Niha Zubair, Arivale Clinical Research Scientist, PhD
[Arivale Hot Topics address health stories currently in the news. The Arivale Clinical Team’s commentary on these news articles is not a review of the scientific evidence, nor an endorsement of a specific study, and is not meant as official medical opinion.]
Many employers offer wellness programs to employees that are increasingly tied to incentives or punitive strategies. For example, an employer will reduce employee insurance premiums if they participate in a wellness program or charge a higher rate if they don’t.
But despite those strategies – as well as the presence in most employer wellness programs of tracking through data or behavior and coaching from individuals with on-the-job training related to diet, activity, and stress management – research suggests poor engagement and poor outcomes are often seen with these generic wellness programs.
Now, research from the University of Pennsylvania published last month in the Journal of the American Medical Association provides some reasons for the under-performance of many employer wellness programs: They are too generalized and don’t take into account individual needs or differences in how people respond to data.
Take, for example, self-monitoring, or tracking. The idea is that self-monitoring keeps you focused on your health and motivates you to take action if the numbers are going in the wrong direction.
However, researchers point out that some people aren’t going to be motivated by seeing their numbers – in fact, they may be so discouraged they lose motivation to improve their health completely, default to blaming forces outside their control, or simply avoid the tracking.
The problem is exacerbated when the “feedback” on monitoring is automated – such as from a mobile app – rather than put in context by a skilled health coach. Imagine how discouraging it can be to get the same feedback week after week: “You didn’t lose any weight this week – keep trying!”
Researchers point out that one recent study of self-monitoring of glucose in people with diabetes showed the worst outcomes in people who got the highest intensity of automated feedback from an app. Basically, from a psychological perspective, neither failure nor simple education about what you “should” be doing is likely to drive long-term behavior change.
But, the study points out there are strategies that are more likely to lead to success.
First, it’s important to understand key psychological differences between people. Which individuals are more likely to be discouraged by the inevitable relapses and setbacks during behavior change and require more support and strategies to boost resilience?
Secondly, they recommend using psychological strategies that help people learn from failure rather than be disheartened by it. Approaches such as reframing thoughts or building emotional resilience through strategies that address the brain’s “negativity bias” can be effective.
We completely agree that behavioral approaches to wellness cannot be “one size fits all.” As noted in the study, just like we now use precision medicine in cancer treatment to target specific tumor markers, we need to apply a precision approach to behavior change that targets an individual’s preferences, environment, overall resilience, and likely response to setbacks.
Providing personalized support for behavior change also takes highly skilled coaches who are trained to a degree unlikely to be achieved simply by on-the-job training in basic health behaviors or formulaic behavior strategies.
At Arivale, we hire coaches who already have deep subject-matter expertise in nutrition, exercise physiology, and behavioral counseling then provide additional training to bring their skills to an even higher level. We also focus on positive psychology strategies that build resilience and empowerment rather than tearing it down. This allows for very personalized interactions that not only drive success in terms of “numbers” but build self-esteem and self-efficacy and minimize the degree of stress that is often associated with behavior change.
There are definitely some people who have a “just do it” mentality and don’t need much coaching. Getting insight into their data and then engaging in simple monitoring may be fine for these folks. But, they are also the ones who are likely to be healthier to begin with.
Behavioral economics shows clearly, however, that most of us don’t behave rationally. Simply knowing that our blood pressure is too high or that smoking is bad for our health isn’t always enough to change behavior. This is where a systems approach to behavior change and personalized coaching becomes essential to driving outcomes.