Influencing Patient Education through Salience &  Self-efficacy

​Limited health literacy is also inextricably linked to socioeconomic status, another component of the Social Determinants of Health. Only an estimated 12% of Americans are deemed proficient in health literacy skills  . Patient populations disproportionately affected by lower health literacy are patients 65 and older, Medicaid patients, Black, Latin X and Native American patients, and patients with limited English proficiency or non-native speakers. 

Despite the significant challenges posed by limited health literacy, we can use powerful, yet simple insights from behavioral science research to transform this problem. On this deep dive, we will focus on making care delivery more salient and enhancing patient self-efficacy, especially when managing chronic diseases.

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Increasing salience in care delivery is a low cost and high impact way to influence health outcomes. Luckily this doesn't involve complex education or training. It merely involves an intentional look at how the organization and providers communicate to patients. For example, a quick memo could be sent to clinicians highlighting the power of framing when communicating treatment options to patients. In the behavioral science field, research has repeatedly shown how influencial framing can be. One of the most foundational studies conducted by Amos Tversky (one of the forefathers of behavioral science) shed light on the power of framing in the healthcare context. They recruited participants to determine their preference for surgery when given a diagnosis of lung cancer. When the surgery was framed as having a 90% survival rate, 84% of patients opted in. When surgery was framed as having a 10% mortality rate, only 50% opted in  . Simply adjusting the frame for surgical outcomes altered the surgical opt-in rate by 34%! This powerful study highlights how increasing salience by emotional impact greatly affects decision making. 

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Research also shows the promising results of implementing situated (over remote) interventions when aiming for sustainable behavior change  . Last week, we dove into unique advantages of utilizing social norms to maximize elderly patient engagement. One of the interventions identified was offering contextual demonstrations of digital tools to elderly patients during their healthcare visits. In terms of making care more salient, we can apply this methodology to all patients. If a patient expresses that they want to sign up for the patient portal, clinicians or front desk staff can demonstrate signing up and using the tool during the appointment, thus making the behavior more salient to the patient. This could increase the likelihood that the patient continues to use the portal for a couple potential reasons. Using the portal might be more salient because how of how novel the tool is or even the emotional impact of someone spending the time with them to accomplish a goal they expressed. Implementing this type of situated intervention during the patient's appointment could yield lasting behavior change over a remote intervention of emailing a patient to sign-up and use the portal.

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Boosting patients' self-efficacy is another way to strengthen personal health literacy and is a critical component on tackling the chronic disease epidemic in the US. An estimated that 60% of Americans have at least 1 chronic disease and 40% have 2 or more. Moreover, based on the CDC, approximately 90% of healthcare expenditure ($3.7 trillion a year) goes toward managing chronic diseases and subsequent mental illnesses  . Self-efficacy, an individual's belief in their abilities, especially plays a huge role in how patients manage chronic diseases. Based on their beliefs to sustain lifestyle and behavioral changes, patients can prevent and properly manage their ailments and reduce healthcare utilization. There are bodies of research that echo similar messages: enhancing patient self efficacy leads to better outcomes. Below, we explore various interventions to improve self-efficacy.

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Improving patient education and health literacy doesn't have to involve taxing and complicated interventions to work. Join Banyan Consulting Co, and together we'll develop simple and powerful ways to bolster patient education and health literacy today!