“Stakeholders across the health care continuum – from biopharma and insurance providers to health systems – are recognizing that despite of all of the innovation in the industry, frontline decision-makers and the ultimate users of health care often behave in seemingly counterintuitive ways,” said Kathleen Starr, PhD, managing director of behavioral science at Syneos Health.
For example, while the majority of people agree that oncology clinical trials are a good thing – and say they would participate in one if they had cancer – very few patients actually enroll in these studies. In reality, reports suggest that fewer than 1 in 20 adult cancer patients enroll in studies.
Medication adherence rates also exemplify this seemingly counterintuitive behavior, with nearly one in every two prescriptions on average going unfulfilled, said Starr, who will be leading a luncheon discussion next week at the 2019 Bridging Clinical Research and Clinical Health Care Collaborative
“But, looking at these things through a behavioral science lens, we can see there are fundamental principles of behavior that help explain and even anticipate these patterns,” she explained.
“For instance, people don’t always weigh pros and cons objectively,” Starr said, adding that people often instead rely on their feelings, good or bad, about a situation.
Opportunities to motivate change
Communicators, policy makers, and others with various goals are increasingly applying the insights garnered from behavioral science to promote informed decision making, reduce human error, and create incentives to participate in the health care system.
“Behavioral science reveals that a scarcity of motivation, cognitive resources, and social support puts ‘natural’ limits on a person’s ability to collect necessary health-related information and use it properly as well as to consistently make short-term sacrifices for their long-term health,” Starr explained.
“Yet, if we think about all the health care system asks of patients, it’s no small feat – from starting a conversation about symptoms that are worrisome or trying new treatments in the face of uncertainty, to navigating a clunky, complex system.”
As the industry aims to improve health outcomes, Starr said it needs to “work around these realities,” looking for opportunities to motivate change by making a desired behavior as easy as possible; aligning this behavior with the patient’s social identity; building trust in their health care providers; and encouraging active planning routines.
“Because behavioral science provides us with a foundational understanding of what influences human behavior, we can apply this to any stakeholder audience whether patients, HCPs, administrators, or others,” she explained.
“To effectively apply these insights, however, it is important to take a deep dive into lived experiences of the intended audience to reveal barriers and bottlenecks limiting the desired behavior.”
Starr said this begins with researching and documenting past experiences, current goals and needs, as well as any cognitive limitations.
“Most people have had the experience of setting healthy goals but find that they just don’t follow through,” she said. Research of this “intention-behavior” gap reveals that the more people visualize themselves behaving in a particular way, the more likely they are to do so.
“Prompting people to plan out the specifics about where and when they will complete a goal behavior has been effective in increasing a range of health behavior including exercise, vaccinations, and cancer screenings,” Starr explained, noting that applying this insight does not to be complicated or costly.
“For example, something as simple as a reminder note with a prompt to write in the time and date of an appointment has been shown to be effective,” she said.
The dark arts? Addressing ethical concerns
Starr noted that behavioral science is sometimes referred to as “the dark arts,” due to concerns about behavior manipulation.
She explained, “There has been growing conversation within academics and policy-making on ethical parameters for leveraging behavioral insights to influence population behavior.”
This concern is likely to accelerate as more is revealed about the manipulation tactics of “Silicon Valley giants” to keep consumers engaged with digital products, Starr added.
To determine if there are possible ethical concerns, she suggests those thinking about incorporating behavioral insights ask the following questions:
- Is there adequate transparency as to the intent of the intervention?
- Does the intervention respect stakeholders’ independence and autonomy?
- Are there any unintended consequences that should be avoided?
- Does the intervention put any other group at a disadvantage?
“I believe staying focused on helping stakeholders make informed decisions and follow through on the decisions they’ve deemed best for themselves is a good rule of thumb,” said Starr.
“One important thing to remember is that human behavior is complex but not unknowable. We need to continue to explore the nuances of behavior and how the drivers vary across environmental context, cultures or generations.”