It is said that all communication is essentially meant to either inform or persuade. By and large, patient education and counseling have concentrated on the ‘inform’ side, for example, demonstrating how to give an insulin injection or discussing treatment options following genetic testing. If educators/counselors were to expand their practice to include more of the ‘persuade’ side, it could improve the effectiveness of their work.
Another reason for incorporating ‘persuades’ strategies is that educators/counselors are already in a constant and complex information competition with a host of others. Many of these competitors are far less well informed than the educators, both generally and about the situation of any one particular patient, but whose influence is pronounced and too often determinative [ 1 ]. These competing actors include friends, family, advertising, and the internet. Some of this influence might be blunted if educators adopted some of the standard techniques of advertisers.
Consider these figures from a Pew Research Center survey [ 2 ] about online health practices:
70% of U.S. adults got information, care, or support from a doctor or other health care professional.
60% of adults got information or support from friends and family.
24% of adults got information or support from others who have the same health condition.
59% of U.S. adults have looked online for health information in the past year.
The survey was conducted in 2012 and reported in 2013. As both availability and use of the internet have increased since then, it is likely that the 59% figure is even higher today. What’s obvious and striking about these percentages is that they do not sum to 100%. Clearly people are looking to multiple sources for health information. For example, as many people looked to family and friends as looked to the internet (60% to 59%) and only a somewhat larger percentage (70%) looked to healthcare professionals. This is a clear indication of the information competition in which educators/counselors now find themselves.
Family and Friends
When speaking of an ailment, condition, or treatment, who has not heard a friend or family member say “Well, I heard that…,” forwarding information like a game of telephone, where with every transfer from person to person the information becomes less precise if not altogether changed. It’s a recipe for mis-information. Often, what’s passed on is what’s easily remembered (lacks complexity), generic (lacks individuation), and non-traditional (lacks a scientific basis). This latter is especially pernicious, fed by a vague distrust of medical authorities and a desire to find cheaper, alternative methods. Its basis is the belief that medical professionals routinely steer patients to more expensive treatments, for their or their institutions’ benefit, not necessarily their patients’ well-being [ 3 ].
The advantages that family and friends have over educators/counselors is that they already have a deep relationship of trust with the patient as well as frequent access to the patient to repeatedly press their ideas.
On the whole, there is far more wrong or misleading health information on the internet than there is truthful and reliable information on these subjects. If, for example, apple cider vinegar really did cure as many ailments as ads-masquerading-as-articles claim, we would surely all be drinking it daily [ 4 ]. Typically, to find good medical and health information, one has to deliberately find a source and then somehow verify that it is reliable. In contrast, the misinformation and easy cures come to us without lifting a finger or conducting an evaluation, simply by way of ads and emails.
We also end up “self-targeting” ourselves by means of our internet searches. Thanks to a process called re-marketing, our search terms are shared with advertisers, who then turn around and send us their information. Search for insulin for instance, and on pages unrelated to insulin you will start to see ads about diabetes treatments. This creates a vicious cycle, where the same, unvetted information is repeated back to us again and again.
In addition to internet advertising, television, radio, and print ads routinely encourage readers to “Ask your doctor about [a prescription medicine here].” The implication is that the doctor is uninformed and not serving the patient’s best interests because she/he has not prescribed this drug. This situation is not only a competitive one (who should you believe) but also subtly adversarial (who really cares about your condition). This can undermine the doctor-patient or educator/counselor-patient relationship and requires that extra time be spent explaining why said drug is not being prescribed.
Educators/counselors could borrow a number of techniques from advertisers, helping to give them an edge in this information competition. Among them are use of repetition, emphasizing benefits, and endorsements.
Repetition of information
In advertising, a metric called “touches” indicates the number of times someone needs to see, hear about, or otherwise interact with a product or service until they either become aware of it or actually purchase it. That interaction can be an advertisement, a display, direct mail, or some other form of marketing. The number of touches required generally varies from five to twelve, with many articles suggesting seven is the magic number. But regardless of the precise number, the conclusion is always the same; repetition is essential to getting someone to become aware of a product and persuade them to purchase it.
Patient educators should similarly try to increase the number of touches they have with their clients. Sending emails, postcards, phone calls, texts, and letters are all good follow-up ways to reinforce messages initially delivered in person. Apps can also trigger periodic reminders and reinforcements. Another approach is to give the patient something that contains key messages and with which they will then come into frequent, repetitive contact at their home or place of work. For example, a refrigerator magnet might remind a patient with diabetes to check their blood sugar level, or a calendar could be customized for a personalized medication schedule.
The other reason for finding a means to repeat education/instruction is that the patient may have been too distracted or overwhelmed at the time of the initial visit to have paid close and careful attention to counseling. Medical settings can be stressful and patients often feel that they are not fully in control of their situation, neither of which contributes to a setting where learning is likely to take place and details are likely to be remembered. So repetition is a good way to deliver information that may have been missed during counseling.
Patient education/counseling may overly concentrate on procedures by cutting them up into manageable steps, giving them a memorable acronym, providing a step-wise diagram or flow-chart. But procedures, whether wound-care, operation recovery, or even pre-natal exercises, are simply not strong motivating factors by themselves. What does motivate is an appreciation of the benefits of following the procedure; e.g., quicker relief from pain, faster return of function, and a healthy birth. So emphasizing, and repeating, benefits is a good way to help patients visualize goals, which in turn will motivate them to follow the procedures.
Advertising has long made use of celebrity endorsements to sell everything from cars to kitchenware, and even medicines. The psychology is complex and the logic somewhat fuzzy, but somehow consumers believe that they can be more like the people they admire or emulate simply by using the same products these celebrities purport to use. Patient educators/counselors can make use of this dynamic by mentioning celebrities who have followed the same protocol to a successful conclusion. For example, Elton John has a pacemaker and actor Tom Hanks, US Supreme Court Justice Sonia Sotomayor, and UK Prime Minister Theresa May all have diabetes. The implied message is simple: these well-known and quite successful people manage their (heart or diabetic) conditions, and so can you.
When patient educators and counselors provide information to their clients, they will likely find themselves in an ongoing competition with a number of outside influencers, indirectly challenging their protocols and courses of treatment. To tip the competition more in their favor, these educators/counselors might adopt some of the methods of advertisers and marketers.
It would be entirely understandable if patient educators/counselors were resistant to applying advertising techniques to their own work. Long denigrated as manipulative, if not devious, advertising’s poor reputation is often well deserved. But it would also be short-sighted to ignore all of advertising’s tools simply because the practice is not held in high regard. After all, patient education and counseling freely borrows from a host of other disciplines like instructional design, cognitive psychology, and even behavioral economics.
In following this advice, patient educators/counselors would have to both do more and tailor those extra efforts individually. For instance, establishing a repetitive regime or frequent follow-up program to increase the number of patient touches will unquestionably require more effort. Similarly, the content of such messaging, like “endorsements,” will have to be carefully selected and tailored to specific age or generational groups in order to be effective. The reward for this extra effort may be greater patient understanding and appreciation of what’s required of them, and most importantly, better health outcomes for those patients.
Just as advertising is not always effective, there is no guarantee that applying these techniques to patient education/counseling will be successful. That said, companies are on track to spend just a shade under US$558 billion this year on advertising [ 5 ]. It’s a fair assumption that they wouldn’t do so unless advertising’s tools had not been proven reliable means of attracting attention and affecting behavior.
[ 1 ] Science | Business, UK: people trust medical advice from family and friends more than evidence from research. (Accessed 4 September 2018) https://sciencebusiness.net/healthy-measures/news/uk-people-trust-medical-advice-family-and-friends-more-evidence-research
and NPR, Seeking Online Medical Advice? Google's Top Results Aren't Always On Target. (Accessed 4 September 2018) https://www.npr.org/sections/health-shots/2017/07/17/537711453/seeking-online-medical-advice-googles-top-results-arent-always-on-target
[ 2 ] Pew Research Center, Health Online 2013. (Accessed 4 September 2018) http://www.pewinternet.org/2013/01/15/health-online-2013/
[ 3 ] Physician’s Weekly, Why Doctors are Losing the Public’s Trust. (Accessed 4 September 2018) https://www.physiciansweekly.com/doctors-losing-publics-trust/ and National Public Radio, Half of Americans Believe in Medical Conspiracy Theories. (Accessed 4 September 2018) https://www.npr.org/sections/health-shots/2014/03/19/291405689/half-of-americans-believe-in-medical-conspiracy-theories
[ 4 ] The University of Chicago Medicine. Debunking the health benefits of apple cider vinegar. (Accessed 4 September 2018) https://www.uchicagomedicine.org/health-and-wellness-articles/debunking-the-health-benefits-of-apple-cider-vinegar
[ 5 ] Statista, Global Advertising Market – Statistics & Facts. (Accessed 4 September 2018) https://www.statista.com/topics/990/global-advertising-market/