Patient Information – Why won’t we do what we’re told?!

“High quality health and care services depend on good information. The right person having the right information at the right time can make all the difference to the experience of a patient, service user or carer….. Information is a health and care service in its own right: it must be freely available to all who need it.” Andrew Lansley – Secretary of State for Health, Foreword to “Liberating the NHS: An Information Revolution” Consultation document – published 18 October 2010.

I have posted before on the developing issue of Patient Information, however, as the quote above demonstrates, this is becoming increasingly important with a current Government consultation on the subject.

The role of Health Information and current challenges

The effective provision of information to citizens is vital to a healthier society.

This premise is built on the assumption that appropriate and accurate information enables people to makes choices or act in a way that is in their own self-interest and improves their own lives and those of their families. The whole point of ‘information’ is to prompt people to act.  The suggestion is that there is an objective body of knowledge ‘out there’ that simply needs to be communicated clearly and individuals will process it rationally and act on it in an identical fashion.

The role of information in a health context is likely to expand further over the next few years. The Health White Paper itself refers to an “information revolution” and the Coalition Government sees transparency as a key driver for innovation and reform. In addition information is also seen as vital for any form of co-production where patients may be asked to self-care with the support of professionals.

Current solutions and their potential limitations

The work of professionals in this field has understandably – and rightly – focussed on precision, accuracy, safety and protection against possible legal liabilities.

There are still clearly substantial barriers to information equality with health literacy and digital exclusion currently seen as the principal challenges.

Simplifying information, using plain English, addressing any cultural issues and improving access through digital inclusion, undoubtedly has a significant impact. And it will continue to be a priority to provide information in as wide a range of forms as possible to ensure that people are treated equally and fairly.

However, we also know that people who have full access to information and are without basic language or literacy problems still do not respond appropriately, i.e. they don’t seem to act in line with our perception of their own best interests to the information that is presented.

Look at some common challenges that we face with health and related services that have been subject of vast amounts of information dissemination:

• Exhortations to encourage us to give up smoking, eat more healthily and take up more exercise
• Raising awareness of the symptoms of testicular, lung and breast cancer and subsequent prompt self-referral
• Encouraging people to take their medicines at the right dosage and at the right time
• Increasing the number of blood donors
• Providing information on pharmacy opening times, availability and services offered
• Encouraging elderly people to keep warm in winter and hydrated in the summer
• Reducing inappropriate use of A&E services

It’s simply not credible to suggest that our failure to bring about ‘behaviour change’ in these and similar areas is because people either have an information deficit or don’t understand what they are being told or asked to do. This is increasingly understood to be the case with  ‘lifestyle’ issues but it is equally relevant with regards to those issues where traditionally the simple passage of information is seen to be sufficient, for example, when providing information regarding self-care following an inpatient stay in hospital.

If people do not respond as we would wish to the information we give them, then a central plank of public policy is flawed and an initiative that seeks to use public money wisely in fact potentially wastes it.

In the rest of the paper we explore why this happens and what one might do to address this. We need to explore how we make information more directly salient to those people currently least likely to use it.

Information and behaviour change: the need for Motivation as well as Ability

One cannot achieve a successful behavioural outcome without addressing two questions for the individual you are targeting.. They are:

• Ability: “Do I have the ability to continue, start, adapt or stop this behaviour”? e.g. skills, tools, finance, time, physical and mental effort, knowledge and physical access
• Motivation: “What’s in it for me, or for people like me, to start, adapt or stop this behaviour?”

Health information strategies tend to aim to focus on the first question-Ability.

This approach relates to tackling and supporting the ability of people to utilise the service or behave in the desired way by making the information as accessible as possible. In other words much of the effort has gone into building mechanisms that enable people to access information without understanding who will use the information and how its use varies between individuals. Understanding how different individuals are likely to respond will make communications more effective, achieve better outcomes and be a better use of resources.

Information and behaviour change: Values

In order to ensure people act on information we need to understand their likely levels of motivation in response to it.

TCC’s central premise is that the way people are motivated to behave – and, in this case, act appropriately on any information we give them – is strongly influenced by their values. Our approach moves forward from the idea that all people of a certain demographic or geo-demographic think the same and are motivated by the same things.

Values are one’s judgements about what is important in life and the lens that you look through when you view and try to make sense of the world.

Our values are derived from our unconscious motivation to satisfy a range of needs as we navigate our way through day to day life. A need is something that is necessary for us to meet if we want to live a physically and emotionally healthy life.

Needs can be objective and physical, such as food and water, or they can be subjective and psychological, such as the need for security or self-esteem.

The key thing to understand is that it is from our ‘dominant need’ that our values – what is most important to us – are derived. And when faced with a decision it is these values that provide the unconscious ‘frame’ that kicks in and sets the context before we actually take action.

Once we understand values, we understand what makes people tick. And we can start to understand how they might perceive services, how to deliver them in an in an empathetic way that matches their values and, crucially, how to motivate them to do things.

UK based values segmentation data is based on 37 years of data collected via the British Values Survey of 8,500 nationally representative survey. The resulting values based segmentation gives us three principal values groups:

• Settlers: motivated by the core needs of safety, security and belonging. Home, family and immediate neighbourhood are important, and the wider world often feels threatening. Change is often seen as negative.
• Prospectors: motivated by the need for self-esteem and the esteem of others. Job progression, money and social status are important to them and although usually optimistic, they can worry for example about their status or the perceive declining quality of an environment.
• Pioneers: motivated by ideas, aesthetics and personal development. Interested in new information and often the initiators of change. They tend to have large social networks, but individuality is more important than following the crowd.

Applying these three core values groups help us understand how people make sense of the world, what motivates them to act, and therefore means we are able to more effectively craft information and messages – whether verbal or written – which resonate with these motivations.

So what are the practical implications arising from this?

Let’s take the example of communicating a message such as the need to apply anti bacterial hand-wash before entering clinical areas in hospitals. This is usually conveyed in a single message – ‘Help us fight infection’ which in values terms is a Pioneer message that ‘it’s the right thing to do. But ‘Settlers’ might respond better to a message which uses sanction or fear – such as ‘protect yourself and your family’ – and with ‘Prospectors’  it might be to emphasise that people who do this are seen to do the right thing – ‘Set the example be a role model’.

This Pioneer message is understandably the likely approach of health professionals who – experience and evidence shows us – are predominantly Pioneer themselves.

How values based segmentation and communication might help?

If we understand levels of motivation and the importance of emotions in delivering messages there are a number of practical ways this can be taken forward.

Some organisations like the Patient Information Forum (PIF) are already exploring issues around the idea of encouraging positive pro-social behaviour change. This is an area that TCC has much experience and, along with its understanding of Value Modes, can add value to. Specifically we can:

• Use the British Values Survey database to understand the groups that are most likely to read the information and yet fail to be motivated by it. This would be supplemented by qualitative research to explore people’s needs, values, world views, motivation and behaviour and how these views relate to accessing and acting on information
• Produce research that would assist organisations develop more effective approaches in both written and verbal information.

Conclusions

The ability of individuals to access to information will continue to increase and will undoubtedly benefit many. Unless an organisation is mindful and seeks to understand the different values of their audience, and how this shapes their actions, the information it provides will fail to engage and connect with some of its most vulnerable client groups.

Jonathan Upton is Chairman of The Campaign Company.