Fullscript is a powerful, free, personalized care platform offering treatment planning, active wellness support, and healthcare’s best supplements and wellness products. Three years ago, as part of its mission to change how health is prescribed, Fullscript began researching treatment adherence in integrative medicine.
Treatment adherence is the term used to describe the extent to which patients are able to follow a treatment plan or recommendations provided by their healthcare practitioner. It is a critical topic that influences patient outcomes and long-term health. The insights gathered from this research led to the publication of a white paper in a peer-reviewed journal. (1)(2) In addition, it launched further investigation into two significant treatment adherence barriers: behavioral change and health literacy.
The Academic Consortium for Integrative Medicine & Health is an organization dedicated to advancing integrative medicine and health through academic institutions and health systems. At the end of February, the consortium hosted the Integrative Medicine and Health Symposium in Chicago.
This symposium enabled the members of the integrative medicine community to share, learn, and connect with and from one another. Fullscript’s Integrative Medical Advisory team had the amazing opportunity to not only attend the symposium but also share their research on behavioral change and health literacy.
Below is a summary of the research shared at the symposium.
Behavioral change in integrative medicine
Behavioral change is the process of adopting and adhering to a health-promoting behavior long-term (≥ six months), ideally without continuous practitioner support. (8)(14)
Prolonged lifestyle and behavioral factors with negative health implications, such as
tobacco use, lack of sleep, and physical inactivity, can increase the risk of chronic diseases (4)(9) and are associated with 40 to 50% of deaths in the United States. (11)(13)
Fortunately, evidence shows the benefit of adopting health-promoting behaviors in reducing
high-mortality rates. Adopting even one health-promoting behavior can reduce the relative risk of all-cause mortality by up to 28%, while adopting four behaviors can reduce this risk as much as 66%. (10)
With this in mind, Fullscript sought to:
- Develop an understanding of the knowledge base for behavioral change in conventional and integrative medicine.
- Survey patient users to identify their feelings about their ability to change/maintain healthy behaviors, their most prevalent barriers, and their needs and preferences related to receiving behavioral-change support.
Research methods
An email invitation to participate in a 27-question survey was sent to patient users (n=30,000) who had received a treatment plan from their practitioner through Fullscript within the last year. Patients were not required to have placed an order through the platform to be eligible for participation.
Takeaways
The results of the survey suggest that patients may require additional support in adopting lifestyle changes. It may take a minimum of six months of actively engaging in new health behaviors before feeling that it has become a habit (transitioned to an active or maintenance stage).
Although the patient users did not report extensive barriers, practitioners should ask patients about factors that can negatively impact behavioral change. The top strategies for behavior change are providing patients with education/educational resources, treatment plan simplification, practitioner monitoring and feedback, and/or goal setting.
Health literacy in integrative medicine
The Secretary’s Advisory Committee for Healthy People 2030 defines health literacy as both:
- Personal health literacy: The degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others
- Organizational health literacy: The degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others (6)
National and international health literacy assessments have revealed that approximately 40 to 60% of American (7) and Canadian (16) adults have low health literacy.
Studies have shown that individuals with low health literacy are often dissatisfied with the quality of care they receive and are more likely to distrust their healthcare providers and the medical system. Consequently, utilization of preventive health services is lower within this population, (3)(12)(15) and people with low health literacy have an increased risk of emergency care use, hospitalization, and all-cause mortality. (3)(5)(12)
With this in mind, Fullscript sought to establish baseline health literacy levels; determine the most common and trustworthy sources of health information; and inquire about educational behaviors, needs, preferences, and barriers of its patient-user population.
Research methods
An email invitation to participate in a 28-question survey was sent to patient users (n=30,000) who had been invited to Fullscript, opened an account, and received a treatment recommendation within the last six months. Patients were not required to have placed an order through the platform to be eligible for participation.
Takeaways
Despite having moderate health literacy, patients still report finding reliable health information challenging. Since healthcare practitioners are the most common and trusted source of health information, they should consider providing their patients with health education and resources in the patient’s preferred format during their clinical appointments. The participants of this specific survey indicated preferring short- (< 5min) to medium-length (5–20min) written educational materials.
Supporting behavioral change and health literacy with Fullscript
Behavioral change and health literacy are two key factors that can significantly impact a patient’s ability to follow a treatment plan or recommendations. Fullscript has developed the following resources to help practitioners better support their patients.
Fullscript’s Behavioral Change Toolkit
In order to help practitioners make evidence-based treatment recommendations that support behavioral change, Fullscript created the Behavioral Change Toolkit.
From this toolkit, practitioners can take a deeper dive into behavioral change by reading the white paper. In addition, practitioners can download various behavioral change patient resources to better assess and support readiness to change.
Fullscript’s in-app Resource Library
Fullscript’s Resource Library is a collection of high-quality, professionally designed resources—simplifying patient education and allowing you to focus on providing the best patient care.
Within the Fullscript platform, practitioners can find a collection of guides, handouts, and graphics on topics ranging from nutrition and lifestyle to supplements and health conditions. Each resource included in the library was developed using the most recent scientific evidence and was medically reviewed by a practitioner on Fullscript’s Integrative Medical Advisory team.
To learn more about the benefits of sharing educational resources with patients, as well as how Fullscript’s Resource Library can help, visit the Fullscript blog.
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- Bailey, R., English, J., Knee, C., & Keller, A. (2021a). Treatment adherence in integrative medicine-part one: Review of literature. Integrative Medicine , 20(3), 48–60. https://www.ncbi.nlm.nih.gov/pubmed/34373679
- Bailey, R., English, J., Knee, C., & Keller, A. (2021b). Treatment adherence in integrative medicine-part two: Practitioner insights. Integrative Medicine , 20(3), 61–65. https://www.ncbi.nlm.nih.gov/pubmed/34373680
- Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., & Crotty, K. (2011). Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medicine, 155(2), 97–107. https://doi.org/10.7326/0003-4819-155-2-201107190-00005
- Chronic Diseases in America. (2022, December 13). The Centers for Disease Control and Prevention. https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm
- Hickey, K. T., Masterson Creber, R. M., Reading, M., Sciacca, R. R., Riga, T. C., Frulla, A. P., & Casida, J. M. (2018). Low health literacy: Implications for managing cardiac patients in practice. The Nurse Practitioner, 43(8), 49–55. https://doi.org/10.1097/01.NPR.0000541468.54290.49
- History of Health Literacy Definitions. (n.d.). U.S. Department of Health and Human Services. Retrieved August 18, 2022, from https://health.gov/healthypeople/priority-areas/health-literacy-healthy-people-2030/history-health-literacy-definitions
- Kutner, M., Greenberg, E., Jin, Y., Paulsen, C., & White, S. (2006). The health literacy of America’s adults: Results from the 2003 national assessment of adult literacy (NCES 2006-483). Institute of education sciences. https://nces.ed.gov/pubs2006/2006483.pdf
- Kwasnicka, D., Dombrowski, S. U., White, M., & Sniehotta, F. (2016). Theoretical explanations for maintenance of behaviour change: A systematic review of behaviour theories. Health Psychology Review, 10(3), 277–296. https://doi.org/10.1080/17437199.2016.1151372
- Liu, Y., Croft, J. B., Wheaton, A. G., Kanny, D., Cunningham, T. J., Lu, H., Onufrak, S., Malarcher, A. M., Greenlund, K. J., & Giles, W. H. (2016). Clustering of five health-related behaviors for chronic disease prevention among adults, United States, 2013. Preventing Chronic Disease, 13, E70. https://doi.org/10.5888/pcd13.160054
- Loef, M., & Walach, H. (2012). The combined effects of healthy lifestyle behaviors on all cause mortality: A systematic review and meta-analysis. Preventative Medicine, 55(3), 163–170. https://doi.org/10.1016/j.ypmed.2012.06.017
- McGinnis, J. M., & Foege, W. H. (1993). Actual causes of death in the United States. JAMA, 270(18), 2207–2212. https://www.ncbi.nlm.nih.gov/pubmed/8411605
- Miller, T. A. (2016). Health literacy and adherence to medical treatment in chronic and acute illness: A meta-analysis. Patient Education and Counseling, 99(7), 1079–1086. https://doi.org/10.1016/j.pec.2016.01.020
- Mokdad, A. H., Marks, J. S., Stroup, D. F., & Gerberding, J. L. (2004). Actual causes of death in the United States, 2000. JAMA, 291(10), 1238–1245. https://doi.org/10.1001/jama.291.10.1238
- Ory, M. G., Lee Smith, M., Mier, N., & Wernicke, M. M. (2010). The science of sustaining health behavior change: The health maintenance consortium. American Journal of Health Behavior, 34(6), 647–659. https://doi.org/10.5993/ajhb.34.6.2
- Paasche-Orlow, M. K., & Wolf, M. S. (2007). The causal pathways linking health literacy to health outcomes. American Journal of Health Behavior, 31 Suppl 1, S19–S26. https://doi.org/10.5555/ajhb.2007.31.supp.S19
- Scott Murray, T., Hagey, J., Willms, D., & Canadian Council on Learning. (2008). Health Literacy in Canada: A Healthy Understanding. Canadian Council on Learning. http://en.copian.ca/library/research/ccl/health/health.pdf