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  • 1. Mobile Health 2012 May 17, 2012 The Future of “Baby Steps” The Health Benefits of Success Experiences David S. Sobel, MD, MPH Director of Patient Education and Health Promotion Regional Health Education The Permanente Medical Group, Inc. Kaiser Permanente Northern California 510-987-3579 david.sobel@kp.org1
  • 2. Language Matters What is the origin of “Baby Steps?” a) “Mother May I” Game? b) Bill Murray? c) BJ Fogg?2
  • 3. Is the “baby” in Baby Steps… A B  empowering?  patronizing?  inspiring?  condescending?  engaging?  insulting?3
  • 4. Do you prefer? A B  Baby Steps?  Simple Steps?  Small Steps?  Tiny Steps?4
  • 5. The Holy Grail of “Baby Steps” What if “baby steps” do not lead to sustained behavior change and ongoing health habits?5
  • 6. A Tale of Donkeys http://www.ishkbooks.com/mulla_nasrudin.html6
  • 7. 7
  • 8. How does behavior effect health? DIRECT EFFECTS of behavior change on health  Exercise, diet, smoking, alcohol/drugs, sleep, preventive care, medication adherence, etc. INDIRECT EFFECTS of successful change  Enhanced mood and confidence8
  • 9. The Mystery Begins… “We were able to demonstrate only weak associations between changes in behavior and changes in health status.”9
  • 10. Chronic Disease Self-Management: Healthier Living- Managing Ongoing Health Conditions Workshop Small groups of people with different diseases 2 ½ hours a week for 6 weeks Peer-led workshop Content: skills for symptom management, exercise, nutrition, problem-solving, communication, advanced directive Process: Self-efficacy, action planning, sharing *Chronic Conditions Self-Management Program Lorig K, Holman H, Sobel D, Laurent D, Gonzalez V, Minor M: Living a Healthy Life with http://patienteducation.stanford.edu/ Chronic Conditions, Palo Alto, CA: Bull, 200610
  • 11. Chronic Disease Self-Management: What we learned about OUTCOMES Outcomes  Improves health behaviors, self-efficacy and health status  Cost effective  Outcomes are long-lasting and robust  Replicable Lorig K et al Medical Care 1999;37:5-14 Lorig K, Sobel DS, Effective Clin Practice 2001;4:256-262 Lorig K, et al Medical Care 2001;39:1217-122311
  • 12. Chronic Disease Self-Management: What we learned about PROCESS Helping others helps  People benefit themselves from helping other people  Social comparison: “Things could be worse…”  Peer support and commitment Confidence counts  Changes in health behaviors were not predictive of improvements in health outcomes  Self-efficacy or confidence was associated with health outcomes  Change the trajectory Lorig, Health Ed Quarterly 1992; Lorig K, Arthritis and Rheumatism. 1989; Ornstein R, Sobel D: Healthy Pleasures. 198912
  • 13. Simple Steps to Health Simple Simple Steps Steps Exercise Confidence Healthy Eating Sustained Success Optimism Smoking Health Habit Experience Self-Efficacy Preventive Care Mood etc. etc. Improved Improved Health Health13
  • 14. So… HOW can we create success? 3 Brief Tales of Trout, Tide, and Tires14
  • 15. Find their Passion What do you REALLY ENJOY?15
  • 16. Discover their Solutions Take your meds! Laundry Detergent16
  • 17. Celebrate their Success17
  • 18. Engaging People in Successful Change 1. Find their Passion 2. Discover their Solutions 3. Celebrate their Success18
  • 19. The Benefits of Failure?? • “Baby Steps” approach is designed for success • When might failure increase motivation, skill, and chances of future success? • When might failure increase appreciation and celebration of future success?19
  • 20. Thank you…20
  • 21. Resources for Change21
  • 22. Making Change Easier22
  • 23. Change and Willpower23
  • 24. Resources for Emotional Health and Wellness24
  • 25. Resources for Happiness and Wellness25
  • 26. Resources for Happiness and Wellness26
  • 27. Healthy Pleasures: 5 Part Online Video Program YouTube “Healthy Pleasures”27