Personalized and community supported health education

How to teach a billion people to self-treat their illnesses

With the rise of many chronic diseases, patient education in self-management of their condition is ever more important. Lapses in self-management are caused either by perceived difficulties in following the procedure, or in maintaining motivation to follow the procedures daily. Personalized learning paths, motivational engagement techniques, and social support are proven ways of mitigating these problems. These ways are also core features in LifeLearn.

Personalized Learning Paths

The main challenge in providing support for healthy behavior is that since a disease may befall anyone, the people who need help with self-management of their condition are very heterogeneous. Some may be medical professionals, while others may not be literate. Therefore, effective education must conform to very different needs and settings.

Combining group lectures with individual tutoring, remote monitoring and real-time support has been shown to decrease hospital visits and increase overall health.[1] Combining a psychoeducational programme with case management has been shown to be effective in self-treatment of diabetes.[5]

Technology is a tool to increase personalization. Instead of patients attending a group lecture, they can e.g. view and review instructional videos and assess their own understanding. Educating patients online (telemedicine) has been shown to be a viable alternative to face-to-face education.[2] The best approach may be a combination of personalized coaching with more generic training materials.[4]

Motivation

A key goal of any health education programme is to have as many of the patients keep following the treatment protocol, and not drop out or slack off. Most research studies in self-treatment education focus explicitly on motivation, and often use techniques that are possible in research settings, such as patient self-selection to participate, motivational interviews, intensive monitoring, and other means, which might not be available in normal day-to-day health education programs (see e.g. [6]).

The question then becomes, how to maintain motivation in widely differing patient populations? While educational materials will of course contain motivational portions, keeping patients motivated permanently on often inconvenient and dull treatment procedures is not an easy challenge.

Certainly the day-to-day activities can be designed to be more motivating. Research into engagement design or gamification provides numerous techniques to increase motivation, and these should be used more in designing the self-treatment programmes people are expected to follow. One aspect that is already well exploited is the effect of peer support and social pressure.

Most self-treatment programs include self-monitoring and reporting. In the case of diabetes, patients measure their own blood sugar levels and record them somewhere. These records are usually only seen by very few people and feedback to the patient usually comes after a considerable delay. These self-monitoring tasks can be made more motivating with simple gamification techniques, and peer support can also be leveraged; even if the exact data is not shared, family members may see whether or not a measurement has been made, and can remind the patient; and if the data can be seen, a discussion on possible interesting changes can be had.

We will discuss both gamification and permanent habit change in future articles.

Rollout: Top-down and Bottom-up

A viable method of providing education and support to a whole nation is the top-down method or the snowballing method, where first a few high level professionals are trained into a core team. They then proceed to train health professional teams in various districts and areas, who in turn will train the rest of their health staff in their location, who in turn will provide education and support to patients. This model has worked well in many situations, including rolling out diabetes care and education in Ghana.[3]

This snowballing method of growing the pool or teachers and tutors is a scalable solution. However, to have lasting results, support is needed in local communities. Educating family members on self-management is an effective way to make sure the patient understands what they need to do and why, and also to keep the patient following the plan.[1]

Getting family members, relatives, friends, and the local community involved in the self-management of a patient serves two reasons: it provides social support in case of difficulties in following the plan, and it provides social pressure (peer pressure) to continue with the treatment plan. Having something become an important issue in a local community also changes social norms and helps turn previously stigmatising conditions into understood illnesses, whose treatment is in everyone’s best interest.

Summary

Health education has the challenge of effecting permanent habit changes in a wide and heterogeneous population. Chronic illnesses such as diabetes are affecting a growing portion of the global population, so self-treatment must be available to everyone. Combining generic content with personalized coaching and tutoring is effective, and continued monitoring and support is needed to keep patients motivated to continue their self-treatment. Getting support from family members and local communities are a crucial part of the social support each patient needs. The LifeLearn Platform aims to provide technology-enhanced ways of bringing personalized training, continued support and feedback to every patient, as well as helping grow communities for teachers and learners alike. LifeLearn will provide gamification mechanics to all its skill paths, and will support feedback and reporting by the patient that can also be used in self-monitoring of illnesses and reporting to the health organization or to friends and family. Patterns in reporting can be used to customize the learning path in various ways. LifeLearn will build on MyData principles, allowing the user to choose what information they share with whom.

References

1. Fireman, P., Friday, G. A., Gira, C., Vierthaler, W. A., & Michaels, L. (1981). Teaching self-management skills to asthmatic children and their parents in an ambulatory care setting. Pediatrics, 68(3), 341–8. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/6792585

2. Izquierdo, R. E., Knudson, P. E., Meyer, S., Kearns, J., Ploutz-Snyder, R., & Weinstock, R. S. (2003). A comparison of diabetes education administered through telemedicine versus in person. Diabetes Care, 26(4), 1002–7. http://doi.org/10.2337/diacare.26.4.1002

3. Amoah, A. G. ., Owusu, S. ., Acheampong, J. et al. (2000). A national diabetes care and education programme: the Ghana model. Diabetes Research and Clinical Practice, 49(2), 149–157. http://doi.org/10.1016/S0168-8227(00)00140-6

4. Gucciardi, E., DeMelo, M., Lee, R. N., & Grace, S. L. (2007). Assessment of two culturally competent Diabetes education methods: Individual versus Individual plus Group education in Canadian Portuguese adults with Type 2 Diabetes. Ethnicity & Health, 12(2), 163–187. http://doi.org/10.1080/13557850601002148

5. Svoren BM, Butler D, Levine BS, Anderson BJ, Laffel LM: Reducing acute adverse outcomes in youths with type 1 diabetes: a randomized, controlled trial. Pediatrics. 2003, 112: 914–922. http://doi.org/10.1542/peds.112.4.914

6. Christie, D., Strange, V., Allen, E., et al. (2009). Maximising engagement, motivation and long term change in a Structured Intensive Education Programme in Diabetes for children, young people and their families: Child and Adolescent Structured Competencies Approach to Diabetes Education (CASCADE). BMC Pediatrics, 9(1), 57. http://doi.org/10.1186/1471-2431-9-57

About the Author

Tarmo Toikkanen is Chief Learning Scientist at LifeLearn Platform. He has over a decade of research experience in the fields of learning environments, participatory design, and educational psychology. His passion is to save the world by helping people learn and teach in better ways. This article is part of a series to explain LifeLearn Platform’s ideas on learning.