February is American Heart Month, a time to bring heightened awareness to the risks of heart disease, which takes the lives of about 647,000 Americans each year. As a population health management company, we’ve spent decades coaching and engaging individual patients from all walks of life to better manage their heart health. In this article, we highlight some of the key patient engagement strategies we’ve implemented to motivate long-term behavior change.
What are the foundational pillars of a healthy heart?
According to the Centers for Disease Control and Prevention, four healthy behaviors that help lower the risk of heart disease include:
- Eating healthy
- Not smoking
- Taking medicines as directed—particularly those that treat high cholesterol, high blood pressure, and diabetes
Health coaches can play a pivotal role in helping people create and stick to action plans that address all four of these behaviors. We met with some of our boots-on-the-ground coaches to get their perspective on which patient engagement strategies can best help people stick to these key healthy pillars.
Engaging Patients to Improve Their Diet and Increase Their Exercise
A diet rich in fruits, vegetables, whole grains, lean meats, low-fat dairy products, and sugar-free beverages can help prevent heart disease. In addition to a healthy diet, regular physical activity helps to maintain a healthy weight and lower blood pressure, cholesterol, and blood sugar levels.
“When it comes to engaging a patient with issues related to diet and exercise, we’ve found that it’s important to set expectations from the start,” says Erica Rew, a registered dietitian health coach at Health Dialog. “It all comes down to building trust and meeting the patient where they are. For example, some people may need to learn basic nutrition information from scratch, while others may have a high level of knowledge.”
Coaches then engage patients to help them examine their motivations and barriers to change, so they can work together to come up with specific, concrete goals. For example, rather than setting a goal to “lose weight,” the goal might be to “work out 10 minutes a day for 3 days a week, and to eat out only two times a week.” Through our interactions with millions of patients over the years, we’ve learned that it’s important for the plans to be individualized. “We’ve got to understand what will work in their day-to-day lives,” says Rew. “If someone has no time for exercise, we’ll focus on diet.”
Along the way, patients can feel discouraged. “We remind them of all the positive changes they have already made and that change doesn’t happen overnight,” says Rew.
One final insight: having someone to be “accountable to” can make all the difference in maintaining motivation. A health coach who shows empathy and patience can be that cheerleader, supporter, and friend.
Motivating and Engaging Patients to Quit Smoking
Smoking cigarettes significantly increases the risk of heart disease, but it’s never too late to stop. Within just one year of quitting, the risk for heart disease can be cut in half.
Quitting smoking—which for some patients, may be a lifelong habit—can be challenging. Working with a health coach in a smoking cessation program can be tremendously helpful, as people embark on their journey toward a smoke-free lifestyle. Over the years, we’ve learned that the key to success in getting patients to quit, and quit for good, is to help them understand the true impact of their tobacco use, identify triggers (such as stress or anxiety), and develop a customized and realistic quit plan that fits their lifestyle.
“We’ve found that it’s important to personalize the program to each individual based on why they want to quit,” says Steve Dowell, a registered respiratory therapist who supervises smoking cessation health coaches. “We look at barriers with our patients and talk about how their lives will be better. For example, we had a patient who wanted to babysit her grandchild, which motivated her to quit. One strategy we used was to have her place wallet-sized photos of her grandchild on her packs of cigarettes as a constant reminder.”
At the end of the day, the timeline and approach are different for everyone. “While some studies show that the use of nicotine replacement therapy and counseling has a greater success rate, we see some people who are able to go cold turkey,” says Dowell. “Sometimes a plan fails and you try something else. It’s important to learn from any failures and build on what works for the individual.”
Over his nearly 13 years at Health Dialog, Dowell has seen thousands go through the smoking cessation program. No two individuals are the same, which keeps coaches on their toes—the learning never stops.
Improving Patients’ Medication Adherence to Cholesterol, High Blood Pressure, and Diabetes Medications
If someone takes medicine to treat high cholesterol, high blood pressure, or diabetes—three conditions that put people at a high risk for heart disease—it is critical that they continue taking those medications exactly as their doctor instructed.
Some people may not take their medications, or may not take them as instructed, for a number of reasons. These might include: forgetting to pick up or take their medications, not knowing why the medication is important or how to take it, fear of side effects, or affordability issues. These are just some of the reasons why people may not stick to their medication regimen, which are described here in more detail.
A health coach can engage a patient to get to the root of why they may not be taking their medication and help them overcome their personal barriers to adherence. “We know that a one-size-fits-all solution won’t work,” says Jenny Glennon, PharmD, MPH, the director of pharmacy services at Health Dialog. For example, if the problem is forgetfulness, a health coach can help a patient set up alarms and use a pillbox to remind them to take their medication. “At Health Dialog, we have found that truly personalized coaching can have a significant impact on behaviors, and ultimately, medication adherence,” says Glennon.
These learned behavior changes that improve medication adherence apply to any medication—including those that treat high cholesterol, high blood pressure, or diabetes.
Maintaining a heart-healthy lifestyle is a day-to-day commitment. And it isn’t always easy. With the support of a health coach, patients can learn to develop plans to stay on track and make lifelong behavior changes. Engaging patients to stick to a healthy diet and exercise plan, a smoke-free lifestyle, and a consistent medication regimen (if needed), can help them prevent heart disease and lead longer and healthier lives.