How an interactive self-portrait can transform health behavior through time travel, points of self care, and the power of pairs
Six months ago, my cardiologist friend Dr. S was huddled in front of our neighborhood café with the last stub of a cigarette still smoking between his fingers. He started to cough and deftly retrieved his albuterol dispenser. As he exchanged successive puffs between a burning cigarette and the pressurized canister of an asthma inhaler, I braced for potential combustion.
Like nearly half of all American adults, Dr. S suffers from chronic disease, conditions that people have a strong degree of ability to ameliorate through their own actions. According to the CDC, chronic conditions account for 70% of deaths and more than 75% of the now $3.8 trillion cost of healthcare every year in the United States.
Chatterjee, A., Kubendran, S., King, J., & DeVol, R. (2014). Checkup Time: Chronic Disease and Wellness in America. Milken Institute.
Dr. S was keenly aware of the most sensible, effective, and low cost treatment available for his asthma, pre-diabetes, and hypertension. He should stop smoking, improve his nutrition, increase his physical activity, sleep better, and reduce his stress. But the needs of the immediate moment – for a cigarette, fast food, all-nighters, or being a couch potato – can sometimes trump the longer-term consequences we frequently defer to some indeterminable point in the far future.
Dr. S was in a pre-contemplation stage of prospective health behavior change with no intention to take any action in the foreseeable horizon. “I’ll quit smoking and join a gym sometime next year whenever my practice is less busy,” he would say.
If a physician with decades of experience cannot heal himself of his own toxic lifestyle, what hope is there for the rest of us? How can our healthcare system possibly compensate for the deleterious effects of billions of unhealthy actions (or inactions) we inflict upon ourselves every single day?
Healthier communities start with healthier individuals. As health entrepreneurs, we have to help people build healthier day-to-day habits that shape overall wellness and well-being. We must address health as an evolving and relative state of being – not a static and binary one. Health is a lifelong journey, not a destination.
Effective health behavior change interventions must be tailored for each person by finding creative ways to:
1. Assess past, current, and potential future states of health
2. Promote self-efficacy, the belief in one’s ability to accomplish goals, and
3. Develop, follow, and iterate personalized mental models, the frameworks for making daily decisions that are self-determined and self-initiated.
One size does not fit all. Our differences define us as individuals, and they heavily influence our successes and failures in preventing and managing chronic diseases.
Just as 2-D selfies depict our unique faces in some activity or environment, 3-D Healthy Selfies™ visualize our entire bodies as an interface to engage with our own clinical data, wellness planning, and self-tracking. They can be used within any point of self care, dyad peer support models, time travel simulations, and seeing ourselves with greater objectivity to drive motivation and improve outcomes.
In partnership with Boston-based Perfetch LLC, my company Medical Avatar launched the 3-D Healthy Selfie™ Cube, which will be on display here at this year’s AHA Hi2 Forum. The Cube uses infrared sensors to generate a realistic 3-D avatar of users along with exact body measurements and other metrics. Access to a suite of customized nutrition, fitness, and diabetes management mobile apps is provided via the 3-D Healthy Selfie.™
The 3-D Healthy Selfie™ Cube by Perfetch and Medical Avatar as seen at Oakwood Healthcare’s Wellness Center near Detroit, MI.
The 3-D Healthy Selfie™ is an immediate shift towards patient-centered communication. In cognitive psychology, the self-reference effect is our tendency to remember information more effectively if it is directly related to our sense of self. In studies starting in 19771, participants were more likely to recall adjectives that described themselves (self-referent encoding) compared to words with a specific letter (structural encoding). Self-referential content is more memorable because the self is a well-developed concept that is constantly used throughout one’s life. Connections to this concept can help trigger elaboration and a more effective organization of available information.2 A realistic 3-D image of ourselves further reinforces this association to self.
When we tailor and personalize health information, we can increase awareness of the discrepancy between current and ideal behaviors to motivate change. For example, when informing Dr. S that he was not getting the amount of physical activity recommended by the Surgeon General, our health app could present his 3-D Healthy Selfie within this personalization framework:3
“You indicated that you would like to be a better role model for your children as well as your patients, but you are having trouble finding the time for regular exercise.”
“You also mentioned that you are concerned about getting injured while exercising.”
Suggested Actions Based on Content Matching
“Based on the information you gave to us, we have provided a list of possible strategies…”
When we visualize self-referential health information, we can improve awareness of an intervention’s efficacy to better motivate change. In a pilot study, I was working with post-bariatric surgery patients who were beginning fitness programs using weights. Participants who weighed themselves at weekly intervals frequently become discouraged when they gained weight, even if the weight could be attributed to additional muscle mass gained through training. Participants who had 3-D selfies generated each week, however, reported higher satisfaction ratings with their progress independent of weight loss or gain. One user wrote, “I weigh a little more since last week, but I can see the shape of my body changing. I’m on the right track!”
Points of Self Care
3-D Healthy Selfies™ and self-referential content should be active in all the places where we live our daily lives. “Points of care” refer to when clinical services are provided to a patient during a doctor’s office or hospital visit. “Points of self care”, a term I coined with my business partner Lawrence H. Krampf, is where people control and initiate their own micro-actions every day to improve their health. Points of self care may include your home, office, gym, grocery store, or drug store (we are developing Points of Self Care™ as a digital map on your phone to track health-related activities in any of these locations).
Activating points of self care is crucial for reducing the costs of healthcare. As Lisa Suennen stated in the previous blog post, getting healthy doesn’t just occur when you get hospitalized. Effective treatment of chronic conditions in the doctor’s office or hospital is expensive and unpractical, because daily actions like glucose monitoring for diabetes are required. For chronic diseases, utilizing your points of self care every day would likely have a great impact on outcomes than the points of care with providers at far less frequent time intervals.
Power of Pairing
Peer-led health behavior change is another utility of the 3-D Healthy Selfie. Peer support, within the health care context, is the provision of emotional, appraisal, and informational assistance by a created social network member who possesses experiential knowledge of a specific behavior or stressor. Peers have similar characteristics as the target population to better address health-related issues of a potentially or actually stressed focal person.4
Typically, peer support in the dyad model has less training than a peer “expert” who presents to a group, or a patient navigator, or paraprofessional. Dyad-based interventions have typically used in-person meetings at public places (churches, outpatient clinics, etc). One-on-one exchanges between peers and the focal persons is facilitated by sharing data between the participants’ 3-D Healthy Selfies.
Health Time Travel
Most of us have a “planning fallacy” when thinking about our future. Or we have an overly optimistic view of what we are going to do and how easy it will be to do it. Episodic future thinking, or the pre-experiencing of the future from a personal perspective, may help counter this bias by increasing the elaboration of future plans and accuracy of future predictions. The more vivid the imagining, the better the thinking is at changing future views, like delayed discounting, or when individuals prefer a smaller reward in the present compared to a larger one in the future.
Delayed discounting is a robust phenomena documented in individuals who smoke and are obese. In studies of obese and normal weight individuals, a randomized episodic future thinking intervention lead to individuals expressing less delayed discounting and eating less food in a buffet tasting challenge. The 3-D Healthy Selfie can be useful in prompting vivid episodic future thinking by showing an individual their possible future self and sparking an individual’s planning about how to get there.
Dr. S participated in a health time travel study I recently conducted at Columbia University to compare different modalities for communicating personalized health content. For an embodied cognition condition, research participants placed their left hand into a metal box with a computer screen on top. As the smoker heard about premature aging of the skin, bone density loss, and vasoconstriction caused by smoking, they would see the effects on their own hand as a real-time video image.
A study participant sees real-time video of his own hand suffering from the effects of vasoconstriction caused by smoking.
I met Dr. S this past weekend, and he told me, “Every time I held a cigarette between my fingers and was just about to light it, I kept looking at my hand. I could see the premature aging, bone density loss, and vasoconstriction visualizations inside my hand. And I kept thinking about all the deleterious effects of smoking your damned study talked about.” Dr. S of course already knew all of this information intellectually and would impart these kinds of details to his patients – but seeing the 3-D Healthy Selfie of his own hand had hit a nerve. After twenty years of regular tobacco use, he registered earlier this month for a smoking cessation program. “We’ll see how it goes,” he said. “No promises.”
When we stepped outside the café, Dr. S reached into his pocket, paused, and smiled. “Don’t worry. I’m getting my phone, not a cigarette.”
If we can get even the most obstinate of physicians changing their unhealthy behaviors, perhaps there’s hope for the rest of us as well.
Written by VIRGIL WONG
with contributions by VIVIAN YEH, PhD
Originally published on April 5, 2015 for the American Heart Association’s Hi2 Forum. Updated on July 21, 2017.