Population Health

Having just driven up to Maine (half the US eastern seaboard) I was exposed to the population at large. While people-watching  at rest stops, traffic jams and city streets, I started thinking about population health and the APTA’s “transforming society” aims.

My first reaction was “Ha, yeah right.” My second reaction was “Hahaha, yeah right.” Now, it’s not that we cannot treat any and all of these individuals within our scope in all movement, pain and return-to-QOL aspects, we certainly can. But “transforming society” is not as simple as treating patients.

The “transforming society” focus is basically on modifiable health factors. Health is driven by individual behavior, and behaviors (of a large nature) are driven by culture. Populations are culture. You notice it in new towns quite easily, maybe even your town. Everyone is jogging, or there are kayaks on the roofs of most cars, or the hipsters have come in and everyone is biking to work, etc. Or, perhaps everyone hangs out at the 7-11, or eats chicken-wings and watches football from the couch. A host of factors can drive culture: the economy, the geography, the town history, family history… culture is there and it permeates all interaction… and that is what we’re trying to change: the culture of the population.

Now, how does culture change happen? Does it occur top-down? Grass roots? Social pressure? More information on decisional outcomes? Understanding statistics?

In any respect, behavior changes when one is ready. Enter the Transtheorectical Model of Behavior Change. 

  • PreContemplative Stage (not ready): They are not ready for change at this point. They do not know there is a problem or do not know there is a way to address anything negative in their lives (learned helplessness).
  • Contemplative Stage (getting ready): They are aware of a problem and of some change actions, but are still aware of the benefits of not doing anything. The idea of change can seem too difficult.  In other words, they are not ready to take any immediate, actionable steps towards fixing things, although they know steps exist and there are benefits to those steps.
  • Preparative Stage (ready!): They are ready, they have thought (seriously) about change and what it takes including joining a gym, buying a book on finance, throwing away the cigarettes, etc. They are ready to be offered an “actionable step.” Read this as: “sign me up for that 5K run/walk, I’m ready to try this.” (*that actionable step will not work for those in prior stages… the gesture would be fruitless)
  • Action Stage (we doin’ this!): They are doing something about it. They are in the gym 4x a week, they are eating within their caloric expenditure, etc. Action stage is defined as the first 6 months of a change behavior. The behavior must be observed (objective) and meaningful to the goal (ex: going to the gym 1x a month for 6 months to loose weight is not Action, it falls under Preparative.)
  • Maintenance Stage (fine tune): They are performing the desired behavior and are fine-tuning it within their lives.  Their focus is not the behavior, but the avoidance of “relapses” out of their new behavior. This stage is excellent, but they are still susceptible to dropping the ball and not making it to the next stage.
  • Termination Stage (ingrained into self): They are no longer changing their behavior, the actions are now part of who they are. This is a fascinating phase, as there is no will power associated with continuing the actions and a thinking-shift has occurred.  They have become a different person. (you will notice this with yourself; it is all the things you do on a regular basis that you do not need any encouragement to do, they are… you.)


*Great link here to ProChange for more detail on the Model.

One of the purposes of this model is to aid us in choosing how to help people through their change.Our message must have meaning to the individual.

What stage is America in? Can a health care group (APTA)  turn a culture around… Literally transform society? If so, what might that look like?

To become “culture,” self efficacy and self control of modifiable health factors must reach and exceed the “tipping point” and cross the chasm for the trend to catch on.

Law of Diffusion of Innovation

Our role in making this societal behavior change is to be a helpful guide for the individuals in our communities and our patients as best we can, within their ability and readiness to change. Additionally we must avoid the temptation to provide” bad-movement” fear-mongering and pathokinematic imagery/explanations to those not moving in a healthy direction. If change is to occur, we must be the right catalyst: ex, matched with each person’s (society’s?) readiness to change. Again, I refer you back to the “Service Plaza” on the New Jersey Turnpike- a collective group (sample) of the population…  how might one determine their Readiness to Change?

Matt D

One thought on “Population Health

  1. Pingback: A Year In Review: II | PTbraintrust

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