Using Technology to Bridge the Gap Between Intention and Behavior

People with high blood pressure need to take medication every day, but many don’t. Those who need to lose weight should exercise; yet, taking that 20-minute walk that studies show makes a difference proves daunting.

It’s not that people who skip medication or sit on the couch don’t know they are harming their health. Quite often, they do—and many want to change. S3 Connected Health, a 16-year-old company based in Dublin, Ireland, is using technology and behavioral science to reach these patients. The company is now making inroads in the United States with programs to close what it calls the “intention-action gap,” with applications in diabetes care, multiple sclerosis, and other conditions.

As value-based contracting takes hold, pharmaceutical companies want to know more, because expensive regimens only work if patients take their medication.

The American Journal of Managed Care® spoke with S3 Connected Health’s Sean Gill, senior behavioral scientist, and William Lyons, marketing manager, about a recently published white paper that Gill co-authored with John Maughan, head of product. Leveraging Predictably Irrational Patient Behavior When Designing Patient Support Initiatives argues that the unhealthy actions people take (or the healthy actions they don’t take), are easily explained. S3 Connected Health has also published a paper that argues the traditional approach of time-based reminders becomes less effective over time, a finding that has been borne out by other research.

Thus, “predictably irrational” behavior must be factored into the design of any digital intervention to support patient care or medication adherence. Gill and Maughan say both “headwinds,” the barriers to healthy behavior, and “tailwinds,” those things that can drive desired behavior, must be leveraged into any health program.

“Change is very hard,” Gill said. Telling a patient with diabetes, for example, to “stop drinking too much Coke,” will probably not work, but it might help to suggest sparkling water. Bringing about behavioral change can’t just being about telling people to not do things, Gill said.

“We have to do other things that bring happiness to their lives,” he said. Better health “is a byproduct of that other behavior.”

Similarly, medication adherence must be a byproduct of other behavior that rewards remembering taking therapy.

S3 Connected Health has created Affinial, its patient engagement and support program, and Lyons said S3 Connected Health can adapt its products for a variety of clients, from health systems to the pharmaceutical industry. Solutions can be very specific to the needs of the pharmaceutical client, especially when helping manage patients with chronic conditions:

Multiple Sclerosis. S3 Connected Health worked with Merck to develop MSDialog, a digital support program that tracked medication adherence in multiple sclerosis patients with a connected injection device. The system also allowed physicians and patients to talk to each other. It has mobile and web capacity and is used in 39 countries and 40 languages.

Diabetes. The public health agency in Northern Ireland worked with S3 Connected health on a diabetes telemonitoring program, which created a decision chain that escalated cases through nurse managers if a patient’s self-monitored blood glucose measures fell outside preset parameters. The system was accepted by 95% of the users, and led to average glycated hemoglobin reductions of 0.9% among men and 2.4% among women.

S3 Connected Health has 4 steps in its process:

• Identify Key Behaviors. Gill calls this the discovery phase, where researchers isolate highly specific actions that patients should take, including a schedule.
• Understanding Barriers and Drivers. In the core design phase, researchers figure out what things might prevent healthy behavior, and what might promote it.
• Find Incentives. Behavioral scientists should be involved in identifying rewards that would help patients overcome barriers to healthy behavior.
• Test Interventions. Comparing the health outcomes of the intervention and control groups shows if the solutions work or if more work is needed.

Gill said, for example S3 Connected Health has worked with health systems on different ways to identify barriers to healthy behavior by having patients will complete online questionnaires or checklists before they arrive at medical appointment. This is less intimidating and promotes more honest responses, and gives doctors more insight into roadblocks to better health.

“The average time for an appointment is somewhere between 10 to 12 minutes,” he said. “No wonder patients don’t raise issues.”

The company has also worked on ways to address information overload, which happens when patients cannot process too much information at once, especially if it’s bad news. Gill said this “ostrich effect” causes patients to ignore information completely. Many companies in diabetes care, as well as diabetes prevention, are built on the idea of encourage small changes over time.

With offices in Poland and one in Boston, Massachusetts, that will be growing over the next year, S3 Connected Health is looking to expand its presence in the United States. Asked how access to health insurance affects medication adherence in the United States, Gill said it’s a huge issue.

He said lack of adherence can be “unintentional” or “intentional.” The first can occur if patients forget to take medication or don’t take it correctly; the second can occur if a parent purposely does not take medication so that he or she can afford other things for the household.

“Both are big issues,” Gill said.