The primary goal of any wellness program whether online, small or large group must be to create lasting changes to unhealthy behaviors that will prevent or delay the onset of chronic diseases such as cardiovascular, stroke, type 2 diabetes, depression and some types of cancer.Because 80% of health care costs borne by employers are a result of health conditions that are PREVENTABLE, really changing the wellness profile of a group is key to employees' health and employer health costs.
One of the challenges to overcome in developing a simple, effective Internet/population based behavior change program is to meet the diverse needs of many people with scientifically based programs that create lasting behavior change in each individual. Wellness programs are presented with a stiff challenge.
How can they draw in the masses, yet influence each person with tailored motivation to make and keep those small healthy behavior changes right for each individual? While countless wellness programs distribute a lot of health information to many people, they do not necessarily create lasting personal behavior change.
On the other hand, other more labor intensive programs may help individuals, but the high cost either precludes organizational return on investment or prohibits the program from reaching scores of people.
So the question is: What elements are key for a digital wellness program that is affordable and that can easily reach the masses AND influence individuals to take those necessary "baby steps" to make lasting change and prevent chronic disease?
- Start with Science. An effective wellness program must start with a scientifically designed health assessment to gather information related to an individual's health status, biometrics, lifestyle factors, health attitudes, interest and readiness to change. Note that health assessments that REALLY lay the groundwork for future behavior change cannot just assess health "risks".
While "knowing your numbers" has been historically a good first step, most humans do not simply change because they learn data about themselves. Individuals make changes that they are READY and motivated to make. Effective health assessments must include factors to assess this readiness in addition to traditional lifestyle and health measurements.
- Use data and grab the teachable moment. An effective wellness program must use the information gathered during the health and lifestyle assessment to individualize and deliver messages at the "teachable moment" which are supportive, motivational, and engage the participant.
The individual must be inspired to engage in an immediate behavior changes which he or she is most ready for and therefore will likely to be successful at changing - one small step at a time.
- Behavior change logic and modules are key. An effective wellness program must provide participants with a scientifically based behavior change program that incorporates individual health beliefs, attitudes, available support, social learning and self-efficacy, and stage of change.
If behavior change programs incorporate all the various stages of change a person is likely to pass through as they make the change, they are more likely to be successful at making a lasting change. Simply put, each of us goes through psychological stages as we make changes in our lives.
Effective behavior change programs actively incorporate these stages so that the participant forms a personal health continuum, repeating the same change steps with successive small successful behavior changes.
Effective Internet based wellness programs incorporate these behavior change principles for every person, individually tailoring the specific steps, suggestions, and information scientifically designed to reach each participant based on his or her unique characteristics, area of interest, and readiness for change.
- Compelling content must be based on proven learning theories. An effective wellness program must contain specific information and direction to the individual the "content" of the program. The teachable moment messages, personal health status reports, and behavior change programs (e.g., stress management, weight management, exercise, nutrition, chronic pain and allergy management) must incorporate proven health behavior change learning theories to guide individuals through change.
And in addition, the wellness program must report on successes of the individual and motivate that individual to build on his/her first successful "little" changes by making more. Wellness needs to be a successful cycle of little changes over time. The learning theories proven over time must be built into any effective digital wellness program.
Why are the learning theories so important? In recent years, many of us have seen the many attempts at causing BIG wellness changes for individuals. In addition to the television series, how many "biggest loser" campaigns has corporate American attempted to drive health improvement in the workforce?
We all know individuals who HAVE successfully made big health changes in their lives, but we all know many more who have tried many times, but seems to drift back and get discouraged with failed attempts at permanent behavior change. Many of these change theories were developed and introduced by Prochaska (1,2) in 1977 while at Stanford University Prevention Research Center and have proven to be successful at creating lasting change.
These learning theories are used successfully in treatment of diseases such as cardiovascular, diabetes, alcoholism and depression, and have been proven to be effective in disease prevention programs, reducing the number of people with risk factors by up to 60%. Here is an overview of some of the learning theories that should be embedded in the logic of a digital wellness program:
- Health Belief Model (HBM) - is a psychological model that attempts to explain and predict health behaviors. This is done by focusing on the attitudes and beliefs of individuals.
- Theory of Reasoned Action (TRA) - looks at a person's (or population's) attitudes toward the behavior as well as influential people and groups who could influence those attitudes.
- Social Cognitive Theory (SCT) - based on the ideas that people learn by example of what others do. The process of learning from other people's behavior is a central idea of Social Cognitive Theory and self-efficacy. This idea asserts that individuals can witness observed behaviors of others and then reproduce the same actions.
As a result of this, individuals refrain from making mistakes and can perform behaviors better if they see other individuals complete them successfully
- Transtheoretical Model (TTM) - assesses an individual's readiness to act on a new healthier behavior, and provides strategies, or processes of change to guide the individual through the stages of change to action and maintenance.
These most well-known and best researched learning theories all suggest that people change for SOME motivation, whether internal or external. And these theories also suggest that we as humans are more likely to keep a change that is small, one that we believe in, one that we are ready for. If we as a nation are going to go after the 80% of health costs that are preventable, we need to appeal to the masses and use learning theories that have been proven instead of looking for one or two individual "biggest loser" successes.
In looking at Healthy People 2010 and CDC reports on our progress since those goals were established a decade ago, it is clear that the American public has much distance to go in our quest for healthier living. Rather than more live coaching programs, "know your numbers" campaigns or paid weight loss games, maybe it is time for corporations to try a new paradigm of scientifically based and effective wellness solutions that are different.
Effective digital/internet based programs may be the answer.
Sources
(1) Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot 1997 Sep-Oct;12(1):38-48. Accessed 2009 Mar 18.
(2) Prochaska JO, Redding CA, Evers KE. The Transtheoretical Model and Stages of Change. In: Glanz K, Rimer BK, Viswanath K, editors. Health Behavior and Health Education. 4th ed. San Francisco: Jossey-Bass; 2008. p. 105. ISBN 9780787996147.
About The Author
Reindl Pjevach spearheads the sales & marketing and administration functions at Medforma. Her experiences include 20+ years of general management experience with specific corporate leadership roles in finance, marketing, manufacturing/quality, human resources and operational change implementation most recently as a VP of Boston Scientific Corporation.
Through entrepreneurial ventures over the past several years, Reindl Pjevach has also developed expertise with web based education, networking, and social media marketing. Her responsibilities include leveraging her experiences to reach target markets at affordable costs to in turn drive the Company's viral growth objectives.
Barb has a special passion and expertise regarding leadership and culture development and for this work was awarded the Twin Cities Business Journal's Top 25 Women Changemakers Award in 2003.
She is active on the boards of several non-profit organizations, holds an inactive Minnesota CPA license and practiced in public accounting early in her career. Barb graduated from University of Wisconsin - Madison with a Bachelor in Business Administration in Accounting and a Masters in Business Administration.
About Medforma:
Medforma helps businesses reduce health care costs and improve employee health through proven and affordable Internet-based behavior change programs and resources. Regardless of other employee benefit provisions, additionally all employers can benefit from Medforma's simple, low-cost solutions.
Confidential, trusted, and based on 35 years of world-renowned research at the Stanford University Prevention Research Center, Medforma programs empower people to improve their health and empower employers to reduce health care costs. Our Health Portraittm, Digital Health, Lifestyle, and Readiness Assessment engages employees to learn about change their health, one step at a time.
Our included Group Portrait Development, gives employers any-time access to their current group information in an easy to use dashboard. Medforma is dedicated to an ever-improving digital wellness program that assesses and coaches individuals to improved health.
We engage our customers in our regular product development enhancements and ALL of our "software as a service" customers benefit from our new features as they are launched. In addition to our effective digital program, which can be a complete wellness solution for any company, we also can and do provide any other desired corporate wellness needs through excellent coordinated partnerships with various wellness service experts.
