Using Mobile Apps to Improve Lifestyle & Mindset of Chronic Patients

Leveraging Psychological Techniques  

Two-way Communication Between Doctor and the Patient

Using Mobile App to Improve Lifestyle & Mindset of Chronic Patients  

Leveraging Psychological Techniques  

Do lifestyle & mindset make a difference in chronic patients? 

It has been reported3 that most (about 60%-70%) health care visits in industrialized countries are correlated with lifestyle-induced preventable diseases. Even adherence to medications4 for primary and secondary prevention remains insufficient globally. Clear evidence exists where complications can be reduced, or the rate of progression can be slowed down by patients following a recommended lifestyle changes in the areas of diabetes and cardiovascular diseases.  Also, the onset of the chronic condition can be prevented or delayed by following the recommendations related to lifestyle.  

In a particular study8, the risk of diabetes was reduced by 58% in the intervention group. The reduction in the incidence of diabetes was directly associated with changes in lifestyle. In another study6, related to coronary atherosclerosis, significant experimental-group patients had an average change towards regression.  

Can lifestyle & mindset be changed for anyone especially chronic patients?  

There is a clear acknowledgement that changing one’s lifestyle and mindset is extremely hard requiring patience, perseverance, and continued motivation. Real world evidence and studies have shown that more often than not, people especially chronic patients fail in making sustainable changes to their lifestyle and mindset. For some, they may never be able to change their habits.  In general, change is hard. Changing oneself from within is harder. Our lifestyle and mindset are driven from within us most of the time. Whether we take a walk or eat the right breakfast or speak to a friend or work towards reducing stress – they are a result of our internal drive. The drive to change lies within each of us.  

Motivation to change is the first and a necessary step. The motivation to change may come from  various places – wanting to lead a healthier life and be able to witness children & grandchildren’s  graduation, marriage, etc., or being able to enjoy an active life style like hiking, mountaineering,  etc., or to simply enjoy a quality life.  

If so, how?

American Psychological Association (APA)1 provides five tips to help one make lasting, positive lifestyle and behavior changes:  

  • Make a plan that will stick  
  • Start small  
  • Change one behavior at a time  
  • Involve a buddy  
  • Ask for support  

The key ingredients to change are practice and perseverance. The adage “where there is will, there is a way” is certainly true for lifestyle and mindset changes.  

Is it sustainable?  

According to a 2009 study2 published in the European Journal of Social Psychology, it takes 18 to 254 days for a person to form a new habit. The study also concluded that, on average, it takes 66 days for a new behavior to become automatic.  

Working on a change like a regular walk, or having a healthy breakfast, or spending time on a  hobby for a period of 90 days has potential to become a habit for many patients, provided their  motivation levels are maintained during that period.  

Challenges  

One of the biggest challenges is to sustain change. More often than not, we go back to our old habits. Its far easier to be sedentary than engage in a physical activity especially when it’s part of a task list. It’s just easy to have a pizza or your favorite dish than have a healthier dish – especially, when its more expensive and more time consuming and not necessarily the tastiest choice. The same is true for mindset and attitude changes. Taking a walk, or engaging in our hobby or  speaking to a friend, or stepping back to get a broader perspective when experiencing unhealthy  emotions like anger, fear or anxiety, etc. is harder than to give in to those emotions and react  instinctively.  

In general, keeping up with the changes we have already made is hard.  

Possible Approaches  

Any approach to improve lifestyle & mindset and to sustain changes, should have some of the following elements:  

Motivation to change should come from within  

Effective feedback as to how we are doing  

Clear & practical steps from a trusted source  

Monitoring the change by a trusted source or by a buddy or by the spouse 

Regular reminders from a trusted source or a buddy or the spouse  

Continued reinforcement of the need to change preferably through self-reflection

Regular reminders of the benefits of the change  

Patient centric approach is the key:  

Ultimately, the ability and capability to change fully rests with the patient. As such, the bottom line in any approach should center around the patient and patient empowerment needs to be the focus when it comes to lifestyle and mindset improvements.  

Solution  

We offer an approach leveraging a mobile app to achieve a scalable and sustainable solution for both the patients and the doctors. A significant percentage of the population use their smart phone for many of their daily needs including entertainment. The smartphone has become a de facto companion. Our mobile app has the content determined by the doctor. It provides the needed motivation on an on-going basis to a patient towards improving his/her lifestyle and mindset.  

MotivationAssist© Approach  

In this approach, all the doctor’s recommendations, such as medical, nutrition, physical exercise, and mind care activities, are condensed into a series of simple daily questions/responses in a customized mobile app – MotivationAssist© app. The app carries the doctor’s recommendations and acts as a trusted source to provide constant motivation to the patient.    

MotivationAssist© Solution  

The MotivationAssist© mobile app is effective because it….  

Acts as a daily reminder of the Doctor’s recommendations  

Monitors patient progress and provides feedback to the patient which subsequently improves patient compliance  

Utilizes proven psychological methodologies such as Positive Psychology, Motivational Therapy, and CBT (Cognitive Behavioral Therapy) techniques. The app provides a regular, on-going, focused response designed to sustain behavioral change Provides daily patient progress to the practice and an opportunity for appropriate intervention  

Patient Benefits  

We know that improvement in lifestyle and mindset has a direct impact on the management of lifestyle diseases like diabetes, cardio-vascular, etc. The reduction and avoidance of pain & suffering for the patients with improvements in their lifestyle & mindset is another clear benefit.  

Cost Benefits to the Payers  

The cost of treating type 2 diabetes9 has been estimated to be well above $101 billion annually.  More than 600,000 deaths (1 in 4) are attributable to heart disease each year and accounts for more than $70 billion spend. Clearly, by reducing the complications wrought by the chronic conditions, the overall health care costs can be reduced through better lifestyle and mindset  

habits of the patients  

Conclusions  

In this paper, we discuss the impact of lifestyle and mindset on the progression of the lifestyle diseases like diabetes and cardio-vascular, etc., and the potential for patients to change. We cover the necessary elements for a patient to change including sustenance of those changes. We present a specific approach and a solution using Mobile app.  

References:  

  1. American Psychological Association. Making lifestyle changes that last https:// www.apa.org/topics/lifestyle-changes
  2. How are habits formed: Modelling habit formation in the real world. Philippa Lally, Cornelia H. M. van Jaarsveld Henry W. W. Potts Jane Wardle. European Journal of Social Psychology Volume 40, Issue 6 October 2010 Pages 998-1009  
  3. Minich DM, Bland JS. Personalized lifestyle medicine: Relevance for nutrition and lifestyle recommendations. Scientific World Journal 2013 Jun 26; 2013:129841. DOI: https://doi.  org/10.1155/2013/129841.  
  4. Thomas A. Gaziano Lifestyle and Cardiovascular Disease. Journal of the American College of Cardiology. Vol 69. No. 9, 2017 Editorial Comment http://dx.doi.org/10.1016/j.jacc. 2016.12.019
  5. Lifestyle Medicine: A Brief Review of Its Dramatic Impact on Health and Survival The Permanente Journal/Perm J 2018;22:17-025 https://doi.org/10.7812/TPP/17-025  6. Intensive Lifestyle Changes for Reversal of Coronary Heart Disease Dean Ornish, MD.  

Larry W. Scherwitz, PhD; James H. Billings, PhD, MPH; K. Lance Gould, MD; Terri A.  Merritt, MS; Stephen Sparler, MA; William T. Armstrong, MD; Thomas A. Ports, MD; Richard L. Kirkeeide, PhD; Charissa Hogeboom, PhD; Richard J. Brand, PhD JAMA,  December 16, 1998—Vol 280, No. 23  

  1. Association of Diet, Exercise, and Smoking Modification with Risk of Early Cardiovascular Events After Acute Coronary Syndromes. Clara K. Chow, MBBS, FRACP, PhD; Sanjit Jolly,  MD, MSc, FRCPC; Purnima Rao-Melacini, MSc; Keith A.A. Fox, BSc (Hons), MB, ChB,  FRCP, FESC, FMedSci; Sonia S. Anand, MD, PhD, FRCPc; Salim Yusuf, DPhil, FRCPC,  FRSC750 DOI: 10.1161/CIRCULATIONAHA.109.891523  
  2. Jaakko Tuomilehto, M.D., Ph.D. et, al. Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle among Subjects with Impaired Glucose Tolerance. The New England Journal of Medicine. Volume 344 Number 18 May 3, 2001  
  3. Joseph L. Dieleman, PhD et, al. US Spending on Personal Health Care and Public Health, 1996-2013. JAMA. 2016;316(24):2627-2646. https://jamanetwork.com/journals/jama/ fullarticle/2594716