The COVID-19 pandemic was a double-edged sword for patient engagement. For some, the inability to access traditional, brick-and-mortar healthcare opened their minds to virtual solutions and helped them get more acutely involved with their health. For others, the past 2 years magnified feelings of isolation and helplessness, which perpetuated a sense of overwhelm about their health. This is especially true for many people with chronic conditions.
Chronic obstructive pulmonary disease (COPD), for example, is the third leading cause of death by disease in the U.S., and a condition that requires daily effort to properly manage. This disease can be very stressful because breathlessness, low oxygen saturation, and coughing fits are a constant risk. Many find themselves homebound as the disease progresses. Others lack the confidence to engage in the world safely, are afraid of having an acute incident that brings embarrassment, or dread the burden of lugging portable oxygen with them everywhere. Add a lack of access to quality care, a fragmented healthcare system, and multiple medications to manage, and many patients succumb to this experience as their only possible reality.
A key component in reversing this paradigm is patient self-efficacy: one’s belief in their ability to achieve a certain outcome by changing their actions. Self-efficacy is a fundamental component to generating engagement and can work in conjunction with other tactics to foster lasting behavior change in our patients.
Fortunately, many of the virtual and digital solutions that emerged during the pandemic offer innovative care options, which are especially critical for those who lack access to in-person care. Many deliver patient-centered care and offer personalized tools to activate and engage the patient in the daily management of their condition — things like taking medications as prescribed, getting regular exercise, and adopting a healthy diet.
Healthcare providers, doctors, and coaches across the care continuum can help leverage new, innovative solutions to create a multidisciplinary “dream team” that is grounded in person-centered care. Each professional fulfills a uniquely important role on the team, and they must work in conjunction to teach, guide, listen, and support people at every step on their journey to better health. From a coaching perspective, here are five core principles to help empower patients and promote self-efficacy.
First, when setting goals and designing action plans, it helps to apply the “Goldilocks” principle. People should set goals that are simultaneously attainable and challenging. If the goal is too easy, it may feel insignificant. If the goal is too difficult, the patient may become discouraged and frustrated. When co-creating goals and action plans, keep the patient’s unique circumstances in mind as you work together to craft an exciting, engaging plan.
Second, celebrate the small wins. Each step forward, no matter how small, indicates a willingness to change and a commitment to advancing one’s health. By remaining positive about the direction in which the patient is moving and helping them foster a growth mindset, they are more likely to stay engaged, build confidence, and remain hopeful about achieving better health and wellness.
Third, actionable data drives behavior change. Unlike traditional methods of care delivery, virtual health solutions typically include connected devices as part of their offerings. These devices allow patients to gain insights into how daily activities impact their health. This direct feedback drives awareness and change, especially when paired with actionable nudges. Most importantly, multi-dimensional solutions can empower patients to be curious, ask questions, and adjust their daily habits to support their health.
Fourth, behavior change is complex and requires more than self-efficacy alone. Patients need not only the capability (knowledge and skills) to change, but also the motivation (desire to change and self-efficacy) and opportunity (necessary social and environmental support) to create lasting change. Self-efficacy is one core component for improving patient motivation, and it’s crucial for coaches and caregivers to understand how a patient’s self-efficacy relates to other factors impacting their ability to change. Building long-term relationships with patients can help the team gain the context necessary to provide whole-person care and meet the patient where they are.
Lastly, it’s important to facilitate human connection, regardless of the care delivery model. Looking at self-determination theory, relatedness — a connection to others and something larger than oneself — is one of the three basic requirements for psychological growth, alongside autonomy and competence. As humans, we need to feel like we belong and are supported. And, since individual health is a large part of our collective experience, having a human component in the care journey is key.
As a health coach in the COPD space, I encounter many patients wanting change but struggling with where to begin. Recently, I worked with a woman who came to me feeling depressed and powerless in trying to manage her COPD. She didn’t feel like anything she could do would make any difference to her health. Her goal was to be able to walk through the grocery store without pretending to stop and look at items, simply to catch her breath without embarrassment. She was incredibly engaged with her care plan but remained discouraged. Despite her hard work, the possibility of a supplemental oxygen prescription was looming. We worked to reframe her thoughts about each new challenge, focusing on her choice to stay engaged. She began to notice she could get around with greater ease, less breathlessness. Although it’s hard, she continues to work on embracing oxygen (and continued exercise) as tools to support her living a full life with COPD.
If we truly wish to assemble the patient-centered “dream team,” we must consider patient self-efficacy as an important piece of every intervention and everyone’s role on that team. We must help people understand that they have a choice in their health, that they have control over their own lives, and can become shepherds of their own care journey.
Bree Gorman, MPH, is the Health Coaching Lead with Wellinks, a healthcare company offering the first-ever integrated, virtual chronic obstructive pulmonary disease (COPD) management system. Gorman is a National Board-Certified Health & Wellness Coach.