must meet consumers of health care where they are — on Internet ratings sites.

Health Care — A Final Frontier for Design

Design must move beyond narrow projects and encompass complex systems.

Halpern02_clip_still: A/B Testing Health Behavior Interventions

A/B Testing Health Behavior

Health care can’t implement changes overnight like Silicon Valley, but we can still learn from their version of treatment and control.

Social Interventions Can Lower Costs and Improve Outcomes

We can better serve our under-resourced patients by helping them access treatments and social interventions we already know to be effective.

Better Communication Makes Better Physicians

How Adrienne Boissy and Cleveland Clinic are focusing on physician communication — and getting results.

Why Real-World Results Are So Challenging for Digital Health

User engagement outside of clinical trials is the critical factor.

Transparency and Trust — Online Patient Reviews of Physicians

Transparency of validated data about delivery-system performance has the power to change the culture of health care.

Patient Engagement Survey: Technology Tools Gain Support — But Cost Is a Hurdle

NEJM Catalyst Insights Council members say patient engagement technology tools must be patient-centric and are most useful for managing chronic disease.

Patient-Researchers and Physician-Consultants Confront Chronic Disease

Personal-use sensors and data applications allow patients with Type 1 diabetes and other chronic diseases to take charge of managing their health. This is the future of chronic disease management.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

Learning to Drive — Early Exposure…

The importance of listening to the patient at the end of life.

Patient Incentives

43 Articles

A/B Testing Health Behavior

Health care can’t implement changes overnight like Silicon Valley, but we can still learn from…

Survey Snapshot: Genomic Data Is Far…

NEJM Catalyst Insights Council members say that clinical and cost data will continue to be…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now