Electronic Health Reporter

By Elise Mortensen, head of growth, HTD Health.

We often think of healthcare as the direct communication between provider and patient in an appointment or clinical setting. However, most of what influences health outcomes sits outside of the doctor’s office: This includes individual health behaviors as well as social determinants of health such as social support systems, access to health education and timely care, physical environment, and financial resources.

As we think about building patient engagement, especially related to preventive care and long-term management of chronic conditions, it’s important to think beyond just the quality of clinical care being delivered. Generally speaking, “engaged” patients are those who feel empowered and actively involved in managing their own health. The specifics of what this looks like may differ by population or condition area, but patient engagement is driven by a few key themes:

– Patient activation: Do patients feel motivated to make choices that will positively impact their long-term health?
– Patient education: Do patients have the information they need to understand how their choices and behaviors impact health outcomes?
– Care navigation: Do patients understand how to navigate the complex healthcare system in order to find and access the care they need?
– Patient support: Do patients have social support systems to help them adopt and maintain positive health behaviors?

In an increasingly technology-driven world, engagement can be improved through strategic and human-centered design of experiences and platforms that help patients manage their health. The following sections outline user experience best practices that can be leveraged to improve patient engagement and influence care quality as a whole.

Patient Activation
Much of the literature around patient motivation and behavior change is built upon theories of behavioral psychology. In her book Engaged: Designing for Behavior Change, Dr. Amy Bucher highlights the different types of motivation that can influence human behavior. These range from controlled (extrinsically imposed “you should…”) to autonomous (intrinsically driven by personal motivations). Understanding patient motivation is key to human-centered experience design.

To proactively change health behaviors, patients must have both intrinsic motivation, or a personal reason for wanting to improve their health, as well as self efficacy, or a belief that they have the agency and ability to meet their goal.

One powerful technique in care delivery is goal setting. Invite patients to reflect on their health goals and what motivates them to achieve those goals. For instance, a patient suffering from chronic joint pain may want to feel pain relief, but likely the true motivation is something more deeply connected to their personal priorities like being able to comfortably ride a bike with their grandchild or join friends in a regular physical activity. Goals that are tied to personal motivation are much more powerful than those imposed externally like a doctor telling them they need to do something.

With goals set, there are many user experience design techniques that can help patients stay motivated over time:

• Break a large goal down into small, achievable pieces. This means zooming in to how daily actions such as diet change, medication adherence, activity level, meditation, etc. together make progress toward the overarching goal.
• Set up a cadence of reminders or check-ins for patients to help them keep track of these small behaviors. It’s important to be mindful of how different users engage with technology and allow patients to choose how they receive reminders (push notifications, emails, text messages, etc).
• Build in positive reinforcement and moments of delight. Though health management is not often seen as a positive activity for patients, there are small elements that can be built into virtual care such as gamification, positive messaging congratulating small wins, and even graphics or animations to build a positive association with small health behavior changes.
• Visualize progress over time to help a patient see the impact their decisions have made. Using data visualization to show important steps of achievement can be incredibly motivating and can help a healthcare team be more responsive to specific patient needs or challenges.
• Give patients an opportunity to reflect on their progress and how they are feeling. Doing so proactively can help reduce anxiety and recency bias when meeting with a healthcare provider in a clinical setting.

Patient Education
Patients have different levels of health literacy and access to reliable health information. Any virtual or in-person care journey should equip patients with educational materials that can help them understand their condition or overall health plus how individual behaviors and factors within their control impact health outcomes.

Be mindful of different learning styles and other factors such as reading level or preferred language to ensure that all patients are able to understand educational content. It is helpful to offer information in different formats:

? Visual graphics or diagrams explaining complex ideas
? Explainer or demonstration videos for breaking down scientific fundamentals or guiding patients in how to complete certain health-related activities (e.g. home exercises or taking blood pressure readings)
? Short written descriptions or articles with clearly defined medical terms and no jargon available at appropriate reading levels and translated into languages spoken by the patient population
? Audio education or patient stories that can be consumed while completing other activities

As patients are tracking their progress toward goals, content can also be tailored or personalized to share helpful tips in response to specific patient reflections or milestones.

Care Navigation
Even for those working in the healthcare industry, it can be difficult to understand the complexity of the system and how to navigate care pathways for different conditions. Building care navigation into virtual care solutions can help patients make sense of the opaque details of insurance, appointment scheduling, billing, etc.

Think about the entire patient journey: How can a care team member or application feature simplify the steps a patient needs to take? Some user experience techniques may include:

? Dedicated care team members who help patients find and schedule appointments with in-network providers
? A clear written care plan from a provider including step-by-step instructions of what to expect at each stage or visit
? A simple map or list of to-dos for patients in one place where they can keep track of logistics, upcoming appointments, and tasks that need to be completed

Patient Support
Maintaining contact with the care team is another great way to improve patient engagement over time. Increasingly, virtual care organizations are hiring dedicated care coaches or non-clinical team members responsible for checking in on progress and applying an empathetic approach to guide patients toward resources or work through blockers.

Health behavior change is also dramatically improved by social support systems including family, friend groups, or networks of patients navigating similar conditions or life stages. While some of these features can be complex to build into virtual care solutions, there are small features that can help patients stay accountable for their goal progress and get positive reinforcement from others in their life:

? Inviting a family member or friend to “follow their journey” may help a patient feel less alone and may also lead those around them to more proactively support target health behaviors such as choosing healthier foods when eating together or inviting the patient to take a walk or hike instead of meeting at a bar.
? Support groups or networks of patients on a similar health journey (with appropriate privacy considerations) can create a space for sharing advice or tips, giving positive feedback on specific achievements, and generally providing a sense of community.

Looking forward
Keeping in mind the many factors that influence health is key to designing a healthcare experience that engages patients beyond just an appointment with their provider. The most successful virtually-enabled provider organizations are finding ways to connect with patients and guide them through complex care. If you’re trying to figure out where to start, look to user experience (UX) research: Meet with patients to understand where they feel supported and where their current healthcare experiences fall short.