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Where do intentions come from?

Understanding how behavioral theories impact Health Plans’ digital engagement strategies

What we believe, whom we rely on for information, and how we maintain behavioral patterns behind the computer screen are not just age-old habits; we learn them. In many ways, we are copycats but we are also original. We, humans, are interesting creatures, to say the least.

Medorion incorporates a range of theories from behavioral science with its proprietary technology to create intelligent, tailored member journeys that result in higher engagement and evidence-based behavior change. For example, one theory we use is the theory of planned behavior (TPB: Fishbein & Ajzen 1985, Fishbein & Ajzen, 2010). The TPB is a theory of behavior change that has been widely applied in health systems to predict and change human behavior. The theory is based on the idea that our behavior (e.g. getting a flu shot) is motivated by our attitudes (do we think getting a flu shot will reduce our risk?), what we believe other people do or expect us to do (social norms), and our confidence that we can do the behavior (self-efficacy). A combination of these elements will determine the likelihood that we will perform a specific behavior. These factors are based on our lived experience, but can also change with exposure to new information, which is where persuasion can be used to change behavior.

One of the most useful applications of this theory is to determine whether you need to persuade people to change their behavior, or just lightly nudge them toward the behavior they intend to do (through reinforcement). This is a critical factor when it comes to campaign strategy and management, and can help to focus campaign efforts on the people who need to be persuaded, using the elements that are likely to change their intention. At Medorion, we apply this theory at different touchpoints, using insights and experiments during the outreach process in order to channel the right messages to the people that are most likely to be engaged and persuaded by them.

Let’s consider two groups:


INTENDERS

NON-INTENDERS

This group has positive attitudes toward health and understands the importance of maintaining their health.

These individuals have more negative or inconsistent attitudes toward health behaviors and are not motivated to adopt healthy behaviors.



What do we know about them?

Past behavior is the most significant predictor of future behavior 




This group is generally engaged with the health system and demonstrates a pattern of adherence to recommended health behaviors.




This group shows lower or inconsistent patterns of engagement with the health system and tends to utilize health services only when absolutely necessary.




Members know what behavior brings positive results and they have intentions to continue




Members who are not convinced that the behavior is necessary or beneficial for them, and do not feel that others perform the behavior, or that they are able to do it themselves.




What message do we want to convey? 



 

REINFORCEMENT

 

 

 PERSUASION

 


Reinforce positive behavior and encourage them to follow through on intention.

Use messages that target their underlying beliefs about the behavior, social norms, and/or self-efficacy, motivating behavior change.


This approach allows us to understand what our population needs - and what proportion of our members fall into each group. Using Medorion’s AI engine, we then direct reinforcement messages to the intenders, and apply persuasion strategies targeting the non-intenders, based on TPB as well as other theories, to target the individual triggers that will move them toward behavior change. Medorion’s proprietary algorithm adapts behavioral science theories according to the behavior of the population, and constantly calibrates the AI engine to sort, scout, and deliver new insights all the time.

Putting Theory to Practice

In our first blog, we created two member profiles, Diane and Jake, so let’s use them as our reference in a second storyline as this is exactly how the Medorion engine works. In our second campaign, we apply the Theory of Planned Behavior, this time to increase adherence with pharmacy. In the first step of the campaign, we use insights to determine which members are likely to be intenders - just like Jake - and which are likely to be non-intenders for this behavior, like Diane.

Behavioral Science experts then work with the clinical data to determine which people are already highly adherent with pharmacy guidelines, engaged with the health system, and actively practice prevention behaviors. We then target the group of Intenders with messages that reinforce their positive behaviors and support efforts to maintain their health. In this case, Jake may receive an e-mail reminding him (and members similar to him) that even though he may be particularly busy or rightfully distracted with many priorities, it is important to keep his health a priority too. The email includes a link to help him act on his good intentions and information about how he can fill his prescription.


“Attitudes are not objective, but they are personal”


At the same time, we target Non-Intenders. For example, in this specific approach (among several options) Medorion creates messages that target members’ attitudes toward taking their medication. Attitudes are personal, subjective beliefs that we can address and change using persuasion. For this campaign, the message targets patients’ mistaken belief that medication is not necessary if they have no symptoms, and explains the increased risk of health complications if they do not take their medication as prescribed. This approach does not point out that the Non-Intenders are wrong but does empathize with the psychological barrier while providing practical advice. In Diane’s case, she would receive an e-mail that acknowledges the challenge and encourages her to reconsider the consequences of her choices, persuading her to lighten her resistance and then change the behavior,

Conclusion

When we tell others that their belief is wrong, they are likely to feel defensive and disengage from communication. By learning to “see” people through the perspective of behavioral science, we can find ways to help them change their behavior. Leveraging proven theories in Behavioral Science such as the Theory of Planned Behavior, together with Medorion’s Patient2Vec AI platform, allows health plan managers to identify members’ barriers to behavior change, and creatively engage and motivate people to improve their health in a way that works to their benefit.

Resources:

Ajzen, I. (1991). The Theory of Planned Behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211. https://doi.org/10.1016/0749-5978(91)90020-T

Fishbein, M., & Ajzen, I. (2010). Predicting and changing behavior: The reasoned action approach. New York, NY: Psychology Press.

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