Featured Articles                                                   September 2010, Vol. III, No. 5
Social Networks Influence Health Behaviors

Individuals are more likely to acquire new health practices while living in networks with dense clusters of connections — that is, when in close contact with people they already know well, according to a new study by Damon Centola, an assistant professor at the MIT Sloan School of Management. Researchers often regard these dense clusters of connections to be redundant when it comes to spreading information; networks featuring such clusters are considered less efficient than networks with a greater proportion of long ties. But getting people to change ingrained habits, Centola found, requires the extra reinforcement that comes from those redundancies. In other words, people need to hear a new idea multiple times before making a change.

To see what difference the form of a social network makes, Centola ran a series of experiments using an Internet-based health community he developed. The 1,528 people in the study had anonymous online profiles and a series of health interests; they were matched with other participants sharing the same interests — "health buddies," as Centola calls them in the paper. Participants received e-mail updates notifying them about the activities of their health buddies. Centola placed participants into one of two distinct kinds of networks — those oriented around long ties and those featuring larger clusters of people — and ran six separate trials over a period of a few weeks to see which groups were more likely to register for an online health forum Web site offering ratings of health resources.

Overall, 54 percent of the people in clustered networks registered for the health forum, compared to 38 percent in the networks oriented around longer ties; the rate of adoption in the clustered networks was also four times as fast. Moreover, people were more likely to participate regularly in the health forum if they had more health buddies who registered for it. Only 15 percent of forum participants with one friend in the forum returned to it, but more than 30 percent of subjects with two friends returned to it, and over 40 percent with three friends in the forum made repeat visits. "Social reinforcement from multiple health buddies made participants much more willing to adopt the behavior," said Centola. Significantly, this effect on individuals "translates into a system-level phenomenon whereby large-scale diffusion can reach more people, and spread more quickly, in clustered networks than in random networks."

According to Centola, the existence of this effect has important implications for health officials. A "simple contagion," in network theory, can spread with a single contact; a "complex contagion" requires multiple exposures for transmission. A disease, Centola suggests, can spread as a simple contagion, but behavior that can prevent the disease — such as going to a clinic for a vaccination — might spread only as a complex contagion, thus needing to be spurred by reinforcement from multiple neighbors in a social network. The public promotion of screenings and other forms of disease prevention might best be aimed at communities and groups that act as closely clustered networks.

Get more information here.

Quotable: HRA Data and ROI

"It’s extremely important to use the HRA aggregate data from your provider and you would want to use it cost-effectively. Good HRAs will provide aggregate data as well as suggestions about programming so that you get the maximum ROI. Success depends as much on process as it does on content. The follow-up to the HRA is crucial. No one has ever demonstrated that simply taking an HRA will do much good or provide any return. Instead, the process must focus on behavioral science. Until now, that’s been the missing element. You must collaborate with your vendors. There are many good ones that have effective HRAs. They should be able to provide you with information from their databases that will help you to plan and deliver effective wellness programs."
                                        — Dr. Wesley Alles, Stanford University Prevention Research Center.

Learn more about HRAs and ROI.

Majority of Employers Offering Health Benefits Offer At Least One Wellness Program

Almost three-fourths (74 percent) of employers offering health benefits offer at least one wellness program, such as health coaching, according to the benchmark 2010 Employer Health Benefits Survey released by the Kaiser Family Foundation and the Health Research and Educational Trust (HRET). Other programs might include weight loss, gym membership discounts or on-site exercise facilities, smoking cessation, classes in nutrition or healthy living, Web-based resources for healthy living, or a wellness newsletter. The survey also found that among firms offering coverage, 11 percent give their employees the option of completing a health risk assessment (HRA) to help employees identify potential health risks. Within this group, 22 percent — or a relatively small two percent of all employers — offer financial incentives such as lowering the worker’s share of premiums or offering merchandise, gift cards, travel or cash to their workers. Large firms are more likely than small firms both to offer assessments and to offer financial incentives.

Workers on average are paying nearly $4,000 this year toward the cost of family health coverage — an increase of 14 percent or $482 — above what they paid last year. The jump occurred even though the total premiums for family coverage, including what employers themselves contribute, rose a modest 3 percent to $13,770 on average in 2010, the survey found.

The survey saw the percentage of firms offering health benefits in 2010 increase sharply to 69 percent, up from 60 percent in 2009, largely because of an increase in the offer rate among firms with three to nine workers. Because most workers are employed by large firms, the shift among the smallest firms did not have a major effect on either the percentage of workers offered health benefits or the percentage of workers covered at their job. The reason for the large increase in offer rate is unclear. Because of the poor economic climate in 2010, it is unlikely that many firms began offering coverage this year. A possible explanation is that non-offering firms were more likely to fail during the past year, with the attrition of non-offering firms leading to a higher offer rate among surviving firms.

Read the full article here.

Wachovia Offers Wellness Information to Employees via the Web
As part of Wachovia's Healthy Connections program, employees with PCs receive a 55-second dose of health and wellness-related information each week that is delivered with the company's daily desktop video news program. The desktop videos launch automatically when users turn on their computers, and are replayed in the company's break rooms, common areas and financial centers throughout the day. These offerings are a core part of Wachovia's wellness culture, says Donna Shenoha, the company's vice president and senior consultant of health and welfare. She adds that the company's Intranet platform offers social networking options as well as the option to "push out" messaging by targeted areas — either geographically or by employee "affinity groups."

Listen to the podcast here.

New Chart: Home Visit Tasks

Sometimes it takes a home visit to a patient with complex chronic conditions to understand the barriers to care compliance that they face. We wanted to see which tasks are being performed during home visits.

Click here to view the chart.

Coaching Without a Coach

Question: Some health coaching companies offer Web-based health coaching programs that do not use a coach. What are your thoughts on this type of coaching? Which health behaviors and conditions will this coaching without a coach approach target?

Response: What we’re seeing is a movement among consumers — and I use that word as opposed to patients or participants — especially with regards to healthcare where they are actively seeking information for self-service, making decisions on their own and becoming a lot more active in the process of healthcare decision-making. There is a segment of the population that is very interested in this self-service or coaching without a coach. Some consumers are interested in the self-service option of using Web tools, Web portals, health information support groups, moderated forums and social networking. There’s interesting things happening in the world around us and in the industry. It’s becoming known as health 2.0, which is a play on words from Web 2.0. The social networking piece where groups of patients and consumers have gotten together to support each other and dig into the research, and in many cases they’re becoming as knowledgeable as their providers are around conditions that they may have. It’s a movement that’s gaining a lot of ground because of all the wonderful tools and processes that are available online.

When we talk about what conditions or behaviors are most amenable, across the board consumers, regardless of their condition or lifestyle that they want to improve, we’re not seeing a huge differentiation. It cuts across everything. You could be a person with rheumatoid arthritis or a person with weight to lose. It doesn’t seem to make that much of a difference. Across the board there is a segment of the population that wants to engage in self-service options, and they want to be informed and explore what’s on the Web. Interestingly, when these people get together, they are very self-policing. Some of the fears that we’ve had around coaching without coaches or social networking is that a lot of misinformation might occur with a person suggesting some treatment modality or method for quitting smoking or method for weight loss that wouldn’t necessarily be a healthy choice. These groups self-police and call people on the spot when they are doing things that are derogatory to others. Health coaching companies are seeing a lot of demand in the marketplace for multimodal coaching. People want it served up to them in the way that they want it. Some will want telephone, some will want Web, some will want e-mail-based, some will want complete self-service. That’s part of a new generation of coaching. We’ve got to be able to serve it up to the individual in the way that they want it.

(Roger Reed, chief consumer engagement architect, Gordian Health Solutions.)

Learn more about Web-based health coaching.

HCH Readers Save 10% on Coaching Resource

Aggregate data from health risk assessments (HRAs) provide a snapshot of population health status that guides healthcare payors, purchasers and providers in the design of health improvement or disease management initiatives. But should the completion of HRAs be mandatory for employers or health plan members? Should HRAs be incentivized? In what format should health assessments be administered, and who should be permitted to review the output from HRAs? 2010 Performance Benchmarks in Health Risk Assessment Use answers these questions and many others with a wealth of actionable information from 116 healthcare organizations on their use of HRAs.

HealthCoach Huddle subscribers should use ordering code HCH to purchase this product at a special price!

Get more information on HRA use.

2010 Benchmarks in Health & Wellness Incentives Use

The use of economic incentives to drive engagement and results from wellness and prevention programs continues to proliferate. This executive summary captures responses of 139 healthcare organizations to HIN's second annual Health and Wellness Incentives Use e-survey administered in February 2010 on the focus, utilization and impact of health and wellness incentives, from types of incentives offered to methods for identifying individuals for incentive programs and reasons for providing incentives.

Download complimentary white paper here.

Take HIN's e-survey on Telehealth in 2010.

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