Diabetes Alert Day was March 26, and our team was busy working with the Centers for Disease Control and Prevention (CDC), health systems, health plans and community-based organizations to get the word out to consumers that diabetes is preventable and what they can do to take action. As part of this effort, CDC launched a new tag line: “What’s your Why?” This got me thinking, “What is my why and how do people find their why?”
One of our partners that delivers the National Diabetes Prevention Program to underserved communities in New Mexico incorporates vision boards in their lifestyle change programs to help participants think about their “why” and what motivates them to stay active and make nutrition a priority. I recently did this exercise for myself and discovered my “why” comes from four places: Staying healthy for my children, managing stress, walking my talk and staving off the back pain that plagues me if I don’t stay fit.
There are a number of things that are important to helping people become engaged in their health and activated to make changes:
- Provider engagement in helping patients find their path to support behavior change is vital. In my own experience, it was my PCP that suggested I start Pilates after my back pain became worse post-pregnancy. What did I do? I went out and signed up for a class. That was 10 years ago, and I’ve never looked back. I credit that provider and her advice with fundamentally changing the trajectory of my life. As I experienced myself, research suggests that patients are more likely to enroll in a lifestyle program when suggested by their provider.
- Patient activation and self-efficacy (one’s belief in their ability to succeed in specific situations) play an important role in readiness to change behavior and sustaining this behavior change. The Patient Activation Measure is a tool available to clinicians for assessing activation. Most evidence-based lifestyle change and self-management programs rely on tactics proven to increase self-efficacy and patient activation, including increasing health-related knowledge, facilitating goal setting, and providing skills training for problem solving and relapse prevention.
- Finally, without community support, it can be difficult for people to fully effect change in their lives. The Health Impact Pyramid illustrates the broader community context we need to consider when striving to help people stay healthy.
What’s motivated you to make a significant change in your life? What have been strong motivators for your patients? Please share your thoughts in the comments!
Comagine Health works with community partners to increase access to self-management and lifestyle change programs like the National Diabetes Prevention Program. Learn more about our work with the National DPP.
what's your why
Ashley, I love this. As healthcare moves forward it is obvious there has to be a shift in thinking. There is the traditional method of a provider telling a patient what to do, but we know this is not always the most effective. The patient has to buy in to their health care plan. They are the managers of it, they are the ones that have to effect change with the actual lifestyle changes or medication compliance. I like how you addressed that you have to look at their environment and resources and make individualized plans to help patients further their health and make them the owners of the changes.
Reply on Why
I agree, Ashley. I think that the only way to move healthcare over in to the patient-centered realm is to familiarize ourselves as practitioners with asking about the patient's "why". Or maybe even asking more basic questions such as: what do you value in your life and as your healthcare provider, how can I help you achieve this? As a general rule, providers usually assume that prolonged amount of time in life is what every patient values, but this is not always the case. Some patients value quality of life over quantity and some value continuing in their unhealthy lifestyle instead of following through with treatment plans. As we come to align ourselves with patient wishes I believe that we can set more realistic goals and increase compliance with treatment plans.
I love this new tagline put out by the CDC. Ultimately, this is the shift in thinking needed to provide patient-centered care. Patient-centered care is simply defined by the Institute of Healthcare Improvement as a relationship between patient and provider in which they work together to achieve health goals most important to the patient. It’s putting the patient with his/her goals and values, or the why, at the center of his/her healthcare (Institute for Healthcare Improvement, 2019). While there are numerous barriers to creating this relationship and providing such personalized care, as stated, sustainable life changes to improve health are near impossible to make without patient engagement. That engagement often comes through providers guiding patients through defining their values and motivations for health, discussing ways to meet those goals, and proving treatment options. This can all occur at a clinic; however, the patient needs to be in a situation that supports the changes he/she is trying to make on a daily basis, which is where the patient’s social support comes into play. Social determinants of health need to be addressed to ensure these goals are achievable. Health begins where people live, work, and play, not in a 15 - minute clinic appointment. All of this comes back to figuring out the patient’s why and moving forward from there. It will require the effort of many, time, resources, policy changes, and system and process improvements to provide this type of quality care for all patients. As a future Family Nurse Practitioner, I’m realizing my greatest responsibilities will be taking an active role to help create the needed changes and increasing quality of life with my patients based on their why.