Like most students who earn a degree in public health, I didn’t envision myself working for an advertising agency. In my five years working as an epidemiologist, I racked up a collection of meaningful and fulfilling experiences. I was a health educator in Nepal. I traveled to rural mining communities throughout Arizona to answer questions about environmental exposure to lead and arsenic. I conducted rabies exposure assessments and once arranged for transportation of rabid mountain lion from the Grand Canyon to the state public health lab (it was less awesome, and sadder, than I’d anticipated). But the 2008 financial crisis created an environment in which already anemic funding for public health programs bled even drier. Then the 2013 sequestration limited federal funding for these programs further still. Constantly writing grants to save my domestic funding was incredibly stressful, and I didn’t have the temperamental flexibility or professional expertise to navigate the complexities of working in a developing country.
While funding for traditional public health programs has taken a hit, there’s a growing interest in improving public health through for-profit, private sector avenues. Health marketers are working with their clients to foster long-term behavior changes that not only support brand objectives, but also improve large-scale patient outcomes. In order to foster these behavior changes, health marketers are relying on some of the principles and best practices from different industries, such the models of behavioral change used in public health.
Insurance providers are using these models to slow the spread of preventable chronic diseases, rather than simply covering health expenses once individuals become sick. They recognize that shareholders’ financial interests are best served in prevention, and they know that by the year 2020, estimates are that more than 157 million people will receive a diagnosis of one or more chronic diseases. They’re taking a more active role in prevention and helping patients manage these conditions through the use of online and telehealth coaches, incentivizing healthier food options by partnering with grocery stores, and expanding services such as meetings with nutritionists and sessions with personal trainers.
Similarly, healthcare payers are increasingly unwilling to reimburse for services that don’t demonstrably improve health outcomes. They’re quantifying readmission rates for healthcare networks and physicians as the cost of nonadherence to prescribed medications takes a greater toll on individuals, families, and society. Some 20% to 30% of prescriptions are never filled; approximately 50% of prescriptions for chronic disease aren’t taken as prescribed; and lack of adherence is estimated to lead to least 10% of hospitalizations and approximately 125,000 deaths annually.
In financial terms, lack of adherence costs the US healthcare system $100 to $289 billion a year. Payers are addressing nonadherence through greater investments in health literacy and patient education to support patients in maintaining adherence to treatment plans.
Tracking readmission trends, investing in health literacy, and providing sessions with health coaches are phenomenal steps in the right direction, but they need to be guided by an understanding of human behavior as it relates to personal health decisions. Health marketers like me are helping our clients identify models of behavior change that address both brand and client needs. For example, the most widely used model to address chronic disease is the Stages of Change/Transtheoretical Model. It identifies the thought process behind how individuals integrate new behaviors, goals, and programs at various stages of their patient journey. These stages include:
- Precontemplation: There is no intention of taking action
- Contemplation: There are intentions to take action and a plan to do so in the near future
- Preparation: There is intention to take action and some steps have been taken
- Action: Behavior has been changed for a short period of time
- Maintenance: Behavior has been changed and continues to be maintained for the long term
- Termination: There is no desire to return to prior negative behaviors
Viewing the patient journey through the lens of the Stages of Change model helps health marketers identify meaningful strategies to help consumers progress to the next stage.
A behavioral change model focusing on motivation, such as the Health Belief Model (HBM), can be a meaningful way to combat nonadherence. The HBM is based on the theory that people take health-related actions (eg, taking medication) if they:
- Feel that a negative health condition (eg, hospitalization) can be avoided
- Have a positive expectation that by taking a recommended action they will avoid a negative health condition (eg, taking their medicine will prevent hospitalization)
- Believe that they can successfully take a recommended health action (eg, they can take their medication correctly and with confidence)
Patient engagement strategies based on the HBM help marketers empower patient to actively manage their treatment plans, rather than simply reading information from a brochure.
While there isn’t a single, unifying theory of behavior change, there are a number of models that health marketers can use to meaningfully engage with consumers and achieve their clients’ objectives. This engagement will only increase as patients adopt new technologies like health apps, electronic scheduling options, physician reviews, and wearables to allow for more nuanced communication between themselves, physicians, pharmaceutical companies, insurers, and healthcare networks. It’s exciting to imagine where all this change will lead and encouraging to see that it’s likely to improve public health outcomes along the way.
Jessie Toporek is a behavioral health strategist in Fingerpaint’s Scottsdale office. She’s worked for a nonprofit in Nepal, federal agencies in the United States, a small start-up in Australia, and multinational healthceutical and medical device companies. She is the reigning Ugly Sweater Contest winner for Fingerpaint’s 2016 holiday party, and doesn’t shy away from reminding coworkers that she believes this to be a significant personal and professional victory.
At Fingerpaint, we use a consumer-driven approach for health products and services. We build from consumer insights and use behavioral methods to empower people to take action for better health outcomes, combining inspiration with education to activate change.