Patient Engagement
Clip
Making Healthy Habits Fun (05:59)

Where does making behavior change effortless overlap with making it fun? Charlene Wong, a pediatrician and health services researcher at Duke University, poses this question about healthy habits to Peter Ubel, a professor of business, public policy, and medicine at Duke, and Roy Rosin, Chief Innovation Officer for Penn Medicine.

“In some cases, the behavior that we want — and need — is effort, in and of itself,” says Rosin. “Making things effortless doesn’t work as well when you need people to move and exercise. That’s where making things more fun gets interesting.” He mentions Pokémon Go. Research indicates that players walked a tremendous amount to capture augmented reality creatures: 144 billion steps, according to Microsoft, or 2,000 additional steps a day, according to Duke. “That’s a great example of how fun gets you out of your chair to go do something,” he says.

Building on that example, Ubel describes patients of his who were veterans, who would go to public golf courses to play and ride around on carts with their buddies. “Stopping the cart 10 yards early and walking to the ball every other shot, that’s something they really enjoy — they’re not even thinking about exercise,” he says. “It’s not exercise; it’s just out having fun.”

Rosin describes a move and recover project his team worked on, inspired by one of their nurses. The nurse, whose nickname was “Turtledove,” would hide paper turtledoves in the artwork around the floor, challenging his patients to go find them. Rosin’s team asked what they could do to both create destinations and clear expectations in hospitals and to make it fun. They created game zones challenging patients to collect cards around their floor, and it worked — people walked more. “The number of people meeting their goals for being discharged more than doubled,” he says.

This reminds Wong, as a mother of young children, of hiding things to get her kids to do something. “You have to make it fun, especially when you’re talking about very young children,” she says. “They’re not going to do the ‘no pain, no gain thing.’”

Rosin adds that he has trouble resisting his wife’s baking. After learning about Paul Rozin’s salad bar study, he decided to try moving her baked goods. But moving them to a different room — even to the basement — didn’t work. “What’s interesting is, there are a bunch of foods I eat that I shouldn’t, and when they’re not in my house, my laziness factor beats out my lack of willpower,” he says. “I’m not going to leave my house to go to the store to get the thing.” Having a nicotine addiction will likely get you out of the house to buy more cigarettes, but for food, it’s much less likely.

“I would say, clear it out for the stuff that’s bad, but for the stuff that’s good, make it fun,” says Wong. She describes broccoli and cauliflower “trees” that she stands up for her kids, and only eating the “best” green beans. Wong also describes Duke’s childhood obesity treatment program. She used to sell the program’s benefits to her teens first — that a team helps them learn what to eat and how to exercise. But now, her first message is about how fun that program is: It takes place in parks with a bunch of their peers working on the same goals, and who speak the same language (i.e., Spanish). She tells parents, involved in shared decision-making, that the program is covered by insurance — they won’t have to pay for a gym membership.

Selling nutrition to teens can be trickier, however. It’s a social norm to consume sugary beverages, for example. When with friends, they might go to the store together afterschool and buy a drink like AriZona tea, which some teens think is healthier because it’s tea rather than soda. Wong has also heard that Sprite is better than Coke. “Even though providing information alone isn’t going to be adequate, in some populations, particularly when you’re talking about younger populations, they may not have heard these messages yet, so providing some of that information is also really still critical,” says Wong.

From the NEJM Catalyst event Patient Behavior Change: Building Blocks for Success, held at Duke University, April 4, 2018.

More From Patient Engagement
Ghafur01_pullquote -digital health health care consumer patient experience

Engaging Patients Using Digital Technology — Learning from Other Industries

Providers can benefit patients and disrupt health care by learning from the experience of other industries.

Mission Hospital Virtual Sitter - Drawing of the Virtual Bed Zone and Rails

Reducing Inpatient Falls and Injury Rates by Integrating New Technology with Workflow Redesign

How Mission Hospital scaled a virtual sitter pilot and reduced unassisted falls by 44% and fall-related injuries by 40%.

Health Care Providers Should Incentivize Patients

Survey Snapshot: Patient Financial Incentives — There Are No Quick Fixes

The NEJM Catalyst Insights Council agrees that while financial incentives are a common strategy to engage patients in healthy behaviors, they are not necessarily effective.

Support of Family and Friends Is More Effective Than Clinician Support in Realizing Health Goals - From the Patient Engagement Insights Report: Why No Single Health Incentive Works.

Patient Engagement Survey: Why No Single Health Incentive Works

Initiatives to improve patient engagement come in a variety of forms. While insurers, employers, and health care providers are all involved in using financial incentives and penalties for engagement efforts, improvement in health outcomes has been elusive. Achieving that ultimate goal will usually require a combination of financial and social approaches.

Health Systems Attending the Nudge Units in Health Care Symposium - Penn Medicine

Key Insights on Launching a Nudge Unit within a Health Care System

Leaders are finding that making higher-value choices easier through subtle changes to choice architecture can have an outsized impact on medical decision-making.

Barriers to Providing an Oustanding Patient Experience

Buzz Survey Report: Patient Experience

An independent NEJM Catalyst report sponsored by University of Utah Health on barriers to achieving an excellent patient experience.

The Patient Engagement Capacity Framework

The Patient Engagement Capacity Model: What Factors Determine a Patient’s Ability to Engage?

Patient engagement assessments often don’t dig deep enough to identify why patients don’t participate in their own health care. We present a new model to help providers pinpoint the reasons for lack of engagement and address them more effectively.

Organizational Mindset Is the Biggest Barrier to Engaging Patients as Consumers

Survey Snapshot: The Patient-Physician Relationship Is Key

Both parties involved in a consumer-facing transaction have access to important information about the product or service — but this isn’t the case with health care.

What High-Need, High-Cost Patients Say About How to Reduce High Utilization of ED and Inpatient Services

High-Need, High-Cost Patients Offer Solutions for Improving Their Care and Reducing Costs

More home health care and after-hours clinics, telemedicine, and home delivery of medications are among top solutions.

Top Physician Pain Points Identified by Chronic Patients

Unmet Needs: Hearing the Challenges of Chronic Patients with Artificial Intelligence

With natural language processing and machine learning, researchers are identifying patient emotional and medical needs that are not being met by clinicians and patient advocacy groups.

Connect

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

Learn More »

Topics

Engaging Patients Using Digital Technology —…

Providers can benefit patients and disrupt health care by learning from the experience of other…

Patient Incentives

72 Articles

Survey Snapshot: Patient Financial Incentives —…

The NEJM Catalyst Insights Council agrees that while financial incentives are a common strategy to…

Patient-Centered Care

265 Articles

Real-Time Pursuit of Outcomes That Matter…

A simple and affordable tool to use at the point of care to drive value…

Insights Council

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

Apply Now