Healthy Habits
In healthcare, patient behaviour is an important factor when it comes to overall patient health. What the patient does in their everyday life significantly impacts the state of their health (DiMatteo, Giordani, Lepper, & Thomas, 2002). Michael works with at-risk populations and Alastair coordinates facilitation with chronic conditions patients. Both patient populations are different in terms of their specific needs however, both groups require a change in healthy habits in order to gain better health outcomes (Sjoerds, Luigjes, van den Brink, Denys, & Yücel, 2014) which requires open communication, intellectual risk-taking (IRT) and active engagement (AE).
The process requires intrinsic motivation from the patient in order to gain adherence to the healthy habits (Sjoerds et al., 2014) that have been suggested by the doctor/nurse facilitator. To gain this motivation patients need to communicate with the facilitator (Ryan, Patrick, Deci, & Williams, 2008) which may be difficult due to the patient’s reluctance to talk openly about such sensitive subject matter.
The Healthy Habits framework is designed to allow patients greater IRT and AE with facilitators through online coursework to gain a better understanding of the patient’s ability to adhere to the healthy habit suggestions. This online model supports mobility, and provides patients access to Healthy Habit resources and consultation in a comfortable, timely, or convenient environment (Leveille et al., 2009).
Blending HealthChange® Methodology (Gale, 2014), Merrill’s first principles of instruction (Merrill, 2002), the Critical Thinking Framework For Any Discipline (Duron, 2006), Bloom’s taxonomy (Krathwohl, 2002), and being mindful of Carol Dweck’s theory of growth mindset of an empathetic design, we developed a five step approach to achieve healthy habits.
The Process
Healthy Habits Framework graphics developed by Alastair Linds
Step one: Prep & Begin
Patients are prepared to begin taking the course to gain healthy habits.
Step two: Discuss & Motivate
Patients are more likely to be uncomfortable discussing their insecurities and thoughts around their health. Facilitators engage patients to find patient’s goals and motivations, facilitators can employ talk therapy (Short, 2018) to encourage engagement.
Step three: Track & Document
Facilitators ask patients to begin and share a diary of progress that fulfills their healthy habit journey toward their goals. Patients may experience difficulty recalling events or situations. It is important for patients to speak openly and discuss their progress. By tracking and documenting progress the learner will have more information to share with the facilitator.
Step four: Meet & Feedback
Patients are encouraged to meet regularly and share successes, drawbacks, feelings and ideas documented in step three. If patients continue to show reluctance to engage, facilitators may employ talk therapy, cognitive coaching, or other motivators to encourage IRT and AE. Steps three and four may repeat several times in order to achieve open communications and healthy habits. If necessary, the facilitator may need to refer to step two to re-evaluate patient’s motivations.
Step five: Test & Testimonial
If the facilitator feels that the learner is ready, the facilitator may offer the learner to provide a video testimonial. This simultaneously tests the learner’s confidence in speaking openly about their journey, helps motivate others to take part in Healthy Habits, and supports the organization providing the course.
Conclusion
As you may see, the Healthy Habits framework was developed to promote active engagement, and intellectual risk taking, through the consideration of an empathetic design. This dynamic approach is designed to be adaptive, and flexible, to encourage growth of our learners.
Feedback
As we are learners in this development, we are thankful for your participation in this process. We are interested in your perspective as an active participant to help us consider any possible barriers that we may not perceive through our lenses. Thank you for helping us grow.
References
DiMatteo, M. R., Giordani, P. J., Lepper, H. S., & Thomas, W. (2002). Patient Adherence and Medical Treatment Outcomes A Meta-Analysis. MEDICAL CARE, 40(9), 794–811. https://doi.org/10.1097/01.MLR.0000024612.61915.2D
Duron, R., Limbach, B., & Waugh, W. (2006). Critical thinking framework for any discipline. International Journal of Teaching and Learning in Higher Education, 17(2), 160-166.
Gale, J. (2014). HealthChange® Methodology for patient-centred care and behaviour change support. HealthChange Australia.
Krathwohl, D. R. (2002). A revision of Bloom’s taxonomy: An overview. Theory into practice, 41(4), 212-218.
Leveille, S. G., Huang, A., Tsai, S. B., Allen, M., Weingart, S. N., & Iezzoni, L. I. (2009). Health coaching via an internet portal for primary care patients with chronic conditions a randomized controlled trial. Medical Care, 47(1), 41–47. https://doi.org/10.1097/MLR.0b013e3181844dd0
Merrill, M. D. (2002) First principles of instruction. Educational Technology Research and Development, (50)3, 43-59. Retrieved from https://doi-org.ezproxy.royalroads.ca/10.1007/BF025-5024
Ryan, R. M., Patrick, H., Deci, E. L., & Williams, G. C. (2008). Facilitating health behaviour change and its maintenance: Interventions based on Self-Determination Theory. The European Health Psychologist, 10, 2–5.
Short, D. (2018). Conversational hypnosis: Conceptual and technical differences relative to traditional hypnosis. American Journal of Clinical Hypnosis, 61(2), 125-139. Retrieved from https://doi.org/10.1080/00029157.2018.1441802
Sjoerds, Z., Luigjes, J., van den Brink, W., Denys, D., & Yücel, M. (2014). The Role of Habits and Motivation in Human Drug Addiction: A Reflection. Frontiers in Psychiatry, 5, 8. https://doi.org/10.3389/fpsyt.2014.00008
Hi Alastair and Michael:
I applaud your efforts in designing a prototype that would help patients develop healthy habits! I could see myself as a learner benefiting from your model. If I understand correctly, is the interaction through the first four steps between the facilitator and the patient, or is there a community of patients in which interaction takes place with one another? I ask this because if not, there might be value in a community support component introduced earlier on than step five.
I am wondering if the opportunity to engage with other learners trying to develop similar healthy habits may provide further motivation for patients to support each other in maintaining healthy habits? Lally and Barrett (1999) suggested that the creation of a cultural community in an online learning environment supports learners to open up and share with each other (as cited in Thomas, 2010). Lally and Barrett (1999) posited that “this [cultural community] can help students develop a need for working collaboratively, a sense to support fellow beings in their needs, and thus, prepare themselves for life, work and citizenship, and further, develop certain foundation skills that are not found in curriculum” (as cited in Thomas, 2010, p. 238). Understandably patient confidentiality or privacy laws are a factor and may prevent this. However, would there be an option to interact with an online support group or community of practice at some point in the process?
References
Thomas, P. Y. (2010). Learning and instructional systems design. In Towards developing a web-based blended learning environment at the University of Botswana. (Doctoral dissertation, University of South Africa, Pretoria). Retrieved from http://uir.unisa.ac.za/handle/10500/4245
Hi Melem,
Thank you for your perspective. I can appreciate your view that there could be additional opportunities for personal growth if there were connections strengthened at earlier stages. Our framework is intentionally designed with higher community engagement in the final stage as some of our population that we work with are quite delicate, and they can require dedicated, and skilled, communication to maintain a healthy homeostasis. For example, I work with a population with severe mental illnesses and often have a history of violence. They are under the care of the state and are deemed not fit to be in a typical community setting. As such, they can be very limited to their ability construct stable connections with others that experience similar concerns. Two, or more, live wires can result in a shocking ending. Therefore, to be inclusive of both Alastair’s and my population, our framework consists of careful initial interactions to foster expression inside a safe environment through the facilitation of a skilled communicator. Once communication is clear, community connections are more easily gained. The key is the foundation, and as Thomas notes, “[c]ultural foundations reflect the prevailing values of a community and its culture” (Thomas, 2010, p. 237).
I think you are mentioning something worth noting. To further our framework, perhaps additional stages could be designed to connect those that are able to clearly communicate with like-minded individuals. A Healthy Habits part B may be a focused solution using those participants that wish to connect further.
References
Thomas, P. Y. (2010). Learning and instructional systems design. In Towards developing a web-based blended learning environment at the University of Botswana. (Doctoral dissertation, University of South Africa, Pretoria). Retrieved from http://uir.unisa.ac.za/handle/10500/4245
Alastair and Michael,
I was very intrigued with your prototype of a course to teach healthy habits to patients. Before I respond to your question, if as a participant I would foresee any barriers, I would like to seek clarification from you on ‘Step 1’ of your prototype, where you indicate preparation of the participant. How do you see this step unfolding? “A growing body of literature supports the importance of self-efficacy in helping to account for initiation and maintenance of behavioral change” (Rosenstock, Strecher & Becker, 1988, p. 179). Self-efficacy is described as the belief a person has about their capabilities rather than what they are actually capable of achieving (Pajares, 2003). I want to use self-efficacy, which is identified as one element of “important determinants of health behaviour” (Rosenstock, Strecher & Becker, 1988, p. 180), to frame my question. Would you use a criteria such as self-efficacy to determine which patients would be best suited for your course? Or which criteria for selection would you need to apply, assuming not everyone would be ready or willing to participate?
In answer to your question, I don’t foresee barriers as long as a patient would bring self-efficacy and motivation with them. I am excited about your design vision and belief it could contribute to empower patients to feel in control over their health.
Pajares, F. (2003). Self -Efficacy Beliefs, Motivation, and Achievement in Writing. Reading & Writing Quarterly, 19. 139 – 158. doi:10.1080/10573560390143085
Rosenstock, I. M., Strecher, V. J., & Becker, M. H. (1988). Social learning theory and the health belief model. Health education quarterly, 15(2), 175-183. doi/pdf/10.1177/109019818801500203
Hi Anita!
Great comment! You are correct, before the course can be taken, the patient will require some level of self-efficacy. We used the principles of autonomy and competence in self-determination theory to help define the necessary motivation before patients may consider the program. I’m sure we have all tried to convince someone to do something they don’t see value in. It’s nearly impossible without some kind of external coercion which self-determination theory defines as “controlled motivation” (Ryan, Patrick, Deci, & Williams, 2008). However, controlled motivation does little to gain long term adherence to the recommendation. It’s better if the patient have “autonomous motivation” (Ryan et al., 2008) which comes from personal values. Willingness and competency comes from this autonomy. Ryan et al., (2008) state that within self-efficacy theory “competence alone is not sufficient to ensure adherence; it must be accompanied by volition or autonomy” (p. 3).
Following this theory, before the course beings professional health facilitators require the patient to have the autonomy for a willingness to change. This will allow the patient to and be more open to accept new competencies, otherwise the likelihood of success may be much lower.
Ryan, R. M., Patrick, H., Deci, E. L., & Williams, G. C. (2008). Facilitating health behaviour change and its maintenance: Interventions based on Self-Determination Theory. The European Health Psychologist, 10, 2–5.
Hi Alastair and Michael,
I really liked the flow and simplicity of the model that you created and that your approach seemed to come from a patient first mentality.
One thing I found was that looking at the diagram it really showed the iterative approach which would allow the patient the time to reflect on what they were doing. I was wondering if you could potentially expand on how you might encourage a bit more of that iterative work towards the end and if you feel that there would be an actual end to the process. Allowing the patient the opportunity to reflect could likely give them the motivation needed to help increase their comfort levels needed. When looking at ways to get someone to engage for our work and in responding to comments we found that research done by Arbaugh (2000) showed that it was by the encouragement of intimacy in online courses was instrumental in improving learning experiences. Your plan encourages that intimacy (with very sensitive subjects) and these observations could apply quite well here as well.
I was also wondering if you had thought about how these different elements would be carried out. What kinds of tools do you think would be needed? Specifically, I wonder what tools would be best to use within step three to “Track & Document”.
Arbaugh, J. B. (2000). How classroom environment and student engagement affect learning in Internet-based MBA courses. Business Communication Quarterly, 63(4), 9-26.
Hi Jeff,
Thank you for your view, question, and inquiry into our framework. As there was a word limit to the blog post brevity was required, but this is accompanied by some elements not being spelled out. From my understanding, you would like us to unpack the aspect of tracking and documenting in step three.
To begin, I think it is important to repeat that in step two there is a communication to establish goals in a clear language and this is documented for future reference as a team approach. Wherein the team consists of the patient currently striving to establish a new healthy habit and the healthcare team that is actively working the patient. Part of this entails the entire team writing out the elements of the habit so that parts of the habit can be considered during the transition. For example, if a healthy habit is to maintain a clean apartment, writing out what constitutes a “clean apartment” would be required – is stove clean, inside of the fridge, floors swept and mopped, etc.
In step three during tracking and documenting, the patient documents through a diary of how their journey to reaching their goal is progressing. In tandem, the other part of this team (healthcare professionals) are tracking their observations around the habit. Dependant on the cycle of the habit, the healthcare team would use a standardized documentation that has checkboxes around the variables of the habit is being established. If the patient chooses to share his/her/their diary with the rest of the team, the language within would be analyzed for positive progress with transitions from future tenses to present tenses in regards to the success of the habit.
Arbaugh’s (2000) study has some interesting elements to it. The differences in the sample population seemed a bit different than ours (MBA students vs medical patients). Nonetheless, of the nine descriptive statistics used in the study, the considerations of usefulness (1), ease of use (2), ease of interaction (5), and student learning (9), are worth being mindful of during the patients’ healthy habits journey.
Thank you for that information to consider. It is a helpful reminder.
Have we answered your question, and do you have any specific tools that you would like to see implemented in our framework that has not been explored currently?
With warm regards,
Michael
Arbaugh, J. B. (2000). How classroom environment and student engagement affect learning in Internet-based MBA courses. Business Communication Quarterly, 63(4), 9-26.