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.org
1

Language Matters
What is the origin of “Baby Steps?”
a) “Mother May I” Game?
b) Bill Murray?
c) BJ Fogg?
2

Is the “baby” in Baby Steps…
A B
 empowering?  patronizing?
 inspiring?  condescending?
 engaging?  insulting?
3

Do you prefer?
A B
 Baby Steps?  Simple Steps?
 Small Steps?
 Tiny Steps?
4

The Holy Grail of “Baby Steps”
What if “baby steps” do not lead to
sustained behavior change and
ongoing health habits?
5

A Tale of Donkeys
http://www.ishkbooks.com/mulla_nasrudin.html
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7

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 confidence
8

The Mystery Begins…
“We were able to
demonstrate only weak
associations between
changes in behavior and
changes in health status.”
9

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, 2006
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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;39:1217-1223
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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. 1989
12

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 Health
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So… HOW can we create success?
3 Brief Tales of
Trout, Tide, and Tires
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Find their Passion
What do you
REALLY ENJOY?
15

Discover their Solutions
Take your
meds!
Laundry Detergent
16

Celebrate their Success
17

Engaging People in Successful Change
1. Find their Passion
2. Discover their Solutions
3. Celebrate their Success
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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

Thank you…
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Resources for Change
21

Making Change Easier
22

Change and Willpower
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Resources for Emotional Health and Wellness
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Resources for Happiness and Wellness
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Resources for Happiness and Wellness
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Healthy Pleasures:
5 Part Online Video Program
YouTube
“Healthy
Pleasures”
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