One of the most fascinating parts of my job is observing patient focus groups. They’re always interesting, sometimes riveting. Whether the topic is breast or prostate cancer, diabetes medications, chronic pain, or smoking cessation, we often ask the participants:
Would you be interested to join any kind of in-person on online support group or community?
9 out of 10 (sometimes 10/10) give an emphatic: No! …sometimes accompanied by eye rolls.
But an interesting thing happens as the focus groups wrap up. People don’t leave. They stay and keep talking: recommending clinicians, trading contact info and recipes… until they basically have to be kicked out of the room. You can see their energy levels escalate and the conversations become more animated.
Thinking about engaging patients in motivation and behavior change, this last point is interesting. When we talk about helping people change behavior or start a new one, we're always trying to figure out how to close or move people across the intention-action gap. And that requires an injection of energy.
Stuck in an Energy Canyon
To steal a concept from evolutionary biochemistry (thank you RadioLab), we’re often stuck in an energy canyon. We need energy, usually more than we have, to move up and out of it to start a new behavior.
Just think how much energy and effort we already expend to get through the day -- and it takes more energy to cope with a chronic condition or a new diagnosis. If anything, these rob us of the very energy we need to move from intention to action.
How can we create the energy people need to start or maintain an action?
In the work we do to engage patients outside of the clinical encounter, we’re always looking for ways to give people energy or mitigate anything that saps it. So helping people understand why they need to do something can provide insight and motivation, and action planning (goal setting) to help people choose a small goal and build on small successes can create a cycle of energy and confidence.
The power of peer groups
As evidenced by the focus group participants, we can also get energy from peers. As a senior researcher notes in The Power of Habit, "There's something really powerful about groups and shared experiences. People might be skeptical about their ability to change if they're by themselves, but a group will convince them to suspend disbelief." So how can we better leverage the energy generated from in-person groups? Clearly, calling something a “support group” is a red flag.
One way to do this is shared medical appointments (SMA’s). SMA’s can be set up different ways but it’s usually a team approach with a physician, a scribe, a nurse or med assistant, and a facilitator. One goal of SMA’s is to provide people with the support, empathy and advocacy of others.
Many people are initially hesitant but, like our focus group participants, most quickly find they love talking with others coping with similar challenges, learning from each other, and they don't feel so alone. SMA's have even been expanded to cooking classes for heart failure or diabetes.
Interestingly, observational studies of peer support suggest that individuals who act as mentors to provide support to other patients reap health benefits that are as good as or even better than those who receive their support.1,2 In fact, the peers who provide social support often report less depression, better self-efficacy, and their own health behaviors improve.3,4
So if patients are stuck in energy canyons, connecting with peers may be one of the best ways to give each other the energy boost needed to spark action.
More on Shared Medical Appointments
How to conduct SMA’s
The World of SMA’s
1. Heisler, M. Overview of Peer Support Models to Improve Diabetes Self-Management and Clinical Outcomes. Diabetes Spectrum Oct: 20(4): 414-221
2. Brown SL, Nesse RM, Vinokur AD, Smith DM: Providing social support may be more beneficial than receiving it: results from a prospective study of mortality. Psychol Sci 14:320 –327, 2003
3. Schwartz CE, Sendor M: Helping others helps oneself: response shift effects in peer support. Soc Sci Med 48:1563 –1575, 1999
4. Van Willigen M: Differential benefits of volunteering across the life course. J Gerontol B Psychol Sci Soc Sci 55:S308 –S318, 2000