Contributor: Connie Mester, MPH
To learn more about Connie, click here.
In Part 1 we defined personalized medicine, precision medicine, and personalized healthcare and revealed a critical missing element that could mean all the difference to the health of a person.
Combining efficacy and effectiveness benchmark data with self-reported outcome measures, economic implications, and real-world evidence of need and applicability enables clinicians to identify realistic and feasible treatment alternatives. These advancements and our ability to more appropriately target treatments have transformed diseases and lives. However, a person’s thoughts, beliefs, and lifestyle behaviors are factors not typically considered on an individual level in precision medicine or personalized healthcare. Could this element be the answer to helping people positively impact health outcomes?
By assessing a person’s emotional state and mental abilities and blending information gathered during a clinical encounter with the realities of a person’s daily life, clinicians and healthcare providers can better balance care needs and personal priorities. This alignment can help increase knowledge for better decision-making, reinforce the practice of newly learned skills [behaviors], help overcome setbacks, leverage experiences, and support the celebration of success.
Research indicates our thoughts and feelings drive our actions [behaviors]. Given that our behaviors account for 40% of our health status, it’s interesting there is such a mind-body disconnect in health “care” delivery. In most cases, a very limited percentage of a person’s lived experiences, emotions, and mindset is taken into account in recommendations and incorporated in treatment plans. What is the result of this limited approach to autonomy and personal choice? Less than optimal or limited sustained healthy behavior changes.
Health is a direct reflection of the choices we make, and most people realize the need for a healthy lifestyle. But several factors stand in the way of making smart health choices, including societal norms and our core beliefs. As a society, we have gotten away from healthy behaviors. There are major challenges, including our sedentary lifestyle, a culture of convenience, and our yearning for immediate gratification. The consequences of unhealthy behaviors aren’t immediate, just as the benefits of healthy behaviors aren’t immediate either. It takes time to see results, which makes the importance, or urgency, of adopting healthy behaviors even harder to communicate in a compelling way.
Relentless advertising from food manufacturers influences our habits, fuels our misconceptions, and overwhelms us with conflicting information. This complicated mix of confusing messages makes us want to stick with what we know. The historical directives to eat three meals a day and strive for the clean plate club laid the foundation for many of our dietary habits. However, now we are told that moderation and portion size are important, and it’s better to eat smaller amounts throughout the day. Yet, in our busy lives, it’s hard to avoid the temptation of picking up something fast and processed, as preparing healthy meals involves more time (and sometimes more money) than convenient, prepackaged meals or preservative-laden, boxed food.
The Human Element [Emotions, Experiences, and Everyday Life]
So, how can we make healthy behaviors a more natural part of our lives? The first step is to figure out what’s really behind our inactivity, poor food choices, and other unhealthy behaviors. Challenges typically include fear, know-how, purpose, mindset, priorities, and expectations. Notice that money wasn’t mentioned; however, typically it is one of the top barriers individuals face. Even for those on restricted budgets, studies show nutritious food can be less expensive than fast food, prepackaged snacks, or other low-quality junk foods.1 Also notice there was no reference to evidence-based treatment recommendations compliance or even a focus on disease.
The thing about change…….it requires changing. Changing is hard and requires effort. It shifts our norm, takes us out of our comfort zone, can trigger anxiety, and deplete our confidence. Feelings of being deprived of our favorite comfort food, or fear of the unknown, such as learning to use fitness equipment, may be too difficult to overcome [with no change in skills or mindset]. Change is a gradual process and is different for everyone, whether changing behavior or changing mindset. Tapping into your thoughts and learning to shift your mindset from a negative view, of worry and doubt, to a positive view, with feelings that you are in control of a healthy future, can be powerfully transformative. Finding the value, the positive side, will help you uncover the purpose. And purpose goes well beyond simply setting a goal of weight loss. Understanding the real purpose helps to give the new behavior the priority attention it deserves. It is the meaning behind the reason for setting the goal in the first place.
The Robert Wood Johnson Foundation is funding Positive Health research to uncover how “biological factors, such as high heart rate variability; subjective factors, such as optimism; and functional factors, such as a stable marriage” impact health.2 In a future article we will take a deeper look at barriers to healthy lifestyles, with a goal to uncover and then target unique individual variables that can be meaningfully aligned in order to deliver truly tailored capabilities at scale.
One example of how person-centered needs are transforming care models can be seen in pregnancy care. Centering Pregnancy provides the traditional schedule of ten prenatal care appointments through patient-centered group sessions, bringing together 8 - 12 expectant mothers with similar due dates. Facilitated by a clinician, these sessions last between 90 – 120 minutes instead of the traditional 10 – 15 minutes and include a one-on-one assessment, interactive learning, patient activation, and community building. The supportive forum provides time and space to open up comfortably and explore topics that are top of mind. This approach not only lessens the participants’ potential feelings of stress and isolation, it empowers them to engage and learn, strengthening their confidence and ability to make healthier decisions.3
The Bigger Picture
Health is much bigger than a diagnosis, staying compliant with medications, or tracking clinical measures on an app. Health innovations that consider the whole person, not just the disease or the patient in a single clinical encounter, and that infuse insight based on emotional and behavioral drivers, are more likely to have a greater chance of success in helping individuals live their definition of personalized health.
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- Beheshti R, Igusa T, and Jones-Smith JC. Simulated Models Suggest that Price per Calorie Is the Dominant Price Metric that Low-Income Individuals Use for Food Decision-Making. (2016) The Journal of Nutrition, 146(11), 2304-2311. https://doi.org/10.3945/jn.116.235952
- Exploring the Concept of Positive Health. Robert Wood Johnson Foundation website. https://www.rwjf.org/en/library/research/2017/08/exploring-the-concept-of-positive-health.html Assessed April 2018.
- Centering Healthcare Institute website. https://www.centeringhealthcare.org/about Accessed April 2018.