Boomer Living Broadcast

Johannes Boshkow - Behavioral Science: The Key to Better Patient Outcomes for Baby Boomers

October 22, 2022 Hanh Brown / Johannes Boshkow Season 3 Episode 160
Boomer Living Broadcast
Johannes Boshkow - Behavioral Science: The Key to Better Patient Outcomes for Baby Boomers
Show Notes Transcript

Imagine for a moment that you have been diagnosed with a chronic illness. Perhaps it's diabetes or heart disease. You know that if you don't take care of yourself, the consequences could be severe. So you diligently follow your treatment plan, checking your blood sugar levels or taking your medication every day without fail.

But then one day, life gets in the way. You miss a dose of medication, or you forget to test your blood sugar. It seems like no big deal at the time, but soon enough, you start to slip into old habits. Before long, you're back to square one, struggling to manage your illness.

And that's where behavioral science comes in. Behavioral science is the study of understanding human behavior. It helps us understand how we can change our behavior for the better, and how we can make lasting changes in our lives.

It's not easy to change our habits, but behavioral science offers us a roadmap for success. With enough patience and effort, we can overcome any obstacle and achieve our goals. So if you're struggling with a chronic illness, don't give up hope. There is help available, and with the right tools and support, you can succeed.

Today my guest is Johannes Boshkow. Johannes always had a fascination with the way things worked - how molecules interact to create physical and chemical phenomena. This curiosity led him to study chemistry at some of the world's most renowned universities: ETH Zurich in Switzerland and Harvard University in the US.

After completing his doctorate, He then joined the business development team at Observia in 2020 where he works on bringing innovative patient support to markets worldwide. He is fascinated by the ways that technology can improve people's lives, and he loves working at Observia because it combines his passion for life sciences with his interest in cutting-edge technology.

Find Johannes on LinkedIn: https://www.linkedin.com/in/johannesboshkow/

[0:00:00]
Hanh Brown: Hi, I'm Hanh Brown, the host of the Boomer Living broadcast. On the show, we address topics that matter to the baby boomers. Thank you so much for joining today and I'm more excited that you're here. So, please participate, ask questions.

[0:00:17]
Hanh Brown: You probably are passionate about this topic and that's why you're here. So, ask away and we'll do our best to answer your questions. Thank you again for joining us. For the folks in the audience, let us know where you're calling from, where you're dialing in, and what industry you're in.

[0:00:37]
Hanh Brown: So today's topic is behavior science, the key to better patient outcomes for baby boomers.

[0:00:45]
Hanh Brown: Imagine for a moment that you've been diagnosed with a chronic illness. Perhaps it's diabetes or heart disease.

[0:00:50]
Hanh Brown: You know that if you don't take care of yourself, the consequences could be severe, so you diligently follow your treatment plan, checking your blood sugar levels, and taking your medication every day without fail.

[0:01:06]
Hanh Brown: But then one day life gets in the way. You miss a dose of medication or you forget to test your blood sugar.

[0:01:14]
Hanh Brown: It seems like no big deal at the time, but soon enough you start to slip into old habits, and before long, you're back to square one, struggling to manage your illness.

[0:01:26]
Hanh Brown: Well, that's where behavior science comes in. Behavior science is a study of understanding human behavior. It helps us understand how we can change our behavior for the better.

[0:01:39]
Hanh Brown: And how we can make lasting changes in our lives. It's not easy to change a habit, but behavior science offers a roadmap for success.

[0:01:49]
Hanh Brown: And with enough patience and effort, we can overcome obstacles and achieve our goal. So, if you're struggling with a chronic illness, don't give up hope.

[0:02:00]
Hanh Brown: There is help, and with the right tools and support, you can succeed.

[0:02:05]
Hanh Brown: So today, my guest is Johannes Boshkow. Johannes has always had a fascination with the way things work: how molecules interact to create physical and chemical phenomena.

[0:02:17]
Hanh Brown: This curiosity led him to study chemistry at some of the world's most renowned universities in Zurich, Switzerland, and Harvard University, the U.S.

[0:02:28]
Hanh Brown: After completing his doctorate, he then joined the business development team at "Observe You", where he works in bringing innovative patient's support to the market. He's fascinated by the ways that technology can improve people's lives and he loves working at Observe because it combines his passion for life sciences with an interest in cutting edge technology.

[0:02:48]
Hanh Brown: So Johannes, welcome to the show. How are you today? 

Johannes Boshkow: I'm doing well, thanks for having me.

[0:03:01]
Hanh Brown: Well, thank you. Where are you calling from and how are things over there?

Johannes Boshkow: I'm calling from Switzerland, right in the middle of it, close to Luzern.

[0:03

:12]
Johannes Boshkow: Yeah, we're going through a bit of a cold spell, but it's good for a lot of people here.

[0:03:25]
Hanh Brown: Hey, congratulations on your new addition, I know I think last time we talked, you had some exciting news there.

[0:03:27]
Johannes Boshkow: Yeah, well, it's still a few months away, but we're expecting our first child. It's really great.

[0:03:48]
Johannes Boshkow: As for who I am, personally and professionally, I have a strong interest in how things work. I took that interest to the road and studied chemistry. I did very fundamental research, which was interesting but I wanted to move more to the business world. Now I try to apply the same kinds of concepts connected to the healthcare arena, specifically within the realm of behavioral science. 

[0:04:21]
Johannes Boshkow: I work within healthcare, specifically focusing on how to best help patients manage chronic illnesses.

[0:04:24]
Hanh Brown: Thank you so much for your time to come here and shed light on the important work that you folks are doing. We spoke earlier about how chronic illness and habits are intertwined and it can be very severe if we're not able to manage them, so I appreciate the work that you do.

[0:04:48]
Hanh Brown: Let's talk about chronic patients that have difficulty adhering to their treatment plan due to underlying issues. People have a lot of trouble following the treatment because they don't understand why we need to take all the pills and shots. Can you explain what causes chronic illness and how it affects the patient's life?

[0:05:07]
Johannes Boshkow: Absolutely. Chronic illnesses are not necessarily the result of poor choices. Generally speaking, we talk of a chronic condition when something lasts for more than a year. Most of them will last until the end of the patient's life. 

[0:05:25]
Johannes Boshkow: The impact that these conditions have can vary significantly. The key to understand is that the disease becomes a part of your life, requiring frequent doctor's visits, tests, or medication that you have to take regularly. 

[0:06:05]
Hanh Brown: So why is it so hard for people to make healthy choices? 

Johannes Boshkow: The human brain has a regimen. If we had to make every decision in our day, like how we walk, which route we take, we would be overwhelmed. So, the brain relies on learned behaviors to make decisions instinctively. In healthcare, however, it's a lot different.

[0:06:24]
Hanh Brown: But just think about it - if you had to make every decision in your day - where you walk, how you walk, which route to take, every single thing you touch - if you had to make a conscious decision every time, you would be overwhelmed. 

[0:06:42]
Hanh Brown: So the way that the brain works, the way that we learn is basically we rely a lot on previous experience.

[0:06:49]
Hanh Brown: For instance, you touch a hot plate once and you learn, okay, this is hot, and you instinctively pay attention the next time. You're not going to think about whether it's safe to touch; you instinctively know what's going on. And that's the sort of feedback that is important for us to learn from. Now, obviously in healthcare, that's a lot different, right?

[0:07:10]
Johannes Boshkow: Yes, you don't immediately feel healthy when you take medication, and you don't immediately feel healthy when you do exercise. So all of that feedback that makes you feel better isn't there. That's why you don't form a good intuition about your health. 

[0:07:30]
Johannes Boshkow: You stick to some certain things long enough and they become a habit and we start feeling better, but it is a tough topic to adopt. And let's not forget, it is inconvenient to pay attention to your health.

[0:07:42]
Johannes Boshkow: Yes, that's an unfortunate truth.

[0:07:45]
Hanh Brown: It's very true. And, you know, chronic patients often feel like they're being judged by their families and friends because they have an ongoing illness.

[0:07:56]
Hanh Brown: How can we help reduce the stigma around chronic diseases?

[0:08:06]
Johannes Boshkow: That's a tough issue. There's two sides to it. From the patient side, often, that stigma is actually overstated. We often fear that stigma more than it actually exists. 

[0:08:26]
Johannes Boshkow: But then on the other side, it is underestimated how much that stigma can actually have an impact. So that means the only way to really address this is to talk about it with your family and your friends, to address the situation directly. 

[0:08:46]
Johannes Boshkow: Understand the concept of that stigma and how it could be impacting you. But fundamentally, you have to be aware of the fact that chronic conditions are pretty common.

[0:09:05]
Johannes Boshkow: So that means it's quite common. So any kind of condition really can't have that much of a social stigma because you're not alone, you're in a pretty large boat.

[0:09:26]
Johannes Boshkow: And when we talk about treatment plans, we also have to consider if your physician gives you specific recommendations on what you should and should not do. 

[0:09:49]
Johannes Boshkow: And with that entire concept, we still don't get around the fact that about half of the patients, every second patient actually has a problem with adherence. So with that social stigma, being afraid of it - you're not alone. It's still a problem, but it's not something that should make you feel like you're alone.

[0:10:11]
Hanh Brown: Okay, so many people

 with chronic illnesses feel like they're a burden to their families and others. What do you think are some ways that we can show them that we care without making them feel pressured or a burden?

[0:10:33]
Johannes Boshkow: It's interesting, these negative feelings are often very distorted because you start to close yourself off. If you feel like you're a burden, you tend not to over-communicate, you start to withdraw. 

[0:10:44]
Johannes Boshkow: This can become a vicious cycle. Our philosophy is that you can only help the patient help themselves. 

[0:11:08]
Johannes Boshkow: You will never fully understand what the patient is going through, even if you have the same condition. So it's important to stay open, be empathetic, try to understand what the patient is going through, and be supportive without being pushy.

[0:11:28]
Johannes Boshkow: Remember, whatever behavior you're trying to change, it's not going to happen by you telling that person what they're supposed to do.

[0:11:47]
Hanh Brown: On a personal level, I have loved ones dealing with dementia, Parkinson's, cancer, diabetes, high blood pressure - you name it. 

[0:12:02]
Hanh Brown: I understand why patients have trouble following their treatment. Sometimes it can feel overwhelming, you're given a long list of treatments and told that you need to take medication for the rest of your life. 

[0:12:22]
Hanh Brown: It feels like too much to handle, so you quickly become discouraged. You don't want to be someone who needs medication just to get through the day.

[0:12:36]
Hanh Brown: You want to be normal. As a result, you have trouble sticking to your treatment plan or you skip doses, or forget to take your medication altogether.

[0:12:45]
Hanh Brown: And every time you fail, it feels like another reminder that you're different from everyone else and that you'll never be normal. 

[0:12:55]
Hanh Brown: So it's easy to feel shame in needing medication. But I believe strongly, even from my personal experience, that there's no shame in being different.

[0:12:59]
Hanh Brown: Eventually, you come to a place where you're able to stick to your treatment plan and then you realize that taking medication doesn't make you less or more than anyone else.

[0:13:14]
Hanh Brown: Actually, needing treatment makes you strong because you're fighting for your life every day. Can you talk about why it's so hard for some people to stick to a treatment plan?

[0:13:28]
Johannes Boshkow: I wonder why that is. The first thing that we're aware of, it's hard. In the past, we had a concept where your physician gives you medication, and often that's just accepted as the way forward. You have to do it. But that's not the case.

[0:13:49]
Johannes Boshkow: Doing something without understanding why you're doing it is just inherently difficult, and it's often underappreciated. The first thing to do is we have to acknowledge that fact, right?

[0:14:02]
Johannes Boshkow: The second part is, having a chronic condition isn't obviously something that you choose. It isn't a failure. If you don't follow a treatment plan, you mentioned that, and I appreciate you sharing personal stories because fundamentally we have to understand that it is also complex. 

[0:14:31]
Johannes Boshkow: Yes, when you have a chronic condition, you become a patient, but first and foremost, you are still a person with your own situations, relationships, issues, challenges, and also dreams about how you want to live your life. 

[0:14:51]
Johannes Boshkow: As you said, you want to be normal and you want to be standard, but that's just not going to happen. Now, we're using the phrase "normal", but I'm also aware that with over half the population dealing with chronic conditions, we could argue about what is actually "normal".

[0:15:10]
Johannes Boshkow: When we have that feeling of being overwhelmed, we understand that it is a tough situation. There's probably no one who comes out of the doctor's office thinking, "Oh yeah, that's easy," or, "I'm super happy with what just happened."

[0:15:30]
Johannes Boshkow: It is fundamentally what we're dealing with. The negative feelings and all of this, you should actually see that as a strong motivator, like the feedback about your health.

[0:15:50]
Johannes Boshkow: As you said, after some time, you find ways of making it work for yourself and, alternatively, very often, it is underestimated that you can actually talk to your physician about it. 

[0:16:03]
Johannes Boshkow: There might be other options available, there might be more explanations that they can give you. Now, I'm not talking about the time of diagnosis. You're too overwhelmed at that stage, but later on, don't forget to mention the sorts of concerns you have with your physician. 

[0:16:23]
Johannes Boshkow: Number one, because the physician might otherwise draw conclusions that are incorrect. If you're not taking your medication, which won't be positive for you. But on the other hand, they might be able to adjust their approach, to give you a little bit of additional help and put you in a shared decision-making scenario.

[0:16:47]
Johannes Boshkow: Once that has happened and you're at the optimal point, there are still things that you can do to cope with it, and there are resources available. You're somewhat special in your situation, but you can count on the

 fact that a lot of people have gone through what you've just been through.

[0:17:07]
Johannes Boshkow: A lot of them will have shared their experiences and their learning, and learning from others is actively beneficial. Seeking out that help can make you more comfortable.

[0:17:22]
Hanh Brown: Here's another reason why people don't follow their treatment plan: side effects. People don't take medication because of side effects. I don't take certain medications because they're hard to swallow or have a bad aftertaste or some side effects. Can you give us some advice on how to deal with side effects of treatment?

[0:17:48]
Johannes Boshkow: I'm not a medical doctor, but you're absolutely right. Actually, I can go a little bit further. We know that a lot of patients will actually associate effects that are referenced with the condition, like your disease progressing and new symptoms developing, with the treatment and therefore don't continue the treatment anymore.

[0:18:07]
Johannes Boshkow: Which makes those effects even worse and, by that point, they might not be manageable anymore, and you'll actually be in a very deteriorated state. Fundamentally, side effects are always, unfortunately, a part of treatment.

[0:18:35]
Johannes Boshkow: The best thing to do is to talk to your physician about that. It's really important to keep them in the loop because there might be other options for you, and also they might be able to give you additional explanations on how to deal with it.

[0:18:55]
Johannes Boshkow: If you've gone through that or maybe you're not getting the support you need, again there's a lot of help out there. Patient groups, patient forums and so on can offer very helpful advice on how to deal with the condition and a very large part of that is how to deal with side effects.

[0:19:15]
Johannes Boshkow: Side effects of medication and dealing with them is a complex process. For some people, simple remedies might work, such as maintaining an appropriate exercise regimen or diet, seeking advice from a trusted friend or family member, or experimenting with alternative treatments. 

[0:19:35]
Johannes Boshkow: You are not alone in this journey. There are others who have had the same problems, and there is plenty of good advice out there. Just make sure that the advice you take is validated.

[0:19:44]
Hanh Brown: Great points. There are a lot of different theories and models out there about behavior change. Each of them has its own individual strengths and weaknesses, but they all share a common goal, which is to help people make healthy changes in their lives. 

[0:20:04]
Hanh Brown: The Stages of Change model is designed to help people understand what it takes to make a change and how to overcome any obstacles in their way. It can be overwhelming to try to figure out which one is right for you.

[0:20:15]
Hanh Brown: Personally, I think the best approach is to first think about what you want to change and why. Do you want to change your behavior because you feel like you should, or because you really want to? Are you trying to change your behavior for yourself or for someone else? Once you have that understanding and sense of motivation, you can start to look at the different theories and models to see which ones make the most sense for you. 

[0:20:39]
Hanh Brown: So, can you talk about some of the most common theories and models about behavior change?

[0:20:55]
Johannes Boshkow: There are many models out there, but I will focus on a few that are relevant to healthcare. The concept of behavior change is not new, but it has some specific applications in healthcare. 

[0:21:14]
Johannes Boshkow: Most of these models were developed for situations like smoking cessation. People know that smoking is unhealthy for them, yet they continue to smoke. So how can we get people to stop smoking? Simply telling them to stop smoking does not work well for the majority of people. 

[0:21:34]
Johannes Boshkow: One of the models you mentioned is the Stages of Change model, also known as the Transtheoretical Model. It's built around a process rather than a single event. It involves stages such as pre-contemplation, contemplation, preparation, action, and maintenance. 

[0:22:14]
Johannes Boshkow: Changing a behavior is not a quick thing. You need to be aware of it and stick to it. Habit formation is crucial in this process.

[0:22:54]
Johannes Boshkow: I like to think about behavior change in terms of habit formation. A habit is something that makes you feel uncomfortable when you don't do it.

[0:23:17]
Johannes Boshkow: In the beginning, taking medication is not a habit because if you forget about it, you probably feel okay. But over time, it becomes a habit. 

[0:23:28]
Johannes Boshkow: Habit formation usually takes around sixty days. So, if you have to take your medication, stick to it for at least two months.

[0:23:44]
Johannes Boshkow: Health is not a one-size-fits-all scenario. Feedback loops typically work for habit

 formation. We typically suggest three or four months as a good benchmark for changing a behavior. 

[0:24:07]
Johannes Boshkow: There are a lot of other models out there. Another common one is called COM-B, which stands for Capability, Opportunity, Motivation, Behavior. 

[0:24:26]
Johannes Boshkow: You need to have the capability to change the behavior, physically being able to do something. For example, you need to be able to physically go for a walk.

[0:24:29]
Johannes Boshkow: You need the opportunity to change. For instance, if you want to go for a walk, you need to have the time and the right environment. 

[0:24:49]
Johannes Boshkow: And lastly, you need the motivation to change. This raises the question of who you're doing it for. All these factors come together to influence behavior change.

[0:25:09]
Johannes Boshkow: Or then we have the chance to actually change behavior. These are some of the principles that you can apply. We've actually developed one of the models ourselves and it's called the Four Free model.

[0:25:29]
Johannes Boshkow: This model combines all of these and is based on a lot of research. It looks at what the underlying drivers are that lead to negative health behavior. This could be anything from not taking medication regularly to not exercising.

[0:26:10]
Johannes Boshkow: The model focuses on four dimensions: social, psychological, financial, and rational. The social dimension relates to how supported you feel by your family and society, and how much social stigma is associated with your condition. 

[0:26:28]
Johannes Boshkow: The psychological dimension takes into account how you respond to authority. For instance, if a doctor tells you to take your medication, will you do it? There's also the aspect of how you perceive yourself in time. 

[0:26:52]
Johannes Boshkow: A lot of people live in the here and now, not worrying about the future. This can impact their decision to take medication, especially if it has side effects they don't want to deal with at the moment, even if it might benefit them in the future.

[0:27:15]
Johannes Boshkow: Another important aspect is the patient's identity. A lot of people struggle to accept that they are a patient. If you don't accept that you're a patient, you're not going to take your medication. 

[0:27:43]
Johannes Boshkow: Financial issues and being able to take the medication also factor in. Then there's the rational aspect, which relates to whether you understand your disease, your treatment, and the benefits and risks of taking your medication.

[0:28:15]
Hanh Brown: Thank you, Johannes, for that in-depth analysis. It's important to know that your company has developed a unique model. I'd like to bring in our other guest, Dr. T. How are you, Doctor?

[0:28:25]
Dr. T: Thank you for having me, Hanh. I think technology is empowering patients to make healthier choices. Technology has the ability to help people adopt healthier behaviors.

[0:28:42]
Dr. T: Cognitive Behavioral Therapy (CBT) is a tool that comes from psychology. It's a way of identifying and replacing negative thoughts and behaviors, which can work quite well digitally.

[0:29:07]
Dr. T: Many tech solutions out there are not optimized for behavior change. So we need to be careful when choosing technological tools. The right tools can empower patients and healthcare professionals to better manage health.

[0:29:49]
Dr. T: But we also have to be honest, it doesn't apply to every patient. It's not a one-size-fits-all solution. 

[0:30:10]
Dr. T: Nevertheless, when done correctly, technology can greatly assist healthcare professionals in helping their patients. Many practitioners lack the time or training to teach patients how to manage their medications, for instance. 

[0:30:36]
Dr. T: Technology can provide alternatives and support for a lot of people. But again, we need to remember it doesn't work for everyone.

[0:30:55]
Hanh Brown: I'm thrilled with what we just discussed, touching on both technology and the cognitive behavioral approach. I'd like to go a bit deeper into the cognitive behavioral approach, and then we'll have a whole section on technology. Cognitive Behavioral Therapy, as Dr. T mentioned, is a form of therapy that seeks to identify and change negative thoughts and behaviors.

[0:31:15]
Hanh Brown: Negative thought patterns of behavior.

[0:31:18]
Hanh Brown: This is based on the belief that our thoughts, feelings, and actions are interconnected, in that by changing our thoughts, we can change our behavior. So, what is its use in treating mental health conditions like anxiety, depression, and eating disorders?

[0:31:36]
Johannes Boshkow: And I guess how does it relate to chronic conditions? Can you talk about in detail about cognitive behavior approach to treatment and provide some examples? Absolutely. I'm really happy to answer. This is a really fascinating concept. So, you think this was developed for mental health treatment, correct?

[0:31:56]
Johannes Boshkow: It's also delivered digitally by the way. This is the most common method today.

[0:32:01]
Johannes Boshkow: And the idea, though, right, is more or less the same because when you think about the mental health issues fundamentally, if we talk about what patients need or what the people suffering from these conditions need, it's ways to cope with their condition. Coping strategies are needed to mitigate any form of negative impact that it can have on your life.

[0:32:32]
Johannes Boshkow: And for many, it's actually not uncommon when we talk about this. As I mentioned at the beginning, you are a person with a disease, so it will become part of your identity, whether you like it or not. And nobody likes that. So, this can create a lot of these negative emotions and thought patterns, which are actually pretty common in mental health disorders.

[0:32:52]
Johannes Boshkow: It's not uncommon for someone with a chronic condition to develop depression, and that is something that can definitely happen.

[0:33:03]
Johannes Boshkow: And because these thought patterns are the same, you can actually treat them similarly. You can actually look into what is it that stops me from taking my medication. It's the same negative thought, like you are afraid of the side effects. This is something common in depression. 

[0:33:26]
Johannes Boshkow: A spiral of fear, something happening in your life that just gets exacerbated in your head, and that's the sort of thing that can actually cause you to avoid taking your medication because you are afraid of the side effects. This fear won't go away so you need to replace that negative thought pattern with something a little bit more positive, and associate it with something that is more positive. This will help you cope with it, and the principles are actually not that complicated.

[0:34:00]
Johannes Boshkow: Reasons for avoidance can be difficult, but techniques like setting achievable goals, maintaining goals can help you overcome specific obstacles. Techniques like mindfulness, medication and just being aware of what you're doing, controlling, learning not just to harbor any negative emotions. These are concepts that are fairly easy to incorporate and when they are incorporated, they will also help in tackling specific chronic conditions.

[0:34:36]
Johannes Boshkow: Problems can be treated fundamentally.

[0:34:43]
Hanh Brown: So we've talked about how behavioral science can help create and customize therapy. What I'm going to ask you about next is, what is a nudge and how can nudges encourage healthy behavior?

[0:34:49]
Johannes Boshkow: Actually, a nudge is something that earned the book "Nudge" a Nobel Prize

 a few years ago. It's a fascinating concept in economics. A nudge comes from the assumption that people should make positive decisions.

[0:35:20]
Johannes Boshkow: But they won't because of certain biases that are at play. A nudge is basically a way of helping someone overcome a bias by presenting the positive action to them in a different way. This is a very theoretical concept.

[0:35:40]
Johannes Boshkow: One of the key examples is when you're getting food in a buffet, whatever comes first is more likely to take a large part of the plate. So now pay attention to what you put first. If you put the hamburger first, then hamburgers are more likely to end up on your plate. If you put salad first, salad is more likely to end up on your plate. 

[0:36:00]
Johannes Boshkow: That is a classic example of a nudge. A nudge is fundamentally building on the bias, which is the fact that you're not thinking about the topic. So you might want to either use the fact that somebody is not thinking about doing something, or you want to phrase it in a way that will actually make them think about it. The moment you start thinking about it, you usually make pretty good decisions.

[0:36:50]
Johannes Boshkow: And when you think about nudges acting in health care, this is pretty interesting. I can give you an example. Have you heard about the experiment that was done, by the way, this isn't scientifically accurate, it was a concept I heard from a friend about how you get people to sleep more? Sleep deprivation is actually a pretty common problem, right?

[0:37:10]
Johannes Boshkow: Is it something I've actually encountered in the context of chronic conditions we're talking about? A lot of times, actually, a lot of these chronic conditions depend on you sleeping well and resting enough because that is when your body heals.

[0:37:26]
Johannes Boshkow: So, if you want someone to sleep more, right? The optimal time is eight to nine hours every night. And you have someone in front of you who sleeps like six hours a night, so two hours short. Now, you tell them, against this lack of activity, every two hours that you don't sleep every night will take away...

[0:37:46]
Johannes Boshkow: They will end up being hours that you don't have at the end. Now, the way you phrase that is quite important.

[0:37:55]
Johannes Boshkow: If I tell you, for example, every hour that you sleep additionally will add to the end of your lifetime, that's a pretty enticing concept. It makes you want to ponder. But if I phrase it differently, emphasize the negative context, and I tell you every hour that you don't sleep at night will take away an hour from your life span, at the end, that's much more compelling, about twice as much to most of us.

[0:38:34]
Johannes Boshkow: And we have to be aware, by the way, that nudges need to be tested. It's not like someone can just easily say I'll phrase the question this way and it's going to be better, which is why nudges are really very useful in your pilot. And actually, when you work with someone who you're trying to get on medication, and you're trying to nudge them...

[0:38:58]
Johannes Boshkow: Be aware that some of the nudges are going to stick, and some are not going to land. Some work on one person, but not on another. But when I realized that reading a book and not bothering my father led him to stop smoking, when I was a wee little kid, stopping, he didn't stop because I painted a picture for him...

[0:39:18]
Johannes Boshkow: Was it worth it? The results were good. I painted a picture with him, and this encouraged him to stop. 

[0:39:26]
Johannes Boshkow: These are the sorts of nudges, they just have to be keen on how you can use them. There's a whole range, right? Like you can highlight the gap. If someone has a certain behavior, you ask, "Would you recommend that to your child? Would you recommend it to your parents?" 

[0:39:56]
Johannes Boshkow: Are you thinking negatively? I'm highlighting the risk that is associated with something. And these are all things that will end up influencing behavior in a way that might be more healthy if they're presented in the right way. But it's also important to remember that nudges can only be used in a positive direction, they cannot nudge someone into something that will be bad for them because the more they start thinking about it, they will be less likely to follow through.

[0:40:16]
Hanh Brown: Okay, wow. I have to remember all these things. These are very good tips when you're raising children as well.

[0:40:23]
Johannes Boshkow: But be careful not to nudge in the wrong way.

[0:40:30]
Hanh Brown: Oh, I remember that. But speaking of that...

[0:40:35]
Hanh Brown: Because I have issues with my daughter's sleeping habits, she doesn't sleep enough. Quite a common problem, you know. And not eating healthily enough, but that's a separate topic. Let's first narrow down the scope of our conversation. Let's talk about digital channels and care, I think this is what you were referring to. What do you think are the benefits of using digital channels to follow doctor's recommendations for a healthy lifestyle?

[0:41:00]
Johannes Boshkow: So, fundamentally...

[0:41:02]
Johannes Boshkow: I think I mentioned that at the beginning. The most important part to remember is that digital channels present a great opportunity.

[0:41:16]
Johannes Boshkow: Whenever we talk about digital transformation, and people start getting scared, you can actually see that. People start getting scared of the idea that they're not seeing a single person anymore. They're interacting with a computer that tells them to do something, then they go on with an app that reminds them to take their medication. 

[0:41:52]
Johannes Boshkow: Digital is really a great alternative where someone has access, where someone can't get to a certain specialist, or get the right advice from their physician. As I mentioned...

[0:42:10]
Johannes Boshkow: You need to talk, that's a different topic. If you're scared or you want to talk because you realize there's a problem that might need help, you want to talk to your physician. But now you're in a position where the physician might be five hours away one way with your car, and you can't just take time off your job. 

[0:42:31]
Johannes Boshkow: So that's a significant barrier. Digital opens up an entire possibility of opening up a conversation with email or other messaging services. 

[0:42:51]
Johannes Boshkow: You can have a synchronous conversation with your physician when they are available and when you are available. There are a ton of tools out there already that can help. If you continuously forget your medication, you can use a reminder like an Apple device, but there are really good ones out there already.

[0:43:11]
Johannes Boshkow: Obviously, if you make a conscious decision not to take medication, then reminding someone won't help. There's a lot of examples, as I mentioned in the beginning. For patients, it might be really hard, there are many funny patients and it's a bit hard to connect with a lot of them and find the ones that need you the most.

[0:43:31]
Johannes Boshkow: But digital opens up the entire possibility to now seek help from a lot of different people at the same time. That can maybe find some people that share some common interests and things.

[0:43:51]
Johannes Boshkow: All of these are great opportunities. Especially these are alternatives. In the West, some people simply can't find these people or channels. It's just that maybe right now or in the past, there was more of a barrier.

[0:44:08]
Hanh Brown: So how do social and behavior variables factor into selecting the digital channel for healthy behaviors? What's your take on that?

[0:44:19]
Johannes Boshkow: It depends a little bit on what the issue is. The thing that I want to stress again is, as you mentioned in the beginning, every person is different. That's why there's a lot of personalization involved, like Netflix was one of the first to think of this. They work so well because everyone is a little bit different, and everyone will need a little bit different things.

[0:44:49]
Johannes Boshkow: So if you think about digital, it's important to understand the inherent drivers and the underlying concepts you have. These are going to be important to take into consideration because not everyone will have the same situation. For example, someone who is a smoker might have some mental health issues and might not want to go to a psychologist because of the stigma associated with that.

[0:45:17]
Johannes Boshkow: Now, digital can actually offer you a complete alternative. There are apps out there that treat depression, anxiety, PTSD and so on, using behavioral therapy, without needing human intervention. They can help you without causing any discomfort.

[0:45:39]
Johannes Boshkow: From the perspective of someone who's afraid of social interaction, digital can provide an alternative. This could be particularly helpful if you're dealing with a topic that makes you uncomfortable.

[0:45:57]
Johannes Boshkow: In the sense of behavioral things, there's a tool that was presented this week. If you're too busy or you don't want to put yourself at risk, there's a convenience play to be made here. 

[0:46:13]
Johannes Boshkow: For example, with mammograms, depending on which country you're in, the advice would be to regularly check your breasts for lumps. That's something that is difficult to do and you will have to schedule a physician visit, which means there's already a barrier, as not everyone will be comfortable doing that.

[0:46:35]
Johannes Boshkow: So, an easy solution in that case would be to find a specific device with which you can scan your breasts on your own. As soon as there's an issue, you will be linked to a specialist.

[0:46:56]
Johannes Boshkow: So, there are some great tools out there that are improving access and can actually help you. You will have to find them. But it's important to understand what your specific situation is and then you can start looking for the right tools.

[0:47:16]
Hanh Brown: What problems do you think doctors can find when advocating in helping patients adopt healthy habits digitally?

[0:47:28]
Johannes Boshkow: One issue is something that I mentioned at the beginning - doctors often have difficulty finding their patients and they can overestimate or misdiagnose symptoms. It is difficult for doctors to identify the underlying trends.

[0:47:48]
Johannes Boshkow: Because it's hard to determine the underlying causes, it's obviously difficult to make specific recommendations. We're not in a realm where we have this one digital solution that solves everyone's problems. We'll probably never get there because health is a very complex field.

[0:48:12]
Johannes Boshkow: The doctor might not understand what would be best for the patient. Taking the time to find that out with limited capabilities is probably not really worth it.

[0:48:24]
Johannes Boshkow: Many underestimate the amount of work that doctors are used to and the tremendous amount of research that goes into any intervention they recommend. In technology, companies use different kinds of metrics to improve, which is obviously beneficial, but creating the same amount of evidence as in traditional research is often missing and it's hard to keep track of that.

[0:49:16]
Johannes Boshkow: From a doctor's perspective, they are less likely to prescribe or recommend any digital solution because, in their eyes, it is not as proven as traditional therapy. From that perspective, it's a difficult scenario.

[0:49:37]
Johannes Boshkow: The sheer volume of digital solutions exacerbates the problem. It's difficult enough for a doctor to stay on top of all the new drugs, developments, guidelines, and recommendations. Adding digital solutions into the mix is just not feasible. It would probably take around six hours a day just to stay on top of it.

[0:50:05]
Johannes Boshkow: So that high volume and the ease with which you can actually create a digital solution exacerbates the problem. There's more to choose from, which means there's less likelihood of adoption of a good solution.

[0:50:21]
Johannes Boshkow: Then there's some patients who find things hard to use, like digital software. That's another difficult aspect.

[0:50:30]
Hanh Brown: Thank you. We have just a few more questions until time is up here. Now for people who are unsure about using digital channels or following doctor's recommendations, what advice can you give them?

[0:50:50]
Johannes Boshkow: Try to keep things simple. Seek out the digital channels because it's a really great way to access care. The beauty of digital is that you can just try and stop if it's not right for you. There's little investment you need to put up front.

[0:51:11]
Johannes Boshkow: Be aware that digital health solutions are designed for specific issues. Even though on the surface they might look the same, they might not be the solution you're looking for. They might not feel comfortable for you, and that's okay. If they don't feel comfortable, you can just drop them and try another one. It's really important to understand that you will have to find that sweet spot.



[0:51:54]
Hanh Brown: Great. Well, thank you so much for your expertise and your time to share on this very important topic. Do you have anything else that you would like to share?

[0:52:14]
Johannes Boshkow: I think it's a pleasure to talk about these topics. It's important to highlight that health behavior is complex and we have to be aware that it's one of the more severe problems that we face in society, especially because of the growth of chronic conditions. This is really important, and we should pay attention to this topic and use any resources for the better.

[0:52:48]
Hanh Brown: Thank you so much. The baby boomers are the first generation to have access to incredibly effective medical treatments and technologies. This has allowed them to live longer than previous generations. But at the same time, they're also the first generation to face significant challenges when it comes to their health. Diseases like diabetes, obesity, heart disease are on the rise in this population, and these chronic diseases are often caused or made worse by lifestyle choices.

[0:53:25]
Hanh Brown: Behavioral science is all about trying to understand how we can help people make better choices for their health, especially as they age. It offers us a roadmap for success. With enough patience and effort, we can overcome obstacles and achieve our goals. So if you're struggling with chronic illness, don't give up hope. Remember that change is possible and with the right mindset, you can achieve your goals. Thanks so much for tuning in today.

[0:53:45]
Hanh Brown: Join us next week on Monday at 11 a.m. We'll be discussing the topic "Don't let the legal issues of aging catch you by surprise". Later in October, we'll discuss how baby boomer entrepreneurs can create a digital brand to attract their ideal customers. This is for business owners, whether you're a baby boomer or not. We'll also talk about how baby boomer entrepreneurs can remain competitive in the digital age. Thanks so much for tuning in today and I'll see you next week.

[0:54:22]
Hanh Brown: Thank you for listening to another episode of "The Boomer Living" broadcast. I know you have a lot of options when it comes to podcasts and I'm grateful that you've chosen this one. Please share this podcast with your friends and family, write a review on iTunes, Spotify, or Google Play. It helps others discover the show.

[0:54:38]
Hanh Brown: You can also contact us at 736-350-68 to leave a review and request content for the show. We love hearing from our listeners. Check out our TikTok, Instagram, and YouTube channel, Aging Media Show, and subscribe to our weekly tips on how to best serve the senior population. We want to help them have a great experience as they age. Thanks for tuning in, until next time.