UNLOCKING BEHAVIOR CHANGE

Vaccines. Antibiotics. Organ transplants. All medical breakthroughs which changed the face of health in the developed world. But while certain causes of death have been greatly reduced, chronic disease has emerged as the next big threat1, and behavior change as the next blockbuster opportunity.

According to the Centers for Disease Control (CDC), 86% of the nation’s $2.7 trillion annual healthcare expenditures go to treat people with chronic and mental conditions,2 and that most chronic diseases are caused by consumer behaviors.2 If someone could unlock the secrets to sustained behavior change, we could radically improve our population health.

Everyone from the government to “big pharma” and major health plans has attempted to tap into the power of behavior change, with mixed results. Fewer than one in five adults (16%) report being very successful at making health-related improvements, such as losing weight (20%), starting a regular exercise program (15%), following a healthier diet (10%), and reducing stress (7%)3

Why is it so hard to change unhealthy behaviors? A 2016 study published in the Public Health journal suggests common errors that prevent the successful implementation of health-related behavior change.4

86%%

of U.S. annual healthcare spend goes to treatment for chronic

and mental conditions.Source: CDC, 2018.

• Assuming human behavior is “just common sense” and that it requires no serious thought. Just because something seems obvious (“just eat less”) does not take into account that change is difficult and requires sustained motivation and support.

• Assuming that messaging/awareness is the primary mechanism driving behavior change. “If only we could get the message out there in a way that people could understand and identify with, then they will change.” Again, this over-simplifies the complex nature of long-term behavior change.

• Assuming people act rationally. It’s a misconception that after being presented with evidence, people will do what they know to be sensible and logical. Even though most smokers want to quit, and dieters want to eat less, behaviors like smoking and overeating are often embedded into their lives, and ingrained into their routines and habits. When faced with temptation and social pressure (“Come on, I don’t want to smoke alone”), rational thought often goes out the window.

We do know that behavior change rarely happens overnight, especially when it comes to achieving longer-term goals, such as losing weight or lowering blood glucose. Willpower, which the American Psychological Association (APA) defines as “the ability to resist short-term gratification in pursuit of long-term goals or objectives3,” is only one factor influencing behavior change.

Willpower is not a fixed trait, and it can be strengthened or depleted. Factors such as positive beliefs and attitudes can mitigate the effects of willpower depletion. With the right motivation, the APA claims, people may be able to persevere even when their willpower has run out.5

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STAGES AND STRATEGIES ASSOCIATED WITH SUCCESSFUL BEHAVIOR CHANGE

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One of the most widely-cited and used theories, the Transtheoretical Model of Behavior Change,6 suggests that people move through change in six stages: precontemplation, contemplation, preparation, action, maintenance and termination. Based on this model, a number of strategies associated with behavior change have been identified:7

Taking ownership and accountability: To begin the process, people need to understand why they need to change, acknowledge that they want to change, and internalize the idea that the healthy behavior is part of who they want to be. Studies have shown that patients who took responsibility for their own health were more likely to succeed in changing their behavior.8

Realizing change is possible: They may not be able to change everything overnight, but people can start to work toward small, incremental, SMART goals (Specific, Measurable, Achievable, Realistic and Time-Oriented).4 “Lose weight,” is not a SMART goal, but a plan that incorporates goals like “walk for 30 minutes 5 days this week” can contribute to a weight loss goal while allowing them to track their progress. If they don’t know where to begin, people can seek out a doctor or health coach and together create SMART goals they believe they can meet.

Finding supportive relationships: Whether it be family or friends providing encouragement to loved ones or like-minded people trying to accomplish similar health goals, behavior change is more likely to stick when it’s connected to social relationships. And online support communities can connect these social relationships and help bolster behavior change. A 2016 study of a behavior-based weight-loss program found that active participants in online community platforms followed instructions more precisely, had a more positive perception of achieving their goals, and reported receiving more social support than those who did not actively participate.10

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Rewarding and reinforcing: Create opportunities to incentivize healthy behaviors and reduce the rewards that come from negative behaviors or inaction.6

Continuing reminders and cues: People need a steady stream of mental cues that support and encourage healthy behavior. This can help reduce the impact of willpower depletion and keep the person from relapsing into unhealthy habits.7,8

A more recent model that also considers consumer-facing health technologies is McKinsey’s “new paradigm for patient behavior,” which offers similar elements of successful behavior change:11

• Engaging individuals more effectively by taking advantage of new insights from behavioral psychology and behavioral economics

• Integrating behavior change as a core component of new care delivery models

• Using the power of influencers and networks to support behavior change

• Utilizing remote and self-care technologies to support, empower, and connect individuals to clinicians and other health influencers

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FITBIT HEALTH SOLUTIONS: SHAPING THE FUTURE OF BEHAVIOR CHANGEAt Fitbit Health Solutions, we believe behavior change represents the next big opportunity in health. Our enterprise health platform, Fitbit Care, pairs the #1 brand in global wearables with a proven health coaching platform to help people manage chronic conditions and aid in lifestyle improvement. Timely human support, combined with scalable technologies, can help break down barriers to behavior change in a wide variety of individuals.

Our vision for the future? Care driven by continuous physiological data that feeds into a personalized and scalable intervention designed to support sustained behavior change.

Since 2007, Fitbit has helped transform millions of lives by giving people continuous insight into their personal health and fitness data. Fitbit’s software, gamified engagement tools, and supporting social network leverages factors proven to aid in behavior change, while contributing to one of the world’s largest databases of activity, exercise, and sleep.

Fitbit Health Solutions now offers a HIPAA-compliant connected health coaching platform that enables a frictionless and personalized user experience for health activation.

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With this platform, people have access to a highly scalable coaching model, customized to that individual’s specific needs, health challenges, and motivators. Workplace wellness plans need not be “one size fits all.” With Fitbit Care, employees can opt to receive personalized health coaching, using technology that allows a single coach to work with a large number of people. And these programs can be highly flexible, changing from week to week based on data-driven feedback and predictive algorithms.

We offer solutions that cover a range of chronic conditions that include hypertension and diabetes. Our programs are designed to improve metrics and outcomes at both an individual and group level, promote individual accountability, achieve a measurable return on condition management spending, and ultimately, help drive sustained behavior change.

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EXAMPLES OF IMPROVED HEALTH OUTCOMESIN DIABETES AND HYPERTENSIONFitbit Care’s health coaching platform is based on six years of clinical research in health psychology and human-computer interaction conducted at the MIT Media Lab. It uses a powerful combination of artificial intelligence-driven insights and human interaction to generate positive health outcomes, automating parts of the coaching process and freeing up time for more personalized care.

Through randomized controlled trials conducted at several world-class facilities, the foundational behavior change principles behind Fitbit Care’s technology helped drive statistically significant improvements in both diabetes and hypertension management.

For example, patients at the Joslin Diabetes Center saw an average 3.2 reduction in A1C after a three-month digital diabetes intervention supported by Fitbit Care’s health coaching platform. This was a greater reduction compared to a 2.0 reduction in patients receiving Joslin’s standard diabetes intervention. In comparison, the traditional diabetes care model — medication combined with periodic physician consults — typically results in only a 0.5-1.0 drop in A1C over an entire year.12

Using Fitbit Care’s health coaching platform, participants in a hypertension intervention at Massachusetts General Hospital saw an average 26mm/Hg drop in blood pressure after three months, compared to 16mm/Hg in the control group.13

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HOW FITBIT CARE WILL HELP CRACK THE CODE TO BEHAVIOR CHANGE

Fitbit is the leading global wearables brand with more than 25 million active users. By leveraging our 10+ years experience in consumer engagement, integrated with technology that combines a personalized user experience with “right touch” scalable health coaching, Fitbit Health Solutions offers a unique integrated solution that delivers proven results.

Companies incorporating Fitbit into their wellness programs have already saved millions of dollars, and the potential for future ROI is huge.14 If we manage to change just a fraction of unhealthy behaviors, we’ll be able to drastically reduce preventable health costs, and help more people live their best lives.

1,2 How You Can Prevent Chronic Diseases | About Chronic Disease | National Center for Chronic Disease Prevention and Health Promotion | CDC. (2018). Cdc.gov. https://www.cdc.gov/chronicdisease/about/prevent/index.htm

3 American Psychological Association. Harris Interactive APA Poll. March 2010.

4 Kelly, M., & Barker, M. (2016). Why is changing health-related behaviour so difficult?. Public Health, 136, 109-116. doi:10.1016/j.puhe.2016.03.030. https://www.sciencedirect.com/science/article/pii/S0033350616300178

5 What You Need to Know about Willpower: The Psychological Science of Self-Control. (2018). https://www.apa.org/helpcenter/willpower.pdf

6 The Transtheoretical Model of Health Behavior Change - James O. Prochaska, Wayne F. Velicer, 1997. (2018). American Journal Of Health Promotion. http://journals.sagepub.com/doi/abs/10.4278/0890-1171-12.1.38

7 The Transtheoretical Model (Stages of Change). (2018). http://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/BehavioralChangeTheories/BehavioralChangeTheories6.html

8 Greene, J., Hibbard, J., Alvarez, C., & Overton, V. (2016). Supporting Patient Behavior Change: Approaches Used by Primary Care Clinicians Whose Patients Have an Increase in Activation Levels. The Annals Of Family Medicine, 14(2), 148-154. doi:10.1370/afm.1904 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4781518/

9 Wellness Programs. (2018). www.hnfs.com https://www.hnfs.com/content/hnfs/home/tw/bene/wellness/wellnessprogramsresources.html

10 Taiminen, H. (2016). How do online communities matter? Comparison between active and non-active participants in an online behavioral weight loss program. Computers In Human Behavior, 63, 787-795. doi:10.1016/j.chb.2016.06.002 https://www.sciencedirect.com/science/article/pii/S0747563216304307

11 Changing patient behavior: The next frontier in healthcare value. (2012). McKinsey on Healthcare. https://healthcare.mckinsey.com/changing-patient-behavior-next-frontier-healthcare-value

12 William C. Hsu, Ka Hei Karen Lau, Ruyi Huang, Suzanne Ghiloni, Hung Le, Scott Gilroy, Martin Abrahamson, and John Moore.Diabetes Technology & Therapeutics.Feb 2016. http://doi.org/10.1089/dia.2015.0160 https://www.liebertpub.com/doi/abs/10.1089/dia.2015.0160

13 Office, R. (2018). Coaching platform improves health outcomes, lowers medical costs . MIT News. http://news.mit.edu/2017/coaching-app-improves-health-outcomes-lowers-medical-costs-0721

14 A group of bus drivers revved up their fitness and improved their health. Here’s the story of how they did it (2018). https://healthsolutions.fitbit.com/wp-content/uploads/RTA_CaseStudy-1-1.pdf

References

Fitbit Health Solutions, part of Fitbit, Inc., delivers health and wellness solutions designed to increase engagement, improve health outcomes and drive positive returns for employers, health plans and health systems. Our portfolio enterprise SaaS solutions includes an engaging wellness program including challenges and reporting, and a proven health coaching platform that combines scalable technology with timely human care to drive healthy behavior change. Powered by Fitbit’s world-renowned suite of smartwatches, trackers and mobile apps, our solutions span the full spectrum of care, from wellness and prevention to chronic condition management.

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