Designing for Sustained Motivation and Behavior Change Jeffrey T. Kullgren, MD, MS, MPH

Transcription

1 Designing for Sustained Motivation and Behavior Change Jeffrey T. Kullgren, MD, MS, MPH VA Center for Clinical Management Research VA Ann Arbor Healthcare System Division of General Medicine University of Michigan Medical School May 9, 2018

2 Translational behavioral science

3 Translational behavioral science Bench to bedside

4 Translational behavioral science Bench to bedside Lab to living room

5 The leaders and best (or just like the rest)? % Overweight Obese Chronic back pain High stress Physical inactivity

6 How can we motivate change?

7 Overview Motivating from the outside using insights from behavioral economics Financial incentives Precommitment Choice architecture modifications Motivating from the inside using insights from selfdetermination theory Autonomy Competence Relatedness Example of how these approaches can be integrated Questions and answers

8 Motivating from the outside

9 Behavioral economics increases the explanatory power of economics by providing it with more realistic psychological foundations. -- Colin Camerer and George Loewenstein Camerer, C.F., Loewenstein, G., Rabin, M. Behavioral Economics: Past, Present, Future.

10 The behavioral economics toolbox Financial incentives Precommitment Choice architecture modifications

11 Financial incentives

12 Present-biased preferences Overweighting of near-term benefits and costs We will forgo large future benefits in order to experience small benefits now Leads to conflicts between long-term goals and near-term behaviors

13 Incentives for smoking cessation

14 Effects of incentives on cessation Higgins ST, Washio Y, Heil SH, et al. Financial incentives for smoking cessation among pregnant and newly postpartum women. Prev Med Nov;55 Suppl:S33-40.

15 Evidence for other applications Weight loss Physical activity Substance abuse Health risk appraisals

16 Precommitment

17 The recipe for precommitment Recognize future temptation Commit future self to a course of action Make it hard to break this commitment Achieve goal

18 Quitting smoking Set quit date Tell family and friends Plan for challenges Remove triggers Consider medications

19 Evidence for other applications Weight loss Physical activity Saving money

20 Choice architecture modifications

21 Contextual factors shape our choices Status quo Fast vs. slow thinking Emotions Social norms

22 Improving beverage choices Thorndike AN, Sonnenberg L, Riis J, Barraclough S, Levy DE. A 2-Phase Labeling and Choice Architecture Intervention to Improve Healthy Food and Beverage Choices. American Journal of Public Health. 2012;102(3):

23 Effects of labels and convenience Thorndike AN, Sonnenberg L, Riis J, Barraclough S, Levy DE. A 2-Phase Labeling and Choice Architecture Intervention to Improve Healthy Food and Beverage Choices. American Journal of Public Health. 2012;102(3):

24 Evidence for other applications Physical activity Calorie labeling Health plan choices

25 Motivating from the inside

26 Our 3 innate human needs Autonomy Competence Relatedness

27 Types of motivation Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68 78.

28 Types of motivation Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68 78.

29 Types of motivation Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68 78.

30 Types of motivation Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68 78.

31 Example of SDT in action

32 Intervention components Silva MN, Vieira PN, Coutinho SR, et al. Using self-determination theory to promote physical activity and weight control: a randomized controlled trial in women. J Behav Med. 2010;33(2):

33 Effects on weight loss Silva MN, Vieira PN, Coutinho SR, et al. Using self-determination theory to promote physical activity and weight control: a randomized controlled trial in women. J Behav Med. 2010;33(2):

34 Evidence for other applications Ryan RM, Patrick H, Deci EL, Williams GC. Facilitating health behaviour change and its maintenance: Interventions based on Self-Determination Theory. European Health Psychologist. 2008;10.

35 Targeting motivation from both sides

36 Financial incentives for weight loss Target present-biased preferences Shown to be effective in the short term Can be scaled to large numbers of people Insufficient maintenance after incentives end Potential to crowd out autonomous motivation

37 Continuum of extrinsic motivation Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68 78.

38 Continuum of extrinsic motivation Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68 78.

39 Continuum of extrinsic motivation Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68 78.

40 Incentives tailored to aspirations Elicit information about aspirations Tailor framing of a financial incentive to connect the incentive and the incentivized behavior to achievement of aspirations Incorporates insights from both behavioral economics and SDT Could be readily integrated into existing incentive programs and health risk appraisals

41 Aligning incentives with goals and values

42 Aligning incentives with goals and values

43 Summary Motivating from the outside using insights from behavioral economics Financial incentives Precommitment Choice architecture modifications Motivating from the inside using insights from selfdetermination theory Autonomy Competence Relatedness Each approach has strengths and weaknesses Opportunities for complementary strategies

44 Thank