- Creating a diagnosis and appropriate treatment plan is only half the battle for doctors; actually getting patients to follow through is its own beast. Providers can better achieve overall patient wellness by using a set of patient motivation techniques that drive better health behavior.
In all of healthcare, but especially in chronic disease management, it is important for patients to be active participants in their own wellness journey. Patients are the sole drivers of health behavior change, care management activities, and medication adherence. And while some patients may be intrinsically motivated to improve their health, others may require provider encouragement.
Below, PatientEngagementHIT.com reviews key strategies for patient motivation that will ideally lead to better patient self-efficacy.
Detecting non-compliance, motivational needs
Before clinicians can tackle patient motivation, they must first understand that some patients are extremely motivated from the get-go. These patients have high intrinsic motivation, recognize the importance of improving their own health, and can target efforts toward that specific goal.
Although these patients warrant support and affirmation from their clinicians, they should not be the target of most provider efforts.
Instead, healthcare providers must learn to recognize the warning signs of a potentially noncompliant patient.
Researcher and chiropractor Robert M. Smith, DA, DACRB, of the American Chiropractic Association (ACA) Rehab Council, found that flagging these warning signs is the first step in an effective patient motivation strategy.
“Being alert to any comments a patient makes regarding ‘Fear Avoidance Beliefs’ can help the doctor focus on reinforcing the importance of rehabilitation and consistently providing motivation before non-compliance becomes a hindrance to care,” Smith wrote in a 2011 literature review.
Some general signs of potential non-compliance include the following:
- History of non-compliance
- A lifestyle that is not conducive to compliance
- Limited patient support network
- No established baseline of trust between patient and provider
Clinicians can also look at the treatment plan to determine if it will instill motivation in the patient.
Does the plan spell out specific wellness goals? Does it provide rationale for each treatment step? Does the plan account for unique barriers within a patient’s life? Is the prescription appropriate and manageable for the patient?
A 2017 analysis of patients who have been non-compliant in chronic disease management regimens also highlighted those questions. Patients who are in treatment plans that are not specific and that do not highlight individual end goals tend to be non-compliant. Patients who do not have regular face-to-face encounters with providers are also less likely to be compliant.
Clinicians can assess their patients and treatment plans to determine if patients will be motivated. From there, providers can enlist other patient motivation techniques to overcome intrinsic motivation barriers.
Using patient-provider communication, motivational interviewing
Ultimately, patient motivation techniques are going to require a positive rapport between patient and provider. Providers can work to encourage and motivate their patients to follow through on a health action by having a baseline of patient trust and good will.
The primary interpersonal strategy for patient motivation is motivational interviewing.
As defined by experts from the American Academy of Family Physicians (AAFP), motivational interviewing “is a method for changing the direction of a conversation in order to stimulate the patient's desire to change and give him or her the confidence to do so.”
During motivational interviewing, clinicians guide patients through the process of setting goals and recognizing the importance of wellness. Providers should not preach to the patient, but rather engage in a two-way conversation surrounding goal-setting.
“In contrast to many other change strategies employed by health care professionals (such as education, persuasion and scare tactics), motivational interviewing is more focused, goal directed and patient centered,” AAFP experts said. “A critical tenet is that the motivation for change must emanate from the patient rather than the physician.”
Additionally, motivational interviewing should help the patient become invested in her own wellness.
“The objective is not to solve the patient's problem or even to develop a plan; the goal is to help the patient resolve his or her ambivalence, develop some momentum and believe that behavior change is possible,” AAFP noted.
Motivational interviewing combines several components, as exemplified in the OARS acronym:
- Open-ended questioning.
- Affirmations, or feedback during different parts of the wellness journey.
- Reflective listening, or helping patients arrive at answers instead of prescribing a need for motivation.
- Summaries, or repeating back to patients observations patients have made themselves. This will help reinforce motivation.
Providers can spark the fire within a patient to maintain wellness or make a lifestyle change using motivational interviewing. From there, providers can offer tangible advice to patients to help facilitate that behavior change and to keep patients motivated along the way.
Incentives to drive patient activation, motivation
Incentive-based models may be useful for providers trying to spark patient activation in some sort of wellness activity.
Health payers and employers often sponsor wellness programs that will drive patient wellness by offering an incentive or prize at the end. In theory, wellness programs keep patients healthier in the long-run, preventing costly health interventions.
Employers sponsor corporate challenges to increase step count, or offer cash rewards for successful smoking cessation. Many health payers offer discounted or free gym memberships to support patient fitness and wellness.
A 2016 HealthMine survey of employees participating in a wellness program said that the most effective incentives were relevant to patients’ lifestyles. Gift cards to appealing stores or cash prizes were popular, as well as discounts on payer rates.
Effective programs also instilled patient participation by offering regular reminders about the contests and by targeting programs to individual patient needs. It was not effective to promote a smoking cessation program to a non-smoker, for example.
Healthcare payers can also use cash incentives to compel patients to visit their primary care providers, according to a study published in Health Affairs. With the influx of patients recently gaining health coverage due to the Affordable Care Act, many payers have been struggling to motivate these patients to utilize services, especially primary care.
Payers found that offering patient education and cash incentives of varying amounts increased patient likelihood of visiting the PCP for the first time. This likelihood increased when payers offered larger incentives, the study found.
Using contextualized mHealth apps, games
Health IT also presents an opportunity to supplement motivation efforts. mHealth apps are growing in popularity amongst patients and can be effective in supporting patient self-management.
One study in the Journal of Medical Internet Research showed that 98 percent of users found mHealth weight loss apps helped motivate them. Patient engagement with and likability of the app, frequent app use, and app educational quality predicted more behavior change than apps without those qualities.
However, patient education within the app must be targeted and cannot be arbitrary, the study showed.
“Though general knowledge alone is often an insufficient change agent, this study demonstrates that knowledge specifically related to ways in which one can improve dietary behavior and the benefits of making such improvements are mechanisms for change when using diet- and nutrition-related apps,” the team pointed out.
These favorable qualities will be useful in future mHealth app development, the researchers said.
“Moving forward, developers of diet/nutrition apps may consider design configurations that emphasize the provision of knowledge to shape attitudes and beliefs, followed by attempts to influence actual skill development in app users,” the researchers concluded. “Elements of gamification or other such paradigms may be useful to maintain user motivation and the desire to be persistent in making weight loss efforts.”
Although it is ideal for a motivational app to deliver positive outcomes, researchers say just having the app itself is an indicator of patient motivation.
One study also published in JMIR conceded that there is little evidence of the clinical outcomes of mHealth apps, but that simply using an app marks strong intrinsic motivation.
An assessment of patient mHealth use showed a modest correlation between app use and goal-setting patterns. Patients using planning, feedback, and monitoring apps were more apt to set health goals.
Driving patient activation in healthcare is often seen as difficult because a patient’s actions are not within the provider’s control. Using strong patient motivation techniques can help put some of that control back into the provider’s hands.
Healthcare professionals can better encourage their patients to take part in important self-management activities by tapping into proven strategies catered to the specific patient.