Education Key to Self-Management Success in the Chronically Ill?

Thursday, November 1st, 2007
This post was written by Melanie Matthews

HealthBeat by Maggie Mahar poses an interesting question about the impact of a chronically ill individual’s education level and socioeconomic status on their ability to “adopt and adhere to complex new treatments” and self-manage the illness. This post uses diabetes as an example, but the idea really could apply to any chronic illness.

From what health coaches and those whom manage coaching initiatives have told us, there are many other factors at play. Often, the chronicaly ill are also suffering from depression, which can seriously affect motivation levels. I think we will see more employers and health plans bring health and wellness coaches on board to reach out telephonically and virtually to these individuals. The questions in the diabetes questionnaire mentioned in this post are not unlike those that coaches use. We’re seeing more evidence that wellness programs will achieve stronger success when they’re motivating and modifying participant behavior in the context of a trusting relationship (that “relationship” being the coaching relationship). This trend is so new that I doubt there is data on the impact of a client’s education level on coaching success. If you’re involved in health coaching of the chronically ill, what are your thoughts?

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2 Responses to “Education Key to Self-Management Success in the Chronically Ill?”

  1. William McPeck says:

    I have not specifically read Maggie Mahar’s post, so it is hard for me to respond to what she specifically means by “adopt and adhere to complex new treatments.” While there may be “complex new treatments” out there for specific chronic diseases, much of what a patient can do to manage their chronic disease and improve their quality of life is neither new nor complex. I make this statement from the perspective of being both a trained health/wellness coach and an instructor for the Stanford University’s Chronic Disease Self Management Program.

    The health literacy literature clearly demonstrates that both education and socioeconomic levels impact on patient compliance. Psychosocial, such as self-efficacy, issues need to be included in the mix as well. It therefore behooves all of us who have contact with a patient to be cognizant that the language we use and the written materials we give out need to be at a level the patient can understand and use to take specific, appropriate actions related to their disease (both acute and chronic).

    The issue of patient compliance is not new, but from my perspective, it is not one being adequately addressed in employer based programs. Individuals are motivated by both intrinsic and extrinsic factors. My understanding of the research is that successful long term change is dependent more on the application of intrinsic motivational factors. As we all know, one size does not fit all.

    While health coaching is an excellent tool for employers to support and use, it is by no means the only one. I am rapidly becoming convinced that successful employer based initiatives require a combination approach that includes:
    * Programs that require employees and other health plan members to opt-out, rather than opt-in
    * Disease management programs
    * Linkages between disease management programs and worksite wellness programs
    * A benefit structure that encourages, rather than discourages utilization, especially use of preventive services
    * Use of major financial incentives
    * An employee/member communications/marketing plan that educates members as to their plan’s benefits, especially benefits associated with chronic disease management
    * An organizational culture that supports and promotes wellness
    * Chronic disease self management and medical self-care education provided at the workplace

    I see employer sponsored health and wellness and health insurance as being at a crucial junction. It will be interesting to watch and even more fun, to be a part of the future as it unfolds. I suspect the ride will be bumpy, so make sure your seatbelt is fastened.

    Bill McPeck

    William McPeck, MSW
    Certified Worksite Wellness Program Consultant
    Work-Life Certified Professional
    Certified Health Promotion Director
    Director, Employee Health and Safety
    Maine State Government
    william.c.mcpeck@maine.gov

  2. admin says:

    Bill,

    Thanks for your thoughtful response. In your “combination approach,” you touched upon many trends that were mentioned in our recent Healthcare Trends & Forecasts 2008 webinar, in particular the role of incentives in behavior modification and workplace wellness initiatives. Much effort must be put into the communications products that you mention to ensure they are engaging, whether they are guiding us through our open enrollment choices or educating us about new programs. None of these elements will be effective without a C-suite that creates, supports and participates in a corporate culture of health.