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The Psychology of Adhering to a Treatment Plan: Why Patients Fail and How Providers Can Help

Regardless of how often you think about the science of habits, it permeates your daily life. As a medical professional, you’re more aware than most of how your choices affect your health and you talk through similar struggles every day with patients.

One of the most frustrating situations for any healthcare provider is watching an individual you’re trying to help fail to put your advice into action. After all, your job — whether you’re a nurse in charge of patient follow-up or a primary care provider — is to respond to the consequences.

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Understanding the psychology of why people struggle to implement new (read: healthy) habits can put your emotions into perspective. And it can also empower you to empower patients to change their lives.

Why Do Patients So Often Fail to Change Their Lifestyles?

“It’s easy for people to make the initial decision to change,” Wendy Wood, PhD, professor of psychology and business at University of Southern California, tells Florence Health. “For example, if you have high blood pressure and you’re not exercising enough or if you’re overweight and have heart problems, that can spur a change in behavior. Most people try to change their behavior pretty regularly.”

To decide to change your behavior, all it takes is being highly motivated and having strong intentions, Wood adds. The challenge arises, however, when you try to “persist” to the point that you’ve formed a habit.

“Intentions alone aren’t likely to get you to persist,” Wood explains. “People who are highly motivated but haven’t formed habits will exercise for a short amount of time, but like so many of us, they quit.”

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In addition, providers and patients alike tend to “focus more on what gets people to change rather than maintaining,” Wood says. As a result, patients don’t understand how to form a habit, and providers end up believing the patient doesn’t truly want a healthier lifestyle.

But, Wood adds, “If you know that change involves more than just motivation, then it becomes more understandable that people can’t follow through.”

How Do People Form New Habits?

Two of the key psychological components to forming a habit are automation and a dopamine release, according to Wood. Your memory associates a dopamine release with a particular action in a particular context, and your brain’s response is: What should I do now in order to get that same rush again? Then, you perform the behavior “in the same context repeatedly to get a reward.” Eventually, it becomes automated.

That said, Wood stresses that psychologists and researchers know much more about the mechanism of changing than they do of persisting — because, by definition, habits happen “outside conscience awareness … We don’t totally understand when people perform them and when they don’t,” she adds.

How Can Providers Help Patients Change Their Lifestyle?

Once you understand how the forming of new habits happens, you’ll be in a better position to empower your patients to do so, Wood believes. You can test your own knowledge of habits at Wood’s website and expand it by reading her book, Good Habits, Bad Habits, which comes out Oct. 1.

Wood also recommends the following tips to help lifestyle changes stick:

Plan out a reward. “You’re not going to form habits for something that you hate,” Wood explains. Tell patients to make the action enjoyable by giving themselves a reward either during or immediately after the behavior. Explain that if they delay the reward too long, their brain won’t form as strong a connection between the action and the dopamine release.

Stack a new behavior on to an existing one. Studies have shown that patients have more success adhering to a treatment plan if they use an existing habit as a trigger for a new behavior. For example, advise patients struggling to remember their meds to place the pill bottle next to their toothbrush and take it right after brushing their teeth.

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Make the behavior as easy as possible. Wood recalls one study that found participants went to the gym an average of five times a month if it was located within 3.5 miles of their home. But if it was 5 miles away or more, they only went once a month on average. Help patients choose behaviors that are “relatively easy” for their existing lifestyle, Wood says.

Another key component to helping patients form new habits? Understanding what you’re up against as a healthcare provider.

“[Patients] live in unhealthy environments and have to make decisions not to respond; those are real challenges for people right now,” Wood says. “Healthcare providers already do an excellent job of motivating and informing. The goal should be helping patients rethink how to live.”

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