Meaningful Engagement Through Behavior Change Design, by Amy Bucher
There is a problem with the phrase “patient engagement”. We’re trying to accomplish our goals – not the patients’ goals. If we’re trying to help people we need to consider who will really get hurt, and who is benefiting.
Behavior change design on the other hand, has engagement at its core. It makes us consider the person and the context of how they exist. Sometimes we’re changing environments. Sometimes we’re shifting mindsets to approach things differently.
One model of behavior change follows the COM-B model. It recognizes that people require:
to achieve their goals. Someone may know what they need to do, and be motivated, but not have the equipment nearby – meaning the opportunity isn’t there to take the behavior.
Another model is the Stages of Change, or the Transtheoretical Model. This considers where a person is in their journey to change:
People learn from relapse and move forward more appropriately. And this is person-centric, recognizing that there are steps between pre-contemplation and action. People need steps.
This model considers the various things that someone needs to become motivated. Motivation exists on a spectrum from controlled (or completely external) to autonomous (or fully intrinsic).
It understands that change may begin from controlled forms of motivation (e.g. someone telling you to do something, wanting to prove something to someone else, etc), and then move into more autonomous forms of motivation (doing things because they support your values and feel right).
Self determination theory tells us that people need to complete their basic psychological needs for autonomy, competence, and relatedness.
Help People Connect to Personally Meaningful Goals
Part of our job is helping people see their own successes. We want to align patient goals with our goals. We want people to find their personally meaningful goals.
There’s concern that if we let patients choose, they’ll choose the wrong thing. But people make decisions that are consistent with their informed values – that tells Amy, as a psychologist, that when people have a say in their treatment they will be better equipped to follow through.