Monday, March 31, 2008

The Whole-Person Integrated-Care (WPIC) Wellness Solution: Part 6

In the first five parts of this series on the Whole-Person Integrated-Care (WPIC) Wellness Solution, I discussed how particular personality characteristics -- i.e., one's cognitions (thoughts), emotions, knowledge, and coping strategies -- determine whether or not people take good care of their health. On one end of the spectrum are the self-motivated "Activists" who are eager to attain and maintain excellent health. On the other end are the "Ignorer/Deniers," who, for a myriad of reasons, strongly and consistently resist self-managing their health.

I now begin to answer the question: What's necessary for people to change the way they think, feel and act in a way that promotes healthy living?

I assert that AWARENESS is the place to start. It's obvious that people have little incentive to change if they are unaware that they have health problems, risks, or are managing chronic conditions poorly. Whether due to ignorance or self-deception, the first thing these people need is greater awareness of their health status and probable future. Becoming aware of their health problems, risks and poor self-management tends to give rise to fear. This fear is based on their belief that they will experience pain, become disabled, or die. For some, such fear a motivator. For others, the fear leads to denial, so it's wise for them to "reframe" the situation in terms of "joy of life" rather than "fear of death," as I discussed in an earlier post. Nevertheless, awareness is essential.

Things that can promote self-awareness are other people, media, and information technology. These people may be sick-care professionals (e.g., doctors, nurses and therapists); well-care coaches and counselors; family and friends; and even "virtual acquaintances" through Internet-based social networking (see Web 2.0). Media include web sites, TV, movies, newspapers, books, etc. Information technology includes health information systems, such as personal health records (PHRs) and online health data repositories.

In this post, I'm going to focus on the good and bad of health information technology for consumers since there is great debate about their usefulness. See, for example, this recent article in Business Week about Google and Microsoft's Internet-based products for electronic healthcare information storage and access, and the Robert Woods Johnson blog for their Project HealthDesign PHR development initiative.

I content that we are in the "Stone Age" of health information technology. Current day products are not very useful to the typical consumer, and could be much more useful to professionals. That's because the greatest value information is not obtained by simply having a place to store personal health data. Instead, value comes from using these data to help consumers and their healthcare professionals prevent physical and mental health problems, treat acute illnesses, and self-manage chronic conditions.

So, what about search Internet engines such as Google? Well, they're not of great value either since only 16 percent of online consumers find what they were looking for since search engines tend to focus on breadth rather than on content quality, which means they usually provide an overwhelming number of generic "hits" that are often of questionable validity. This is particularly true for searches on health topics such as alternative medicine, herbal and nutritional supplements, prescription drugs, disease cures, and nutrition. In fact, 70 percent of scientific studies show that quality of online health information is a major problem.[1]

Things have been improving, however, with web sites such as Helia Health, Organized Wisdom, , Revolution Health, and WebMD. The problem is that they all focus on providing general rather than personalized information. This means people must scan through pages of information and links, the vast majority of which have nothing to do with their needs. And when they finally navigate to where relevant information is located, it tends to be generic, not specific to each individual, which can lead to information overload, knowledge underload, and inaccuracies.

What's needed is an easy, low-cost way for data from health care providers and consumers, no matter where they are stored, to be transformed into useful information. This information should not only increase people's awareness of their current health status and risks through comprehensive holistic assessments, but also provide targeted personalized information that increases their knowledge and understanding about the most cost-effective ways to deal with troubling health-related issues. These issues may include such things as coping with a stressful life situation, changing unhealthy lifestyles, adhering to one's plan of care, making valid diagnosis, and deciding wisely about which treatment option and insurance plan to choose. As I discussed in a previous post, these capabilities go way beyond data storage and access and enter into the realm of personalized, holistic (mind-body-spirit) decision-support and self-help assistance. Today's PHRs are very immature regarding these types of capabilities.

I've long been recommending the creation of disruptive (radical, discontinuous) technologies that are able to achieve the lofty goals I described above. By way of full disclosure, I've been developing such a system, called the Personal Health Profiler™, for over two decades. It is a major departure from the kinds of PHRs and web sites in use today in that it promotes rapid and more complete understanding of a person's:

  • Current physiological, psychological and mind-body functioning and risks
  • Wellness interventions and self-management plans
  • Sick-care treatments
  • Changes in health status (trends over time)
  • Clinical outcomes and costs of care received.

This information is presented in a personal health profile and yields better (deeper and broader) understanding of a person's problems and needs, thereby improving diagnostic and treatment/intervention decisions. It comes from analyses of detailed data about the relationships between one's:

  • Internal factors--including problematic physical signs and symptoms, illnesses, emotions, and cognitions (thoughts, attitudes, perceptions, beliefs, "self-schemas," attributions & appraisals, expectations, memories, etc.), and knowledge & understanding.
  • Behaviors--including diet, exercise, alcohol and substance use, risky activities, sleep, mobility, etc.
  • External influences/causes--including stressful interpersonal relationships, stressful and unhealthy physical (e.g., work, living) environments, economic pressures, etc. on the one hand, and supportive conditions that promote good health on the other hand.
  • Medications and abnormal lab test results --to identify possible interactions (e.g., how certain drugs being taken may be causing one's white blood cell count to drop and interfering with one's sleep).
  • Mind and body-- such as medication side-effects and physical illnesses that present as mental health problems, as well as physical symptoms that may be due to (or exacerbated by) stress.

In addition, this next-generation application provides these essential functionalities:

  • "Pushes" targeted information to consumers and professionals to fill knowledge gaps and increase understanding, instead of requiring that the information be "pulled" by them. This means exceptional "findability;" that is, navigating to and accessing relevant information is a breeze compared to the complex and often convoluted process required to obtain and filter desired information from typical web portals and search engines
  • Identifies key stressful/distressing life issues and health risks, which help focus wellness-counseling efforts.
  • Identifies how a person's underlying beliefs (cognitions) and related emotions foster or hinder healthy behaviors and wellbeing, which also help focus counseling efforts and helps break through resistance and denial.
  • Delivers warnings and alerts essential to effective prevention.
  • Delivers ongoing feedback to the consumers and professionals as to their progress, so any necessary adjustments to the wellness plan can be made efficiently and good continuity of care can be maintained.
  • Uses a structured, personalized coping & problem-solving methodology that helps a person achieve positive results as quickly as possible by targeting the most problematic situations first and applying a proven method for resolving them.
  • Supports well-care/sick-care integration.
  • Continually evolves using flexible software modules, data sets and algorithms that are all transparent and easily modifiable.
  • Accommodates any current and future data and technology standards
  • Continually feeds a knowledge base with de-identified treatment and outcomes data to support research efforts.

These capabilities not only increase consumer awareness, but they cut the time the health professionals have to spend trying to understanding a person's problems, needs, and cognitive-emotional blocks, which speeds the creation and improves the accuracy of their care plans. And the targeted information, self-help tools, warnings & alerts, structured coping & problem-solving methods, and continuous knowledge base feeds offer a cost-effective way to help improve outcomes, including better health, wellbeing and overall quality of life, increased productivity, and workplace safety.

Note that such a paradigm-busting disruptive technology need not make conventional technologies obsolete since they can work together.

In subsequent posts, I'll explain how the Personal Health Profiler™ works and offer an opportunity for collaboration in its continued evolution.

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[1] "Health Information Search Engines Emerge; Growing Consumer Demand for Health Information Increases Need for Better Quality, More Personalized Searches, Says Expert at 11th World Congress on Internet in Medicine." Internet Wire (Oct 18, 2006).

Monday, March 17, 2008

The Whole-Person Integrated-Care (WPIC) Wellness Solution: Part 5

In my last post [click here for the first of the series], I discussed the personalities, coping strategies, and health-related needs of the third type of individual, the "Inactives." I now conclude this series by examining the fourth and most resistant group: the "Ignorers/Deniers."

Simply put, Ignorers/Deniers just don't focus on their health. This is for a variety of reasons, which I'll be discussing. These people "close their eyes and ears" to information about healthy living. They refuse to acknowledge or accept they have health problems or risk factors; or they refuse to do anything about it. These maladaptive behaviors are a consequence of a mindset they adopt, which includes thoughts such as:
  • "I do not accept there's a problem with my health" – despite convincing evidence to the contrary.
  • "I fine the way I am … It doesn't matter what others say" – even though their health is deteriorating, relationships are crumbling, and overall quality of life is suffering.
  • "I'm different … I'm special … I'm not like those other people … Nothing's going to happen to me!" – a false sense of security and invincibility.
  • "I don't trust doctors" – an attitude based on gross overgeneralization.
  • "Getting help is a sign of weakness ... A strong person handles one's own problems" – an irrational belief driven by pride and based on distorted measure of self-worth.
Ignorers/Deniers, therefore, differ from the other personality types in important ways; for example:
  • The three other types of individuals think about their health and, when confronted with a health problem, many question whether they are able to make good decisions and help improve things, which may make them feel anxious due to self-doubt. Nevertheless, they are willing to learn and act wisely despite their anxiety and doubt. Many Ignorers/Deniers, on the other hand, are so terrified by notion they may have (or get) a seriously illness that they avoid thinking about their physical and emotional health—preferring, instead, to pretend everything is all right. As a result, Ignorers/Deniers may refuse to accept the reality of their situation, even when confronted with the threat that they will probably die from their health problems; to them, the thought of being or being ill is too great to consider. Although this self-deception may keep their fear in check for a while, their inaction and ignorance makes them very vulnerable to worsening health and personal problems.
  • If Ignorers/Deniers did think about their health, many would feel hopeless and helpless, believing they are incapable of dealing with serious illness or personal problems. And those who portray an air of invincibility are likely covering up great self-doubt and fear; or they may be delusional.
  • While other types of individuals may have valid concerns about finding a competent healthcare practitioner, some Ignorers/Deniers are so distrustful of the healthcare profession that they won't even consider seeing a doctor, even if they are in pain or distress, often until it's too late.
  • While health problems may cause other types of people to become sad, or even depressed, for a time, they are able to get themselves motivated and begin to take constructive action because they want to live and be happy. Ignorers/Deniers, on the other hand, may be so lonely and depressed that they believe they have nothing for which to live. For them, the prospect of living longer in chronic emotional pain isn't motivating. And when confronted with the knowledge that their health risks can kill them, many Ignorers/Deniers deny the facts because the idea of dying is also too emotionally painful for them to acknowledge; the threat of death, therefore, isn't a motivator. In fact, the odds are great that such a person will fail to make substantial lifestyle changes, even if facing probable death. This prevents them from having the drive and focus needed for constructive action.
  • While other individuals are willing to get help when they need it, Ignorers/Deniers may have been so influenced by their cultures that they believe seeking assistance for personal problems is a sign of weakness.
  • Unlike the other personality types, Ignorers/Deniers may have physical addictions or powerful psychological compulsions that prevent them from focusing on healthy living until they reach "rock bottom," which, unfortunately, may be too late.
What this means is that Ignorers/Deniers rely on some of the same "avoidance" coping strategies as the Wannabes and Inactives; that is, they may:
  • Try to feel better by doing enjoyable or interesting things, rather than gaining knowledge and developing a plan of action
  • Act as if nothing has happened or trying not to think about their problems
  • Resign themselves that nothing can be done to improve the situation, even though they lack adequate understanding and fail to exert adequate effort.
As I discussed in my previous posts, these coping strategies are maladaptive in the long-term since the inertia (inaction) they promote allows their health risks to emerge as serious problems and their existing health problems to worsen.

Because these thoughts, feelings and reactions are so deeply ingrained in their personalities, getting through to Ignorers/Deniers is very difficult. However, all is not lost! Consider the following:
  • There are compelling discoveries in the fields of cognitive science, linguistics and neuroscience about how "reframing" serious health-related issues can help motivate resistant people to change. For example, instead of trying to break through the denial of Ignorers/Deniers through threats they will die, it may be much more useful to reframe the issue in a way that focuses them on a vision of "joyful living" rather than a "fear of dying," since joy is a more powerful motivator than fear [reference]. This kind of reframing changes the mental structures that shape one's view of the world; it typically requires months of psychological counseling to the break through the thoughts and feelings that block Ignorers/Deniers' awareness and motivation to change.
  • When cultural influences create a "machismo" attitude, in which Ignorers/Deniers perceive getting help as a sign of personal weakness or failing, cognitive-behavioral counseling can combat that belief. In addition, innovative self-help software, that guides the person toward healthier behavior and thinking, can be useful. One focus would be on reframing the situation from (a) getting help reveals weakness to (b) receiving help when it's needed and using it to improve one's life is a sign of wisdom and personal strength, whereas the refusing help is childish and self-destructive.
  • Dealing with a person's lack of trust may require intervention of a wellness coach who takes the time to establish a close, positive relationship with the Ignorer/Denier, and who has the knowledge and experience to gain the person's confidence.
  • As for Ignorers/Deniers with addictions or compulsions, lengthy counseling (and possible medications) may be needed before they acknowledge their problems and have the will to confront them.
When it comes to wellness programs, the Ignorers/Deniers are the least likely to participate, so engaging them is critical, such as offering meaningful incentives to take a self-assessment and speak with a wellness coach. The initial goal of such wellness counseling should focus on understanding and helping reframe their beliefs and perceptions. This will enable them to be more open to gaining awareness about their health situation. Innovative technologies that help focus and entice people to break through their negative mindsets and resistance would be helpful. Once Ignorers/Deniers stop deceiving themselves, have a stronger desire to live and enjoy life, gain trust, are more aware and open to receiving help, and are no longer controlled by their addictions/compulsions, they can be treated as Inactives or Wannabes as appropriate.

Monday, March 10, 2008

The Whole-Person Integrated-Care (WPIC) Wellness Solution: Part 4

In my last post, I discussed the personalities, coping strategies, and need of the "Wannabes." This time I examine the "Inactives."

Inactives think about their health on occasion, but do not believe they should or can do anything to improve their health and wellbeing. This is because they tend to have thoughts such as:
  • "I doubt I'll be able to do what's required to improve my health, so why even bother."
  • "I don't deserve to be sick…it's not my fault…so why should I have to be the one to do anything about it"—or—"I do deserve to be sick…Illness is my punishment…I'm just getting what I deserve."
Inactives, therefore, doubt that they can deal effectively with their health risks and problems, which causes them great stress. Some of them also believe they don't deserve what has happened to them, which makes them feel resentful and angry. This stress and resentful anger not only distracts them from focusing on constructive health improvement activities; it is also likely to worsen their physical health since illnesses such as coronary heart disease and cancer may be exacerbated by a negative psychological state (for examples of how this mind-body connection affects one's health, see: this link, this link, and this link). Other Inactives may have different views, such as believing they deserve to be sick and there's no hope because they are doomed.

The result is that the Inactives, like the Wannabes, lack the self-confidence and motivation they need to improve their health and wellbeing. But what makes Inactives less likely to change their unhealthy lifestyles is that:
  • Their self-doubt is stronger because it comes from the belief that they are not able (rather than may not be able) to (a) make the correct decision about treatment for an existing problem or (b) make the attitude and behavior changes required for better health and wellbeing.
  • Their inertia (inaction) may be exacerbated by (a) fear that they will be shamed if they try to improve their health and fail causes them to resist taking constructive action, (b) the belief that there is no good way to solve their health problems or prevent their health risks from becoming problems, and (c) despair related to the belief they deserve to be ill.
  • Their stress and resentful anger likely worsens their health through distraction and the adverse affect of negative emotions on physiology.
Furthermore, they will likely look for reasons for not adhering to the wellness care plan, such as:
  • Money problems that prevent them from carrying out their wellness plan of care (e.g., buying more healthy foods, a gym membership, prescribed medications, diagnostic tests, etc.)
  • Family and other demands that consume their time and thus make lifestyle change difficult
  • Physical handicaps or cognitive impairments.
The result is that Inactives fail to deal with their health risk and problems in a timely and effective manner, while at the same time worsening their health and wellbeing through inertia and emotional distress.

The way Inactives attempt to cope with their pessimism, fear, anger, resentment, and despair is similar to the negative avoidance strategies the Wannabes use. That is, they may
  • Try to feel better by doing enjoyable or interesting things, rather than focus on the problem
  • Act as if nothing has happened or try not to think about their problems
  • Express negative emotions by yelling or crying, taking it out on others, or avoiding certain people, rather than doing something constructive
  • Hope a miracle will somehow make things better or that one's wishes or prayers would be answered, rather than gaining knowledge and developing a plan of action
  • Resign themselves that nothing can be done to improve the situation, even though they lack adequate understanding and fail to exert adequate effort.
While these coping strategies may alleviate their emotional distress temporarily, they are maladaptive in the long-term since their inaction allows their health risks to emerge as serious problems and their existing health problems to worsen.

Nevertheless, since Inactives think about their health & wellbeing on occasion, it is possible for them to become more focused and motivated with the help of wellness coaches/counselors and useful health information technologies. They may be willing, for example, to take health risk assessments that evaluate their health status, especially if they have concerns about their physical health or emotional state. They may also be willing to gain greater knowledge about their problems, risks, and constructive strategies for dealing with them, although they will likely have to be convinced (through counseling, and maybe incentives) to use these tools and professionals. And they may be willing to get help to:
  • Use the knowledge they gain to make a treatment decision for dealing with an acute physical or mental health problem
  • Implement a wellness care plan designed to self-manage a chronic condition
  • Make positive lifestyle changes to avoid a risk factor from becoming a health problem.
All this means they will need wellness counseling, which should focus on:
  • Overcoming their inertia, changing their self-defeating cognitive and emotional blocks (including self-doubt, fear, anger and shame)
  • Replacing their negative avoidance-based coping strategies with the positive strategies of the Activists.
This counseling ought to include powerful forms of persuasion in which well-care professionals--using next-generation health information technologies, which I will describe in a future post--help increase their willingness to take responsible action that improves their health and wellbeing. This is likely to involve significant effort focused on changing beliefs/thoughts. Note that I have previously posted about the relationship between beliefs and physical health, starting at this link.

In my next post, I examine the fourth and most difficult personality type: the "Ignorers/Deniers."

Monday, March 03, 2008

The Whole-Person Integrated-Care (WPIC) Wellness Solution: Part 3

In my last post, I explained why "Activists"--the first of four types of people whose health is affected by key psychological characteristics-- tend to be healthiest, and why they are the ones most likely to take advantage of wellness programs. I discussed how they have the kind of personality traits that enable them to cope with health-related issues through positive action and rational acceptance. In this post, I discuss a second group of individuals with different personality and coping strategies: the "Wannabes."

Wannabes talk about improving their health & wellbeing, and are willing to learn about healthy living, but they never seem to act on it, or do so half-heartedly. This is because they tend to have thoughts such as:
  • "I may be able to do what's required to improve my health, but I'd rather not deal with it right now."
  • "I'm not sure what to do."
  • "I'm just not ready."
As a result, Wannabes tend to be aware--or are willing to be aware--of their physical and mental health problems & risks, but they lack the self-confidence and motivation they need when it comes to doing something about it. Their self-doubt and lack of drive may come from the belief that they may not make correct decisions about preventing or treating their problems. This uncertainty, in turn, may cause them to avoid making decisions and changing their attitudes & behaviors for fear of failure; i.e., they don't want to be ashamed or embarrassed if they try, but fail. Or if they believe there's no acceptable way to solve their health problems or prevent their health risks from becoming problems, they will likely take no action.

Wannabes, in other words, tend to cope with their doubts and fears through avoidance. What they do, for example, is:
  • Try to feel better by doing enjoyable or interesting things, rather than focus on the problem
  • Act as if nothing has happened or try not to think about their problems
  • Express negative emotions by yelling or crying, taking it out on others, or avoiding certain people, rather than doing something constructive
  • Hope a miracle will somehow make things better or that one's wishes or prayers would be answered, rather than gaining knowledge and developing a plan of action
  • Resign themselves that nothing can be done to improve the situation, even though they lack adequate understanding and fail to exert adequate effort.
While some of these coping strategies may alleviate their emotional distress temporarily, they are maladaptive in the long-term since they foster procrastination, which allows their health risks to become serious problems, and allows their existing health problems to worsen. Nevertheless, there are several positive and negative aspects of the Wannabe personality.

On the positive side, since Wannabes think and talk about improving their health & wellbeing, they will likely want to participate (to some degree) in health promotion programs that:
  • Evaluate their health status, especially if they have concerns about their physical health and/or emotional state.
  • Help them gain knowledge about their problems or risk factors, including understanding the pros & cons of different treatment and prevention options.
On the negative side, Wannabes are likely to procrastinate when it comes to:
  • Using their knowledge to make decisions about dealing with (treating) acute physical or mental health problems
  • Acting on wellness plans designed to self-manage chronic conditions and avoid complications
  • Making positive lifestyle changes to avoid risk factors from becoming health problems.
If they have money problems—which prevent them from carrying out their wellness plan of care (e.g., buying more healthy foods, a gym membership, prescribed medications, diagnostic tests, etc.)—they may use it as an excuse for not making a firm decision or adhering to the wellness care plan.

If they have family and other demands that consume their time and thus make lifestyle change difficult, they will likely use it as an excuse for non-action, as well. And if they have physical handicaps or cognitive impairments, they will likely use these limitations as excuses for inaction.

All this means they will need wellness counseling focused on modifying their self-defeating cognitive and emotional blocks (including self-doubt, fear and shame), as well as changing their avoidance-based coping strategies. The goal is to help them become more like the Activists. Only then will they be willing to take responsible action that improves their health and wellbeing.
In my next post, I'll examine the third personality type: the "Inactives."