Scalable health coaching

Digital health coaching

The concept is digital health coaching.  It is a form of health coaching that relies on the digital environment.  Why I say digital is because it isn’t limited to the computer only; for example, we’re also using mobile channels.  Our main goal is to change behaviour, health related behaviour. That can encompass areas like smoking, alcohol consumption, exercise but also compliance with medication.  The main benefits of our model are twofold  On the one hand the threshold to participation is very low—it is easier to participate in an online program than it is to join a live coaching program. And on the other hand, and possibly most importantly, the model is highly scalable.  We’re not claiming to be better than live coaching. In fact, most research shows that digital coaching is equally effective to live coaching.  The main difference is scalability: we can make this service available to thousands of people without having to invest in progressively more healthcare professionals.  

Prevention is our main focus.  The main reason that people live unhealthy lives is because there is no immediate incentive to eradicate unhealthy behaviour.  Most people with an unhealthy lifestyle experience more benefits than pain.  The pain comes later, when you get older.  That’s why an unhealthy lifestyle is normal; we have a normal tendency to be unhealthy.  Our goal is to counter that tendency and let people experience the joy of health, to feel more energetic and upbeat about life.  We work with individuals, but our clients are companies and government agencies who make our services available to their staff.  The benefits for the employer are a healthier and more productive staff—that’s been proven in research studies.  And health insurance companies obviously benefit too.

The basic process of our programmes follows.  It begins with an assessment of your current behaviour after which a tailored coaching programme is worked out for you. This involves an action plan with regular feedback loops and a benchmarking tool.  Benchmarking—call it a form of social comparison, anonymous obviously—is really important to motivate people.  Also important to note is that the ongoing interaction happens via small triggers. This type of coaching is not based on constant education and the provision of lots of information; small triggers are usually enough to affect behaviour.  Obviously there also are various detection points and alerts in case the person’s condition becomes serious.  The degree of customisation is pretty advanced. I’ve been told by several people that they sometimes forget that they’re interacting with a machine.

Roots in Health Psychology

I’m a researcher and clinical psychologist by training. During my psychology training I realised pretty quickly that I didn’t want to work as a clinical psychologist.  So when I was offered an opportunity to go to the U.S. to do research work, I accepted.  I spent four years in the U.S. and that’s where I first became involved in the field of Health Psychology. This discipline of psychology looks at how health can be improved via behaviour change; not only via purely preventative behaviour such as stop smoking but also by helping medical patients manage their health better.  For example, cardio patients have an important responsibility in their treatment with regard to taking medication properly and living healthier lifestyles.  

Limburg stops smoking

On my return to Belgium I was offered a position at the University Hospital Leuven combining clinical and research work. After I graduated there with a doctorate in the medical sciences, I realised I wanted to focus my efforts more on lifestyle promotion.  In 2003 I set up the company and started doing health coaching focused on smoking and stress. That worked well—for the people in the groups, because they were motivated.  The problem is that most people aren’t in the group because the threshold to participation is so high.  In a work environment, people are hesitant to expose themselves to colleagues in that way.  They also have to free up time to fit with the coaching schedule. Language issues sometimes exist too.  It all adds up to a pretty significant barrier.  That’s why we started experimenting with online approaches. Our first project—an online stop smoking campaign for the province of Limburg (limburgstoptmetroken.be) was very successful.  We reached a very large group and still managed to offer people highly personalised advice based on their input.  People felt really engaged—and we noticed it in our results. We had control over our databases and could clearly see who improved and who didn’t—and thus we could react appropriately, optimizing the programme as we went.  We also were lucky that we could partner with organisations like Stichting Kanker to share the financial risk.  They were looking for a partner to develop these types of programmes and scoured the entire European market for a suitable supplier. That they chose us was a tremendous endorsement that we were on the right track.  

Building the platform

The stop smoking programme was a tremendous success, not only because we attracted so many subscribers but also because it is so sustainable.  We were able to stay with people for the long term and noticed that people were changing their health behaviour more generally.  Hence we expanded the scope of the programme to cover 8 health domains in the area of occupational health.  The result is a digital health coaching platform we called ‘i change’.  The investment has been huge but we managed to launch the platform last April (2010) and currently have six companies making use of it, with more coming soon.  And they’re happy.  It just works.  Companies sign on and subsequently make it available to everyone in the company.  It is a very democratic approach; we don’t charge on a per-user basis.  We also coach our clients to make sure that they get as many people as possible involved.  It is important that a certain buzz around the service is created for it to take off.  But that it does; at our clients we average a 30% participation rate—that is tremendously high—and they stay on the platform for months.  At this stage we’ve just come above water and are hugely excited.  We’re with 9 people now and at the cusp of a major growth trajectory.

A unique model

I never understood that.  In Europe we do appear to be unique. It is unfathomable, because it seems so obvious.  I could be because the investment required is pretty significant. Also, it requires intense collaboration between psychologists and IT professionals—and that is not easy.  They’re two very different profiles. They don’t think in the same way. For example, web developers tend to have experience making websites that are very marketing oriented, or they’re very rational and logical in their approach, being used to business applications.  Health coaching is different.

In the U.S. they are ahead in this. We’re watching the key players there very closely and in fact are collaborating with some of them.  I’ve invited them to our conference (Healthy Company,31/3/11) and I attend theirs.

This will be big

I’m absolutely convinced that digital health coaching is going to become huge.  Information technology is making it possible to do effective health coaching at a tremendous scale.  People are gradually going to get accustomed to using these tools—and that will have an impact on our health.

In Belgium we tend to be slow in adopting new technologies and methods. We’re somewhat conservative.  But also here we’re going to start using digital coaching tools at scale. We’re showing that when given the chance, people do make use of them. 

It is important to customise the tools to local culture and language.  For the Netherlands we’re adapting our platform pretty significantly.  It’s the little details that matter. For example, in the Netherlands it makes sense to encourage people to use a bicycle for home to work  travel, but that doesn’t hold everywhere—the geography or infrastructure often isn’t setup for that.  

Challenges

I’m a psychologist.  I had no experience as an entrepreneur and had to learn as I went.  Possibly that was a good thing because I was naïve. I invested like crazy in our platform. Perhaps if I was an entrepreneur I would have been more careful.  But then the product wouldn’t exist today.  Also, we realise today that we started our company in what is probably the most difficult and conservative market: Belgium.  But we’re succeeding and are now keen to internationalise as fast as possible.  We’re talking to investors to fund that growth.  So the next phase will be about managing that growth, while simultaneously keeping on renewing and innovating.  

Health care trends

I’m seeing increasing interest in health promotion everywhere because the costs of health care are spiralling out of control.  Also culturally I think there is a shift toward people taking more responsibility for their health.  You can see that in the way that people are taking responsibility for their lifestyles—fewer smokers, more physical exercise, improved diets—but also in the way insurers are beginning to look at this, for example, by rewarding healthy lifestyles.