Tag Archives: social media

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.


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

Social media advocates now have something to cheer about… sort of

[tweetmeme source=”Healthmessaging” only_single=false]Over the last year or two, lots of people have been jumping on the social media bandwagon, i.e., Twitter, Facebook, and so on. There has been a lot of talk about how social media and social networking will revolutionize health care…but little evidence to back this talk up.   Until now that is.
Before I get to the evidence that I referred to, I need to clarify something. The goal of social media as I understand it is to get people talking, sharing information and creating new ideas.   As applied to health care, one of the goals of social media is to get people/patients with like medical conditions taking, sharing and supporting one another.  Health care researchers refer to this phenomenon as peer support.   Peer support is not new to health care. Disease specific support groups (Breast Cancer, Diabetes, etc.) have been around for years. “Group” physician office visits comprised of patients with the same diagnosis have been around for years as well.
The Study
Now to the evidence. As anyone with a chronic condition or who treats patient with chronic conditions knows, patient self care is critical. Knowledge, skills and confidence are prerequisites for effective self care management.
A random controlled study recently published in the Annals of Internal Medicine looked at the efficacy of two alternative approaches helping patients with diabetes develop self care management efficacy:

  • one-on-one telephone conversations between two patients (of similar age)with diabetes
  • telephonic nurse care management

Male diabetes VA patients were randomly assigned to one of these two groups.  The HbA1c levels and blood pressures of patients assigned to both of the above intervention groups was measured at the start of the study and again at 6 months.  Patients in the peer support reviewed their test results, talked about care plans and received brief training in peer communication skills.  Peer partners were encouraged to call each other at least once a week.

Patients in the nurse care management group reviewed their test results, receive information about diabetes self care management and available care management services, and were encouraged to schedule follow-up telephone calls or face-to-face visits with that nurse care manager.

The Results

The study found that:

  1. patients in the peer support intervention achieved HbA1c levels that were 0.58% lower on average than those of patients who received nurse care management.
  2. patients in the RPS group with baseline HbA1c levels greater than 8.0% achieved a mean decrease of 0.88%, compared with a 0.07% decrease among those in the NCM group.
  3. patients on insulin in the peer support intervention with HbA1c level >8% were more likely to have their treatment intensified.
  4. patients in the peer support intervention reported a higher level of “diabetes-specific social support.”

These differences are both statistically and clinically significant.


The peer support intervention (like the nurse care management intervention) involved older males (average age of 62 years).  Older men are the last group I would have expected to pick up the phone and call another older male for information and support.  Presumably if peer support is well received by this group one can expect a broader adoption among other segments of the population.

The study provides hard evidence that peer support provided over the telephone can improve HbA1c levels among diabetic males.

The study presumes some level of knowledge and training in peer support communication skills among participants.

Take Aways

This study is one of the first randomly controlled studies to document the efficacy of a peer support intervention for a chronic condition.

This study did not look at web-based peer support. More research is needed to document efficacy of peer support delivered via the Internet, including e-mail and text.


Heisler, et al.  Diabetes Control With Reciprocal Peer Support Versus Nurse Care Management – A Randomized Trial. Annals of Internal Medicine. 2010;153:507-515.

Dale, J. et al.  Peer support telephone calls for improving health. The Cochrane Library. 2009, Issue 3.

Patient-centered Care and Physician Use of Social Media

[tweetmeme source=”Healthmessaging” only_single=false]I came across a piece in USA Today this week about “Doctors who are not on Facebook, Twitter and blogs risk becoming irrelevant” by Kevin Pho, MD, author of the KevinMD blog. This article prompted the following post.

The Patient-Centered model of care is predicated among other things on physicians factoring in knowledge of the “person behind the patient” into their treatment.   That’s means understanding and, where practical, honoring the patient’s beliefs, values and preferences.   In order for a communication between a physician and person (patient) to be “patient centered,” it must be congruent with patient preferences for how they want their physician to communicate with them.

So Just How “Patient Centered” Is Social Media?

Let’s consider test result reporting to patients.   If you are among the 5% of patients who (in very recent large-scale studies) indicate they want to receive normal test results by e-mail for example, e-mail results reporting is very patient-centered. Only 1% of patients prefer receiving abnormal test results via e-mail.   Social media, e.g., e-mail, is not very patient-centered however if you among the other 95% of patients that prefer to be notified of normal and abnormal test results by telephone, snail mail, or in person visits with your doctor.   I understand that e-mail is not necessarily considered “social media” like Twitter, Facebook, or blogs, but it is the only “indicator” we have to date in the research literature.   I also acknowledge that non-physician blogs and social networking sites such as PatientsLikeMe show great promise in building self care management skills, confidence and support among people with similar chronic disease conditions.


This is not to say that physicians should avoid social media when communicating with patients.   I am just saying that, according to the evidence, social media is not for everyone at this point.    No doubt patient preferences involving social media will evolve with the development of new applications and privacy protections…but we are nowhere near that point yet.

From my vantage point, when it comes to communicating with patients, physicians’ time would be much better spent by:

  1. Learning what their patient preferences are (with regards to communications, medications, exercise, nutrition, etc.).
  2. Tailoring conversations with patients during office visits to their preferences and concerns. The evidence shows that by doing, physician can more effectively engage patients, increase patient adherence, reduce cost and improve outcomes and satisfaction.

I have yet to see large scale studies that shows how social media can do that.