Engaging Consumers in Health and Wellness

Earlier this week, I had the privilege of presenting at the North Carolina Association for Healthcare Quality (NCAHQ) Annual Conference in Durham. I have been a member of NCAHQ since 2004 and I served on the Board of Directors from 2011-2018. It was fun to attend the conference as a member as well as one of the invited speakers.

As many of you know, my education and training are rooted in health education. However, I spent most of my career working in healthcare quality improvement before returning to my health and wellness roots about five years ago when I became a health coach.  I have sometimes struggled to figure out how to meld the two worlds I’ve lived in professionally for the past 20 years, but I think I managed to do so with my presentation topic: Innovative Ways to Engage Consumers in Their Health and Wellness. I thought I would share some of the highlights from my presentation.

Health 2.0: Consumer-Driven Health Market

My presentation began by making the business case for the rise in consumerism in healthcare. As just about everyone knows, the US spends more money on healthcare (as a percentage of the gross domestic product or GDP) than most developed nations YET we have some of the worst health outcomes, including life expectancy. In addition, about 80% of the spending in healthcare is tied to the treatment of chronic conditions that are rooted in lifestyle choices. You know the list: heart disease, stroke, Type 2 diabetes and of course, obesity. These conditions are the most common and costly – but also the most preventable – of all health conditions.

With the rise of high deductible healthcare plans, which many employers are now turning to as a way to help reduce healthcare costs, consumers are now feeling the pinch in their own pockets. A physician office visit that may have incurred just a $25 copay in the past may now cost upwards of $100. This shift in the health insurance industry has been a wake-up call for many consumers to take a more active role in managing their overall health and wellbeing. We are also seeing the rise of “lifestyle medicine” – the use of evidence-based lifestyle approaches (e.g., a healthy diet, regular physical activity, adequate sleep, etc.) to prevent, treat and in some cases reverse the progression of the chronic conditions noted above. Healthcare is shifting (albeit much slower than many of us would like) from a sick-care model to one with a greater emphasis on promoting health and wellness through preventive services – with individuals taking a more proactive role in their health and wellness decisions.

Consumer Engagement Strategies

I prefaced my presentation by noting that my own passion for health and wellness grew out of my experience being overweight in my youth. It wasn’t until a good friend encouraged me to play sports in high school that I lost weight, gained confidence and realized that my behavior choices could directly impact my health – positively or negatively. This epiphany turned into a desire to help others on their own health and wellness journey. However, I also shared one of the first (and hardest) lessons I learned from my early days as a health educator – that not everyone is intrinsically motivated to make healthy choices or take care of themselves. Sometimes it takes a little extra incentive to get them engaged in the behaviors we know are linked to better health outcomes. I chose to share some of the more innovative strategies being used to help engage consumers in healthy lifestyle behaviors:

  1. Wearable Technology: A blanket term for electronics that can be worn on the body either as an accessory or as part of the material used in clothing. The most common format is the ubiquitous fitness tracker, such as a Fitbit or Apple Watch. However, there are some new products on the market including the Spree Smartcap and the Hexoskin Smart Shirt. The major selling feature of all of these items is the ability to connect to the internet, enabling the exchange of data between the device/product and a network. This has resulted in the user having access to a whole range of information about their health, such as steps taken, calories burned, heart rate, and sleep, at the touch of a button.

 

  1. Gamification: Essentially, the application of gaming elements and digital game design techniques to everyday problems including business dilemmas, social challenges or lifestyle behaviors. The idea is that gamified services tap into our natural desires for competition, achievement and status – and of course, the desire to have fun! One of the more common formats is smartphone apps and I chose to highlight a few including Plant Nanny (to help increase water intake), mySugr (to help diabetics manage blood sugar levels), and Stop, Breathe and Think (to support one’s meditation practice). All of these apps strike a balance between information and entertainment, but most importantly, are designed to help the user achieve sustainable change around the desired health behavior.

 

  1. Wellness Incentive Programs: Many employers and health insurance companies have been offering wellness programs for a long time so the idea itself may not be that innovative, but what has evolved are the types of incentives offered to individuals. In the past, employees or customers were often rewarded with small, health and wellness-related products such as water bottles, sweat towels or exercise bands. Then, many programs shifted to rewarding participants with gift cards to their favorite retailers. Today, we are seeing the rise of benefits-based incentives, where achieving a certain level of points for engaging in wellness activities or programs translates into a reduction in health insurance premiums and/or an employer contribution to Health Savings Accounts (HSA). Although these benefits-based incentives are considerably more expensive to implement, studies indicate that they do increase employee engagement in wellness programs.

Helping Individuals Find Their “Why”

I was the final speaker at the two-day conference and in years past, the final presentation has traditionally served as a way to end the conference on a positive note and provide attendees with some inspiration as they return to the workplace. Knowing how hard healthcare quality and safety professionals work every day, I wanted to give them a chance to focus on their own health and wellbeing. Thus, I dedicated the last 15 minutes or so of my presentation to lead attendees through the vision and values exercise I use with my coaching clients. Although we did not have time to take a deep dive into this exercise, I wanted to at least get them started thinking about their own vision of optimal health and wellbeing. Oftentimes, healthcare professionals tend to neglect their own health as they are so focused on taking care of others. This was a gentle reminder of the need to take care of themselves first so that they can continue to take care of others.


If you work in healthcare in North Carolina and are not already a member of NCAHQ, I encourage you to visit their website to learn more about the association and the work of its members to promote excellence, professionalism and continuous improvement in healthcare quality across the state.

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Keeping Your Eye on the Prize

For most of my adult life, walking has been my “go to” exercise – whether it be walking with family and friends outside or taking advantage of my treadmill and/or various walk at home DVDs when the weather isn’t conducive to exercising outdoors. Like many walking enthusiasts, I jumped on the pedometer bandwagon in the early 2000s. After all, I needed to know if I was achieving the recommended 10,000 steps a day to help maintain good health. As an added incentive, the company I worked for offered a walking challenge as part of the employee wellness program and I could earn prizes based on my steps.

I recall becoming frustrated with the pedometer over time. I had the simple kind that just hooked on to your pants, but this posed a problem if I wore a dress or some other outfit without a place to attach the pedometer. Even if I wore pants, the pedometer often slipped off. And there was always the question of what to do with it when needing to use the rest room so as not to lose said pedometer down the toilet. Eventually, I gave up and stopped wearing one altogether.

Wearable fitness trackers: friend or foe?

Fast forward about a decade to the introduction of wearable fitness trackers. I recall a friend owning one of the earliest products, which was technically still a clip-on device, but it did more than just measure steps. These new products could also track and monitor calories burned, sleep activity, and floors climbed. I’ve never really been an early adopter when it comes to technology, so I took a wait and see approach. As the technology and design improved, I finally jumped in a few years ago and purchased one of the more popular band-style fitness trackers. (Note: I am not going to name which brand I use as I am not endorsing or criticizing any particular device or company.)

At first, I was enamored by the wealth of data this device could supply. The accompanying app was user-friendly and the dashboard was customizable, so I could set it up to include as much or as little information as I wanted. My primary interest was in steps taken, minutes of exercise, calories burned and sleep. I have to admit it was fun at first, monitoring my progress and hoping to see green icons at the end of the day, meaning I had met my goals. I invited friends to participate in step challenges, so that we could hold each other accountable with a little friendly competition.

Wearing the device has definitely made me more aware of my level of activity and it has helped me achieve some health goals. But recently, I have started to question whether the fitness tracker is as beneficial as I first believed it to be. For example, I aim to get 10,000 steps per day. On average, my normal daily activity typically adds up to about 5,000 steps and then with at least 30 minutes of exercise, I can usually make it to my goal. However, I sometimes find myself “gaming the system,” if you will. I use the feature that reminds me to get up and move each hour if I have been inactive…except more and more lately, I find myself ignoring the notification and staying put in my seat. Then, later in the day when I realize I am behind on steps, I may find myself pacing the halls to get to 10,000 steps before bed. This is not helping me sit less during the day, and it often drives my husband crazy when I pace the bedroom trying to get in those last 500 steps or so.

The other feature that I have started to second guess is the sleep tracker. At first, I was excited to have this information at hand to get a better sense of the quality and quantity of my sleep. I typically aim to get about seven and a half hours of sleep per night during the week and maybe a little more on weekends. I have never really had a problem with sleep. I usually fall asleep quickly and often wake up before my alarm even goes off. I am an early riser as I meditate and exercise in the morning before going to work. Because of my schedule, it’s important for me to get to bed at a decent hour. So, I aim to have lights out no later than 10pm and wake up around 5:15am, giving me between seven and seven and a half hours of sleep.

When I started looking at the sleep data, I was surprised to find that I was often getting less than that according to the tracker. Most days I was lucky to be getting six to six and half hours per night, and sometimes it was even less. In looking at the breakdown of sleep stages, it indicated that I was often awake for an hour or more overnight. I realized over time that seeing these numbers was actually stressing me out about not getting enough sleep…when in reality, nothing had changed about my sleep patterns. For the most part, I was not waking up for significant amounts of time during the night and I usually felt refreshed and alert when I woke up. It took me a while to come to the conclusion that having this sleep data was doing more harm than good, so I recently made the decision to stop wearing the device at night (it was never really comfortable to me anyway) and I removed the sleep data from my dashboard. It is the best decision I have made in a while.

A ha moment

I have been having mixed feelings about my fitness tracker for some time now, but the “a ha” moment happened last weekend when I was in the middle of Nia class. I glanced at the tracker to see how many steps I had and found myself disappointed that it was less than I expected. Then it hit me – I had totally lost sight of my true goal. The bottom line is I exercise to maintain good health so I can enjoy life. The most important thing is that I am active and that I enjoy the activities I engage in. Whether or not I get 10,000 steps a day is really irrelevant. I had taken my eyes off the prize: being active because it feels good and is good for me.

So, does this mean I am tossing out my fitness tracker? No, at least not yet. I do believe there are benefits to wearing it and monitoring the data, but I won’t allow the data to stress me out or dictate how I spend my time. I am also going to take breaks from it now and then so I don’t feel so tethered to this little device on my wrist. Unfortunately, it seems that fitness trackers have become one more piece of technology that we can become addicted to, so it’s good to unplug from them every now and then. Take it off, then go walk, run, swim or play…just for the fun of it.