By Anna Codrea-Rado, Contributor
When lockdown came into effect in the United Kingdom, Sandra wasn’t worried about how she was going to continue her treatment for her Type-2 diabetes. Seven months prior, she’d started using Changing Health, a digital self-management app for Type-2 diabetes and weight loss.
“I’m doing press ups on the stairs at home and some weight exercises with tins of beans, things I’d never normally do,” Sandra says. “My coach has helped me with all kinds of different [exercises] and showed me what I could change and how.”
Users like Sandra receive a personalized behavior change program straight to their phone to help manage symptoms and improve their health. The program provides a research-based education program via its app, along with bespoke lifestyle coaching over the phone.
Changing Health’s program takes behavioral science techniques and delivers them at scale. A user is referred to Changing Health by a health organization, usually a doctor or their health insurer. From there, they complete a course of learning content on their phone, tablet, or computer, which is personalized based on how they answer questions about their current lifestyle, habits, and preferences. Along the way, they’ll be asked to begin logging their weight, steps and eating habits.
The user is then assigned a dedicated lifestyle coach to show them how to implement what they’ve learned from the app. Their coach will help them create a manageable plan for their lifestyle change and support them to sustain that change, while continuing to log their progress.
At a time when healthcare services are under pressure and it’s difficult for patients to access in-person treatment, could scalable digital programs like Changing Health be the answer?
Type-2 diabetes causes the level of sugar in the blood to become too high and, if left untreated, increases the risk of heart disease, stroke, and blindness. It’s the most common form of diabetes, affecting 30 million people in the U.S., according to the Centers for Disease Control and Prevention. The most effective treatment is lifestyle change such as diet and exercise, which, in some cases, can even reverse the disease.
Many patients, however, struggle to implement these changes. Patients find that weight-loss management programs designed to help their diabetes are too impersonal, focusing on which foods to avoid and how much exercise to undertake. Changing Health’s program uses behavioral psychology to help people build sustainable habits.
“Long-term behavioral change means that people know how to keep up their new habits without the need for further intervention or support.”
—Professor Mike Trenell, CEO and co-founder, Changing Health
“The focus on sustained behavioral change as opposed to a ‘quick fix’ creates positive, clinically significant long term user outcomes,” says Professor Mike Trenell, CEO and co-founder of Changing Health.
He explains that behavior change is about finding small, positive changes you can enjoy and are more likely to maintain for good. This contrasts with a 12-week crash-diet plan or boot camp exercise routine, which are not sustainable and typically result in yoyo weight loss. “Long-term behavioral change means that people know how to keep up their new habits without the need for further intervention or support,” Trenell says.
Trenell’s research shows that when it comes to lifestyle choices, some behaviors are planned or deliberated on, while others are automatic and unconsidered. Picking the same option for lunch every day is automatic, for example, while deciding between takeout and a home-cooked meal is deliberated on. To facilitate change effectively, the patient or practitioner needs to understand which type of behavior they’re influencing.
Behavior-based weight loss programs are known to be effective. In 2018, the U.S. Preventive Services Task Force analyzed 89 programs and found that “intensive, multi-component behavioral interventions in adults with obesity can lead to clinically significant improvements in weight status and reduce the incidence of Type-2 diabetes among adults with obesity.” The report also found that risk factors of these programs were “small to none.”
According to Trenell, people feel more empowered by behavior-focused programs. “By putting the user at the crux of their health management in making sustainable behavioral change the key, users become self-reliant in managing their own well-being effectively,” he says. “This ensures they don’t need the support of a third party, who won’t be there forever, to keep up their lifestyle change long term.”
As a white label product, Changing Health is paving the way for scalable healthcare services. “All individual programs are delivered on one digital platform, which can be customized to fit any brand,” Trenell says. “The behavioral change platform provides a bespoke program for the individual user and is curated in a way which allows it to be customized and scaled for any partner.”
One of the organizations using Changing Health’s platform is the U.K.’s National Health Service (NHS), which incorporated it into a national diabetes prevention program in 2019. For a cash-strapped national health service, scalable systems offer a way to deliver vital treatment and services to more patients in a more effective way.
“Scalable digital services can improve the efficiency of the patient journey and create consistency of care standards.”
—Dr. Yusuf Rajbee, partner, Portland Medical
“The pandemic this year has brought into sharp focus how behind the NHS is in terms of digitization,” says Dr. Yusuf Rajbee, a partner at the NHS medical practice Portland Medical. “Scalable digital services can improve the efficiency of the patient journey and create consistency of care standards.”
The potential benefits of such systems include aiding data capture, improving clinical monitoring and outcomes, as well as driving improvement and research. “We need sophisticated digital tools to support the decision making of clinicians so that they can use their expertise where it is needed,” Rajbee says.
In growing its digital offering, Rajbee’s practice uses DoctorLink, a digital patient triage system. “At Portland Medical, we have recognized that scalable digitalization is something that needs to become embedded in day to day care,” he says. “With such systems, patients will get appropriate and safe advice and identify those that need live clinical intervention.”
While digital healthcare services still has some way to go before they reach full scalability, for those already using them the results are clear. “I feel in a much better place now,” Sandra says. “I’ve lost 45 lbs. on my lifestyle change program and it’s completely changed my life.”