"If you stop smoking today, you will lower your risk of heart disease, stroke and cancer, and it will likely add years to your life." "If you lose weight, you will lower your risk of heart disease, stroke, diabetes, musculoskeletal disorders, and some cancers, and it will likely add years to your life."
Both of these statements appear persuasive enough to motivate behavior change. If you do X and/or Y, you will lower your risk of disease and death. Sold! If only it were that easy. Both are powerful messages, amply supported by facts and research, but the unhealthy behaviors that should be extinguished are incremental and difficult to change.
Will one more cigarette cause cancer? Will one more pastrami on rye lead to heart disease? These behaviors are comforting, habitual, and part of one's everyday life. Previously, the medical community labeled a patient as "noncompliant" if he or she didn't stop smoking or lose weight after a doctor's recommendation.
This is where preventive health often ended. However, healthcare reform and the quest to save healthcare dollars have led to increased scrutiny of risk factors that lead to preventable chronic disease. Employers, insurers and legislators are becoming increasingly involved in preventive health.
It's no longer just between an individual and their personal physician--there are many concerned stakeholders. What does this mean for the field of preventive health, especially as it relates to corporate health and wellness? Should the medical community look to marketers for help in promoting or influencing behavioral change?
Marketing and Medicine Compatibility
If the medical field looks to the field of marketing, specifically experiential marketing (EM), how will it respond to employees who smoke or who need to lose weight? How will EM encourage employees to exercise or eat a healthy diet? With EM as a guide, employees will be immersed in carefully orchestrated healthy experiences.
While education is still important, ("If you do X and/or Y, you will lower your risk of disease and death"), EM recognizes that knowledge is not enough. Rather, EM will look to the power of each contact and seek to create an emotional bond between the employee and healthy behavior.
Each stage of a corporate wellness program, from its initiation through maintenance, will be designed to create thoughtful interactions that lead to permanent, positive behavior change. EM has its work cut out for it. There is no doubt that smokers feel an emotional connection with a cigarette.
Along those same lines, people may feel equally attached to their pastrami on rye. EM must create a deeper emotional connection between the employee and the healthy behaviors-one that leads to true healthy engagement.
Marketing and Medicine Engagement
The first stage of any health and wellness program must entice the employee into participation. Of course, there has been a lot of scholarly debate about whether this should be accomplished with a "carrot" or a "stick". Does the employee receive an incentive for participating, or does the employee face a penalty for not participating?
Some employers take it a bit farther-are there outcome-based programs? Financial incentives may get the employee to the table, but can that keep them there? Is money enough to effect long lasting, life altering change? Probably not. After all, psychologists have long recognized the importance of "readiness to change" as a prerequisite for success.
As we "entice" the employee to participate, he or she may be in the "precontemplation" stage of change. Perhaps he or she doesn't know there is a problem or is in a state of denial. The employee may feel resigned to the unhealthy behavior or believe that the behavior is unchangeable. As the employee fills out a health risk assessment, in preparation for a company-wide health screening, he or she may sense that some responses indicate some unhealthy behaviors.
The employee may feel ambivalent as the HRA is completed and may begin to contemplate a healthier lifestyle. Possibly he or she was already contemplating change long before the health and wellness program was presented. The "contemplation" stage can last months, years or even the rest of the employee's life.
The day of the health screening is a pivotal moment to influence change. The day of the health screening is the moment to truly engage the employee-this is where EM will shine and show its value in the relationship. The "proposal" is set in motion. EM will provide a platform for change, inspire interest in making change, and make the health screening a life changing moment.
The health screening experience will immerse the employee in healthy messages, accelerating the emotional connection. It's all in the details. Will an employee feel immersed in health and wellness if the health screening takes place in the cafeteria where he had a milkshake and fries the previous day?
Will an employee feel comfortable sharing that her boss contributes to her high blood pressure when she can see her (and someone else may hear her?). In order to most effectively enhance the employee's emotional investment, every aspect of the experience must be thoughtfully designed. Screenings need to be sufficiently clinical, but just as importantly, private and relaxed.
After all, the health screening is the ultimate teaching moment. With the HRA completed prior to the screening, the health professional will have valuable information to engage the employee in meaningful 1:1 dialogue. The employee is the central focus of the interaction.
The health professional can explain the measurements, address barriers to change, and immediately connect the employee with the appropriate wellness programs. Every employee is met where he or she is in his or her personal health journey, and the screening experience is encouraging, regardless of the measurements.
Although the health screening may have stimulated excitement and commitment, it's important to remember that the work has just begun as employees enter this new chapter of their lives. They may feel remorseful about the life (and habits) they left behind. Figuring out where the wellness programs and health coaching fit in their lives may be difficult.
As in any good relationship, EM should continue to be present unconditionally. Employees may be in different stages of their "readivness to change", and they can be supported through specially designed health apps, an easy to use online health portal, tools to track progress, email reminders, supportive texts-the list goes on and on.
Ideally, while the employee's life is getting a healthy upgrade, so is the workplace. Flexible policies that support work/life balance, exercise opportunities, and ongoing championing of the program by leadership are just a few ways to continue to deepen the emotional bond.
For Better or Worse
There may be rough patches along the way. Holidays, certain people, or certain activities can stimulate the desire to return to past behaviors. Relapses are common when extinguishing any habitual behavior.Previously, medicine may have called a relapse "noncompliance" and called it quits. Not anymore.
The healthy messages continue uninterrupted, and when it is time for the annual health screening, the anniversary reaffirms the emotional connection and the effect is cumulative for the employees as individuals and the corporate culture as a whole.Although this marriage may have been initiated to save money, its impact on saving lives is the true ROI.
Entice: Generate interest among employees. Precontemplative : "I can't change" or "I don't want to change." Contemplative. "Maybe I should change."v Notification of health and wellness programsv Completion of Health Risk Assessment Pre-program promotional materials Easy to use online scheduling programs.
Engage: Provide a healthy platform and inspire behavioral change. Preparation for Change "I am going to change." Biometric Screeningv Laboratory Testing Other Health Testing Healthy promotional videos and educational materials Healthy product sampling Specialty staffing (e.g., nutritionists, exercise physiologists)
Experience: Provide activities that encourage healthy behaviors. Action Employee has initiated healthy behavior (e.g., stopped smoking, started exercising) Wellness classes Health coaching Flexible work policies Healthy changes to workplace (e.g., healthy food in vending machine or cafeteria, walking paths) Post engagement communications Senior Management Champions Specially designed apps Interactive teaching programs Online tools to track progress Easy to use health portal Email reminders Supportive texts.
Enable: Provide evidence of progress and opportunities for further action. Maintenance and prevention of relapses Annual health screenings Ongoing health and wellness programsv Ongoing EM support
Information on readiness to change from Prochaska JO, DiClemente CC, Norcross JC. In search of how people change. Am Psychol 1992;47:1102-4 and Miller WR, Rollnick S. Motivational Interviewing: preparing people to change addictive behavior. New York: Guilford, 1991:191-202.
About the Author
Valerie Hamilton began her career as a critical care registered nurse and later pursued MHA and JD degrees at The Ohio State University.
Presently, Valerie serves as the Vice President of Compliance and Communication at Promerica Health where she has shifted her focus to prevention and wellness.