When it comes to health behaviors and sustaining change, traditional incentives may not have the results you were hoping for.
Dr. Steve Feyrer-Melk
Director of Lifestyle Medicine at Optimal Heart Center | Chief Science Officer at Nudge
August 29, 2018
Have you ever attended a great conference and felt inspired and motivated by the awesome presenters you heard?
And have you ever felt a fervent desire to put all those awesome ideas into action when you got back home?
Well, I’m sure you won’t be surprised to hear that we rarely implement the wonderful things discovered at such events, and even if we do, we are seldom able to sustain them over a long period of time.
But don’t be alarmed or start doubting your personal dedication to your profession.
Instead, know that the inaction or absence of long-term adherence is not due to a lack of interest in making a change and that this response is actually a lesson of how action is dependent upon how we personally respond to motivation in our own real world.
Incentives And Patient Engagement
Considered the linchpin for positive outcomes, patient engagement is highly dependent on effectively connecting in a way that incorporates the personal, multi-dimensional characteristics of a particular individual.
Because engagement is so essential, many health programs and professionals have resorted to incentives as a way to motivate individuals to connect and take action.
Unfortunately, using traditional incentives in health programs has consistently shown to be a short-sighted strategy, proving to only offer short-term success (increased enrollment) and not the long-term, sustained engagement and adherence that we know are necessary to get results.
Even so, and with countless research projects on the subject, the current health care industry often intentionally or unintentionally, continues to implement a “one-size-fits-all” approach with broad strokes, generalized interactions and programs and treatments that continue to remain fundamentally the same for all.
It’s no wonder we see disappointing health outcomes.
What Motivates Patients To Engage?
So how do we address this issue?
An important guide in the application of the principles of motivation is found in the numerous studies on the subject that provide us with a foundation for engagement.
Even so, it is still up to health professionals to roll up our sleeves and realize that to best engage and effect positive health change, we must see health consumers as distinct individuals that require a targeted approach that includes the appropriate application of motivation methodology.
Therefore, a basic understanding of 3 key components of motivation will provide a solid base to build upon for better health outcomes.
An external condition or stimulus, usually in the form of a reward, which is meant to compel an individual to act in a desired way of behavior. External rewards include money, gifts, trophies, praise, etc. These types of “motivators” are called incentives.
An internal reason or stimulus for acting in a particular way. Action is based on internal reasons like pleasure, enjoyment, a desire for optimal health, etc.
(More on intrinsic vs. extrinsic motivation)
The personal, optimal set of conditions whereby a particular individual engages and sustains in a desired behavior.
From the 30,000 foot perspective, researchers find that individuals are motivated based on personal reasons. These reasons vary from individual to individual and can change over the passing of time.
This insight makes 2 things essential in the creation of effective health programs and protocols:
(1) That the professionals working directly with members assist in identifying these personal reasons and help strengthen the association with the recognized reason to the desired health-related behavior change, and
(2) That program creators and managers never implement incentives that lead to associations that could never lead to long term intrinsically-motivated adherence from a patient.
For example, if a person takes the first step in a health program to earn a financial incentive, then you've created an association that is hard to overcome. The patient internalizes the idea that, "I acted because of that money, so I will act again when more money is available."
Change is infinitely more sustainable when it starts for personal reasons.
Of course, this is easier said than done.
But if we acknowledge that an individual is personally motivated from a targeted method that fosters a connection within them, we must take the necessary steps to foster this connection. But how do we do that?
Well, without trying to shock anyone, I want you to understand the true dilemma surrounding the concept of motivating another individual. You see, we cannot motivate an individual to do anything they do not wish to do.
Think about it.
Even the offer of an extrinsic motivator, often said to be the motivation to act, cannot make an impact until it is effectively converted to an intrinsic motivator that propels a person to act.
It's Hard To Translate Extrinsic Into Intrinsic
For example, I may offer 10 people $100.00 each to join a class to train for 3 months and run a marathon.
Out of the 10:
4 say “no” right from the start
3 say “yes” but drop out after 1 week of training
2 say “yes” but drop out after 4 weeks of training
and 1 completes the training and runs the race.
So what happened? Why were the responses different?
Well, in the case of the 1 who completed the task, this individual found some type of inner desire to accomplish all of the difficult requirements for the event. Maybe they always wanted to do it but just needed a little nudge.
On the other hand, the 9 who did not participate failed to determine a personal intrinsic link strong enough to motivate them to meet the rigorous training required to compete in a marathon.
But what if I instead offered them $10,000.00? Would more do it? Possibly yes, possibly no. Again the result would depend on the individuals’ intrinsic motivation of why they should complete all of the difficult requirements for the event.
You see, no matter what the incentive, each of the ten must take the external stimulus (motivation) and internalize it to see if the pros outweigh the cons, and if an intrinsic reason why can be identified that is strong enough to sustain a change in behavior.
If this intrinsic transition does not meet the individuals’ threshold for change, no sustained action is possible.
Our Value To Patients
As health management teams our value lies in the ability to develop the appropriate motivational environment by which individuals become intrinsically motivated for positive health-related behavior change.
This is accomplished through the development of strong relationships that help us build individualized connections where we can target our approach.
These human relationships are the stickiest form of engagement.
In some cases, extrinsic motivators or incentives, can prove to be a way to open the door to intrinsic motivation. However, caution must be used as some may be repelled from certain extrinsic motivators, making it even more difficult to effectively engage.
The Bottom Line
For some individuals, extrinsic motivation in the form of incentives can “nudge” them into considering change or even taking steps to actual change, yet sustainability is impossible unless a deeper, intrinsic reason develops.
If your program has engagement problems, start with a quick demo of our platform and then I'd love to connect for an initial conversation about your needs.