Dive into the environment to provide a better patient experience
Dive into the environment to provide a better patient experience
By Kathy Moriarty, associate director, behavioral services for MicroMass Communications, an Ashfield Health Company.
When seeking to understand why patients aren’t adherent to treatment or which barriers are impeding their access to health care, do you ask about their environment? This isn’t just finding out their ZIP code, although that’s part of it. Recognizing the impact of environmental factors helps us better understand how to reach and connect with patients as people.
When we think about patients, there’s a tendency to focus on individual factors that influence a patient’s engagement in their health. We pay attention to specific behaviors that patients do, like missing a doctor appointment, filling a prescription, or researching their condition. We also examine how they think and feel about their condition. How well does the patient understand their condition and the treatment options available? How are they adapting and coping? How are they adjusting to managing their condition with living their normal lives?
The answers to our questions and considerations regarding patient behaviors help identify specific ways to intervene and support. However, they don’t tell the entire story.
Focus on the patient within their environment.
When we only focus on individual factors, we can forget that these factors are affected by a bigger context: what’s also happening within the environment. We are all impacted by a dynamic set of influences: where we live, work, and socialize influences our thoughts, feelings, and behaviors. Our environment has a direct correlation to people we encounter, resources available to us, education opportunities, and more.
There is a study that I often reference because it demonstrates the impact of environment on long-term outcomes. The Adverse Childhood Experiences (ACEs) study found that when children experience potentially traumatic events, they are more likely to have chronic health conditions, mental illness, limited access to education and employment opportunities, and more. Examples of potentially traumatic events include living with someone who abused substances, having a parent with a mental health condition, and having parents who are divorced. The higher the number of these experiences faced during childhood, the greater the likelihood that the child will have negative outcomes during adulthood. What I find fascinating is that children have practically no influence over what’s happening in their environment, yet their circumstances have such a dramatic impact on their outcomes.
In fact, these examples are referred to as social determinants of health (SDOH)— various environmental conditions that impact health risks and outcomes. Early childhood experiences are part of SDOH, but so is the availability of transportation, social support, educational opportunities, housing, employment, and other factors that impact people throughout adulthood.
These large, systemic influences often impact individuals’ abilities to engage in their health. Yet, an immediate reaction might be to identify and try to change individual factors. But neglecting to pursue the SDOH factors is an industry oversight, and one that we can work together to address.
Consider how to engage with a person living with obesity, for example. Initially, it might seem logical to encourage making lifestyle changes (individual factors). But what might not be immediately apparent is that this person grew up with food insecurity (an environmental factor). And now having an abundance of food represents stability, so encouraging this person to change how he eats will be perceived as a threat to his sense of stability. Another example is someone who chooses to work during the third shift so that she and her spouse can divide and conquer childcare; however, this schedule makes it difficult to prioritize her own well-being. Having these more nuanced perspectives enable us to engage these individuals in more meaningful ways.
Use behavioral science to drive positive change.
I find that marketers are often at a loss about how to address environmental factors because they don’t feel like we can change the environment. Thankfully, there are many ways to drive positive change around environments. The challenge is uncovering these factors and coming up with solutions that address the root of the problem, not just the individual factors.
Here are few things to keep in mind:
• Talk to real people in the target population you’re trying to reach. Instead of guessing or making assumptions, ask them what they want or need. When doing market research, make sure you’ve recruited a diverse group of patients, which may mean going beyond digital methods to ensure that patients with different means and technology access can participate. Or conduct social listening to see unfiltered conversations and uncover patients’ true experiences. This will help identify environmental factors that may be a barrier, leading to better discussions about possible solutions.
• Engage them using evidence-based approaches. Approaches like community-based participatory research prioritize the involvement of community members and local organizations to identify needs and produce solutions. Forge trust with the community and empower them to implement new changes, and then help sustain them over the long term. This has the added benefit of building and reinforcing support structures within the community.
• Focus on real, practical, and modifiable barriers. Lack of available transportation is a critical barrier, and its impact has been studied in numerous disease states. Yet so often, suggestions center on asking a friend for a ride or trying to plan for transportation needs. These well-intentioned suggestions may not address the core, underlying issues that someone is facing, and therefore will not resolve the transportation barrier. Helping patients go through the steps of problem solving can provide more personalized and useful guidance to help them address their transportation needs – approaches like this help address underlying needs without offering up a generic solution.
Often, patients are told what to do to manage their health without any appreciation for the environmental factors that may be getting in their way. Brands that demonstrate authentic consideration for their circumstances and provide realistic resources will achieve unique loyalty with patients. Changing behavior starts with understanding the human dynamics that drive it.
The next time you’re trying to understand why patients are experiencing challenges with adherence, or you’re developing a patient journey to identify specific barriers that may occur along the way, make sure to prioritize environmental influences. To fully understand a person, you have to see more than just their individual factors. You need to see where they live, what they have access to, and what they’ve grown up with to understand what impacts their health today. It’s only when you do that that you can begin to move the patient.
