Looking For A Way To Engage Patients In Behavior Change? Try “Storytelling”


[tweetmeme source=”Healthmessaging” only_single=false] My wife had just finished meeting with her medical oncologist for her bi-annual check-up at MD Anderson’s Thoracic Clinic.   We were sitting in an area called “the Park” rehashing what her doctor had said when a mother and her daughter sat down at our table.   There were lots of empty seats in area but for some reason they decided to sit with us.  Call it serendipity.   It turned out that both my wife and Megan (the daughter) had just gotten “good news” from their respective oncologists.

We ended up talking with our new friends for one and a half hours – my wife and the daughter about the travails of cancer (hair loss, uncertainty, and so on) – the mother and I about care giver stuff (insurance authorization, navigating the health system, etc.).  My wife and I always feel so energized after “talking story” with other dealing with the same issues.   You see these “chance meeting” always happen to us….and a lot of other patients as well I suspect.

Talking Story Hawaiian Style

I have always supposed that there was some “therapeutic benefit” to these chance meetings with other cancer patients.    Turns out I was right according to a recent study of hypertensive patients in the Annals of Internal Medicine.

The study explored the use of culturally-appropriate “storytelling” among a population of inner-city African-Americans (71% women) diagnosed with hypertension.   In the study, an experimental group of patients received a DVD showing “people just like them” talking about their experiences living with high blood pressure.  For example, lessons learned about how to best interact with their physicians, and strategies to increase medication adherence.   A control group received a general introductory DVD on hypertension without the “storytelling.”

The study found that that patients diagnosed with uncontrolled hypertension benefited the most from receiving culturally sensitive “storytelling” messages promoting hypertension control.  People in the experimental group (at 3 months post baseline) had an 11mm Hg greater reduction in systolic blood pressure than the control group.  Smaller reductions (6mm) were also found for diastolic blood pressure among the experimental group.  No change in systolic or diastolic blood pressure was found among patients in the experimental group diagnosed with controlled hypertension.   Blood pressure reduction in these patients from baseline to 6 to 9 months also favored the intervention group for systolic and diastolic blood pressures.

Researchers theorized that narratives or “storytelling” can break down cognitive resistance people may have to behavior change by helping listeners:

  • make meaning of their lives
  • actively engage them in their care
  • influence  their health behavior
  • get them to imagine picture themselves taking part in the same behavior/action

So What Does This Mean For You?

Storytelling may well turn out to be an effective, inexpensive, and highly appealing strategy for engaging patients with all kinds of conditions in behavior change.  Primary Care Medical Groups, Accountable Care Organizations, Health Plans, Population Health Management and Disease Management Vendors should explore ways of “pairing up” culturally-like patients…say with uncontrolled hypertensive patients with culturally similar patients who have successfully gotten their condition under control. Same thing diabetes, asthma and other conditions. Social media, e-mail and the telephone are ways that patients can begin sharing their stories…and improving health outcomes.

If you would like more information on “storytelling” and how it might work for your organization, feel free to contact me by leaving a comment below.

Sources:

Houston, T. et. al.  Culturally Appropriate Storytelling to Improve Blood Pressure A Randomized Trial.  Annals of Internal Medicine. 2011;154:77-84.

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10 responses to “Looking For A Way To Engage Patients In Behavior Change? Try “Storytelling”

  1. The Dept. of Gynecologic Oncology at Tufts Medical Center in Boston has a “chemo room” that accommodates 3 patients, as well as seating for friends & caregivers and curtains that could be drawn for privacy if desired. While I was being treated for ovarian cancer there, the opportunity to chat with other patients being treated for the same thing was invaluable. Even when we didn’t feel like talking, it was nice to share the space with others sharing similar experiences, as well as to nod or exchange a few words with the doctor, chemo nurse, and others who came in & out throughout my 6-hour infusion session.

    Once, when my doctor was out of town, I had to go to the Infusion Center on a different floor, where each patient was put in a separate room. The isolation was awful; I could neither see nor hear other any other patients or their friends/caregivers, never saw a doctor, and saw the chemo nurse only when she came in to change the bag. The experience was so unpleasant that the next time my doctor had to be out of town, I rescheduled my infusion so I could have it in the DGO’s chemo room.

    Sometimes, it doesn’t even take a whole story; just meeting someone else with a similar experience can make a huge difference.

    • Finn,

      Thanks for sharing your experiences. I have witnessed the exact same dynamics between patients while sitting with my wife in the infusion room. Health care providers could learn a lot just witnessing the “caring” that goes on between patients in the “chemo room.” I hope you are doing fine now!

      Steve

  2. A fascinating and thought provoking post! Back in my youth I recall the ‘old folks’ sharing tales about illnesses and treatment and not understanding why they would want to (1) talk about their own problems and (2) listen to someone else’s. Fast forward 20+ years and I have started to understand. Now I read your post and realize that the ‘old folks’ (then and now) are on to something!

    • Ann,

      Thanks for your kind words. I lived in Hawaii for a few years and they used the term “talk story” which everyone that lived there understood and engaged in. That phrase seems to capture the essence of how people everywhere interact. We all have stories that tell others who we are. This applies to the physician-patient relationship in spades! Too bad most doctors don’t take the time to listen.

  3. Having attended several groups on various topics at various times in my life I think sharing can help. Sharing practical information is helpful and I like to share what I know with others. There is no reason to re-invent the wheel. As you mentioned there is a deep bond between people going through the same experience.
    There are times however, when discussing can be a drain on you. Some research – I can’t remember the specific source – shows that if you have an active and supportive network, being involved in a support group can be a negative experience. You may begin to feel guilty about being able to cope when you hear how others cannot.

    AA for example, has saved millions of people. But some people become more attached to other AA members than to their spouse and children. So after being there for the person while they were ill, they don’t get to enjoy them when they are in recovery. All in moderation, I suppose!

  4. Now more than ever, outcome-based health solutions need to explore new paths to get there. The story-telling concept is new to me, yet I’ve seen this kind of behavior helping others in lots of medical situations. I’ve think you’ve got something here!! I can only pray that our new healthcare environment takes heed. Can you imagine how comforting it would be to talk with someone who’s achieved a healthier disease state, diabetes, cancer, etc. ?! Thanks for a great article.

    • Julie..thanks for the comment! I see the day when each “community” of hospitals and physicians enable their own patients to meet and engage locally in health story- telling!

  5. Pingback: Looking For A Way To Engage Patients In Behavior Change? Try “Storytelling” | Mind The Gap « Share Marketing, Engagement and Redesign

  6. The value of groups is well known in the overall well-being of breast cancer survivors. Story is how we relay our personal history. I love it when health and survivorship topics return to basics. Humans are wired to be in groups, to talk and to interact. Those bonds, and strengthening them, is key to health.

    Siting on the front porch telling stories used to be regular life. Now we call this “peer-to-peer” healthcare. Every Monday evening on Twitter we do this on the #BCSM (breast cancer social media) tweetchat.

    Thanks for a great post. I’m familiar with “The Park” at MD Anderson and have had many lovely conversations with others there.

    -jody

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