To screen or not to screen?


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Dr. Jeff Dobro

By Dr. Jeff Dobro, RedBrick Health Chief Medical Officer

The upward trajectory of healthcare costs has given rise to a debate about the value of annual health screenings. Are they really necessary? Do they surface enough potential medical issues to outweigh the costs of screening an entire population?

At RedBrick, we’ve screened hundreds of thousands of consumers across the organizations we serve. This experience, along with the evidence we’ve gathered, has convinced us that periodic health screenings as part of a workplace health and wellness program make sense.

Screenings can help to:

  • Identify health conditions early. The obesity epidemic is driving higher rates of hypertension and diabetes and even worse, a significant percentage of people with these conditions don’t even know it. Screenings can catch these health conditions earlier, before complications and high costs occur. For example, we’ve seen very clinically-meaningful improvements in blood pressure in our studies, in large part because individuals with screening measurements outside a normal range are directed to seek medical treatment.
  • Encourage compliance with treatment. Regular screenings remind those with biometric risks about the importance of following recommended therapies.
  • Drive engagement. Screenings raise awareness of health risks, and are often the “call to action” people need to make a change in their health behavior.
  • Save lives. They bring to light biometric measures that are considerably outside a normal range so those individuals can be referred for immediate medical attention. Just measuring blood pressure is likely to save 2-3 lives per 50,000 people screened every year. Our consumer success stories include examples of individuals who were referred for immediate medical intervention as the result of a screening, in some cases with life-saving results.

 

We recognize that the USPSTF and other professional organizations have very specific recommendations based on each individual’s specific health status and risks that differ from a yearly screening, yet highly personalized screenings are not practical or cost effective for large populations. Identifying common and costly risks is the first step toward increasing the overall health and well-being of your population.

Find out about RedBrick’s screening options here.


Top 10 tips for creating engaging consumer health communications

June 24th, 2015


team_Karin-BultmanKarin Bultman, RedBrick’s vice president of market development, participated on a recent panel at the Health Access Summit. The following is based on her presentation titled “It’s How You Say It” – Strategies for Optimizing Health Communication and Engagement. Karin offered the audience the top 10 things RedBrick’s learned about crafting engaging health communications so audience members could consider them for their own programs.

We know you invest a lot of time and money communicating health and wellness initiatives to your consumers. But are those messages helping you meet your goals? How do you ensure your communications are effective, engaging, and inspiring your consumers to better health?

The recently retired David Letterman made the Top-10 list an institution. We’re continuing the tradition with our own list, Top 10 tips for creating engaging consumer health communications:

  1. Get your evidence together. Give your communications credibility. Accuracy and rigor matter. Agree on what sources are acceptable for your organization. Create your own, catchy “hook” supported by your evidence to attract the reader’s attention.
  1. Conduct A/B tests. Do mini-experiments to learn what works best for your audience. Try issuing the same email to two different groups using a different headline on each one to see what type of message gets you a higher open rate.
  1. Be trustworthy. Consumers need assurance that you know what you’re talking about. Some of the ways to instill trust include referencing relevant accreditations and recognitions, quoting respected experts and using citations.
  1. Provide appropriate context. Explain, in simple language, why the health information is important, especially when you’re requesting information from your consumers. Be aware that your audience might be sensitive to some health topics. Use both visuals and words for clarification.
  1. Test for reading level. Follow plain language guidelines, and evaluate text using built-in tools or other gold-standard tests. Know how to swap out or interpret challenging health terms so they’re more easily understood.
  1. Meet consumers where they are. Health behavior changes must fit into everyday life if participants are going to continue to follow them. Present flexible options with varying levels of difficulty, complexity or duration to encourage ongoing participation.
  1. Invest in localization. The language and culture of the recipient will affect how they interpret your message. Do multiple translation reviews and use idioms wisely to avoid confusion. Make sure to offer culturally appropriate options and suggestions.
  1. Include great visual design. Pictures boost comprehension. Incorporate illustrations and photos into your communication design—and make sure to do this as part of the original design, not as an afterthought.
  1. Listen to your consumers. Ask your consumers what they find engaging and useful. Gather this information using techniques like focus groups, surveys and comments. Make revisions based on what you learn.

 

And the number 1 tip for communications that engage and inspire consumers…

  1. Design for behavior. Don’t just tell consumers what to do. Give them reasons to act. Apply behavior theory and choice architecture. Tap participants’ intrinsic motivations. Build in social support and feedback. And most of all, don’t sound too serious or earnest. Make it fun—if it feels like a chore, consumers will eventually drift away.

 

Have your own tip to share? We’d love to hear it.


Traditional triage vs. choice: Put the person back into personalization to get better results in health and wellness


RBH-shoot_day2_EZ_15[1]Eric Zimmerman, chief marketing officer at RedBrick Health, is guest-posting on the Benefitfocus Blog today with additional thoughts on choice architecture:

  • What’s missing from traditional wellness program design.
  • Why you should make consumer choice a core element of your wellness program.
  • How to incorporate choice architecture to get better engagement – and how better  engagement translates to clinically-meaningful outcomes.

At RedBrick Health we like to do what works, rather than what’s traditional. And—as it turns out—choice works. Visit the post to learn more.

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What works in wellness? Letting people choose.


team_Jeff-Dobro

Dr. Jeff Dobro

Part 2 of a 3-part series
By Dr. Jeff Dobro, Chief Medical Officer, RedBrick Health

In part 1 of this series, we presented the case for choice for engaging individuals in their health. We found that by putting the person back into the personalization—letting individuals select their own healthy activities and way to interact—we were able to find equivalently strong impact on health results regardless of the choice between live coaching, virtual (or digital) coaching, and self-tracking.

In part 2 we focus on the segment of the population with chronic conditions—a group that can comprise up to 20% of the typical working population and drive up to 80% of total healthcare costs.

A traditional health management stratification design would focus on recruiting these high-risk, high-cost individuals into intensive phone coaching, and specifically into a disease management intervention. At RedBrick, we do condition management, but we let consumers choose where to place their focus. Why? Choice allows them to exercise their preferences and taps their intrinsic motivations—like improving appearance, living longer to see their kids and grandkids grow up, boosting energy, or fitting into a smaller size—that encourage engagement.

And, as it turns out, given the choice, 80% of those with a chronic condition choose to focus their coaching experience on a lifestyle issue—like nutrition, exercise, weight loss or stress. And we let them. By using a whole person approach we avoid the pitfalls of treating people as disease states, risk factors or body parts. We start with what’s relevant for them and consistent with preferences and intrinsic motivations.

Is this “choice architecture” driven approach clinically defensible? We think so. Key clinical topics are covered on every coaching call: Medication compliance and condition monitoring, working effectively with your doctor, self-management plans, health education and overall well-being. We make sure to weave in a call with a nurse to review their condition in detail during at least one out of four coaching sessions And, somewhat paradoxically, by letting people choose their focus, we end up coaching three times as many people on issues that are still highly relevant to their condition, and four times as many people in total. Using our small steps approach, we build upon each small success and drive a much broader level of clinically-relevant results than a standard disease management approach.

As it turns out, health improvement isn’t a linear process. Lifestyle habits affect chronic conditions, and a change in a chronic condition will, in turn, impact day to day lifestyle behaviors. Getting more active reduces weight, which helps mitigate blood pressure, elevated cholesterol and diabetes. Psychologically, making a single, small improvement builds self-efficacy and making consistently healthier choices helps re-shape self-perception.

When it comes to helping individuals better manage chronic conditions, start with choice.

In part 3 of this series, we’ll explore how different populations respond to different engagement modalities—and why to avoid a “one-size-fits-all” approach.


What works in wellness? Letting people choose.

May 15th, 2015


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Eric Zimmerman

Part 1 of a 3-part series
By Eric Zimmerman, Chief Marketing Officer, RedBrick Health

At RedBrick, we’ve been saying for years that creating consumer ownership of health means providing strong, data-driven guidance, but ultimately letting consumers make choices. This idea may sound logical, but surprisingly it flies in the face of conventional health management models. Conventional wisdom says use risk data to identify and stratify populations and select the intervention for the consumer. Those at higher risk get phone coaching. Chronic illness? Disease management. Everyone else? Offer low cost portals, newsletters, self-trackers.

While it seems logical to stratify populations by risk level and to focus the more costly interventions on those at higher risk, the approach leaves someone out of the decision process: The consumer. But can a choice-based model produce real outcomes?

We recently completed a large-scale study to find out.

Our study focused on nearly 50,000 consumers whose baseline biometrics placed them at elevated risk due to either elevated Body Mass Index (BMI), blood pressure or non-HDL cholesterol. We defined success as year-over-year clinically-meaningful improvement in these objective measures.

Instead of following the traditional health risk stratification model, we used data to offer a bounded set of pre-prioritized choices, applying a core principle of behavioral economics called choice architecture. We recommended three personalized focus areas—like stress, nutrition or a health condition—but didn’t limit people to focusing on their highest risk or chronic condition. And we let individuals decide how they’d like to engage. They could choose a convenient digital coaching (online) option within their chosen focus, they could opt for the use of a digital daily activity tracker that connects to popular apps and wearable devices or they could take advantage of the opportunity to work one-on-one with a behaviorally trained coach on the topic of their choice.

Conventional wisdom would suggest that the more resource intensive phone coaching would produce superior results. However, we found a different, and somewhat surprising, result: When consumers were allowed to choose their intervention focus and modality, they achieved clinically meaningful improvements at almost identical rates. Live phone coaching worked. So did digital (online) coaching. As did online self-tracking with connected apps and devices. No modality outperformed the others.

What does this finding mean? Our view is that it means choice works: It produces better engagement and stronger personal commitment. It lets people start where they are, rather than where a risk-streaming algorithm suggests they should be. In other words, it puts the person back into the personalization.

In Part 2 of this story, we’ll look specifically at those with chronic conditions and the impact of choice within coaching on the level of engagement in condition-relevant coaching.


Susan Bailey, 2015-16 Michigan Wellness Council Chair

November 26th, 2014


SMBailey_HeadshotHelping people be healthy is our motto. Every day we imagine, design and build technology to help our clients provide an engaging environment to foster better health, and we couldn’t do it without the wealth of industry knowledge and experience of our RedBrick Health employees.

One such distinguished personality is Susan Bailey, Director of Client Services. While often seen in our Minneapolis headquarters, Bailey is based in Michigan and provides strategic consultation for both RedBrick Health clients and the non-profit Michigan Wellness Council. In 2015-2016, she will lead the board as Michigan Wellness Council Chair.

The Michigan Wellness Council partners with local employers and the state to bring successful wellness best practices to the workplace, operating as a hub of quality resources and forums. Bailey has been working with the Michigan Wellness Council in a variety of roles for eight years, and is excited to start her first two-year term as Chair.

Congratulations, Susan! We’re excited here at RedBrick Health to see your next steps as a leader in the health and wellness industry.

Learn more about the Michigan Wellness Council here.

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Helping People be Healthy, One Race at a Time


IMG_0804_smallerAt RedBrick Health we work every day to help people be a little bit healthier than they were yesterday. That work doesn’t stop with our clients and partners – it’s something we strive to include in our own offices, communities and lives.

“For me, helping people be healthy is much more than a job; it’s a lifestyle,” said Joe Garrison, our Southwest regional sales leader. “I believe in what we do at RedBrick Health and I’m striving to lead by example.”

Garrison, who is based in California, has been working with RedBrick since 2010, and he’s been doing triathlons for just as long. This summer he completed eight Olympic distance triathlons and a half-IRONMAN in preparation for his first full IRONMAN in November.

An IRONMAN is the ultimate triathlon, composed of a 2.4-mile swim, 112-mile bike and a 26.2-mile run. Garrison will be racing at the Tempe, Arizona course, known as the premier mainland race due to atmosphere, surrounding events and strong IRONMAN tradition.

RedBrick will be matching Garrison’s entry fee dollar amount with a donation to the IRONMAN Foundation. The Foundation has supported global, national and local charities with $18 million in grants and donations since 2003.

IMG_0805_smallerWe’re very excited to support Garrison in his first IRONMAN race, his donation to the IRONMAN Foundation and his efforts to be healthier every day and inspire others to do the same. Good luck in Tempe, Joe!

Contact Joe Garrison to contribute to his IRONMAN Foundation donation at jgarrison@redbrickhealth.com


Thought Leadership Series

October 17th, 2014


Kurt_Cegielski

Kurt Cegielski, Thought Leadership Series host and moderator

On Wednesday, October 8th, RedBrick Health hosted almost 50 health and wellness leaders from Minnesota’s largest employers, consultant groups and other influencing organizations. We invited these movers and shakers to a panel discussion focused on the key drivers of health engagement in a rapidly changing healthcare environment.

We were pleased to present four panelists with distinct industry perspectives about what health engagement means:

·        Ken Paulus, CEO at Allina Health, provider lens

·        John Naylor, Commercial Market SVP at Medica, payer lens

·        Jeni McGill, from the benefits team at Cargill, employer lens

·        Sean Wieland, a Piper Jaffrey senior analyst, industry lens

Each panel member introduced their organization and background, provided insight into what health engagement means for them and described the unique and active initiatives they are pursuing to improve health, contain costs and stay relevant. As host and moderator, I had the pleasure of taking the panelists and audience through a series of questions that inspired exchanges around the room. We look forward to providing you key insights, audio and video from the event in the coming weeks.

As a part of the event, we hosted a social hour at RedBrick Health headquarters, where we were able to connect with customers, meet new contacts and tally the number of steps taken with our attendees’ new FitBit® devices. A huge thank you to President and CEO of YMCA of the Twin Cities Glen Gunderson, who was on hand to receive our donation based on the millions of steps attendees took from registration to reception!

Feedback from our attendees has been positive, fueling several requests to host more events going forward. We’re looking at making our Thought Leadership Series a regular event, perhaps coming to a city near you.

A sincere thank you to our distinguished panelists and all of our sharp and focused attendees for making this event such a success.

Healthy regards!

Kurt Cegielski, Founder and SVP of Employer Solutions at RedBrick Health

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Really Small Changes That Make A Big Difference (Part II)


Robert B. Cialdini, Ph. D.

Robert B. Cialdini, Ph. D.

 

 

Robert B. Cialdini, Ph. D. presented at the RedBrick Health Client Summit last April, where he spoke on effective and persuasive communication in an uncertain health care environment. He is collaborating with RedBrick again to share insights from his new book The small BIG: Small Changes that Spark Big Influence in a two-part series.

Find Part I here.

 

 

Persuasive efficiencies

Since the publication of my book, Influence, I’ve been asked to speak—in corporate training sessions, at large conferences, or in front of university classrooms—about these principles.  In the process, I’ve noticed something that captures audience attention to a remarkable degree (almost as much as if I’d mentioned sex):  If, when describing one or another of the principles, I say, “Now, I’m going to give you something small, really small, that you can do to make this principle work in your behalf,” the room changes visibly.  Bodies incline forward, faces lift to the stage, and pens poise over pads.

It’s understandable.  Audience members are responding to an attractive return-on-investment proposition; but, not in the traditional sense of a small financial outlay that leads to outsized financial profit.  Instead, they are responding to a desired kind of ROI that may be of greater value in their increasingly overloaded lives—a minor investment of time and effort that will lead to disproportionate returns.  In a world of time-challenged, hyper-busy, multi-tasking individuals, minor steps that generate big rewards are like found gold.

With this recognition in mind, a pair of colleagues and I have written a new book2 that identifies a set of 52 slight shifts in persuasive approach that can produce large payoffs.  In conversations with Red Brick personnel about the book, they suggested that I author a blog post for their clients that described a few such small changes and how they have been shown to play out in health contexts.  Space limitations prevent an exhaustive treatment, but let’s look at how just one of the six universal principles of social influence—Commitment/Consistency—can be activated to great effect via small changes in persuasive procedures.  What’s more, let’s look at how such changes can make a significant difference even within traditionally difficult to influence populations.

Healthcare-related examples

Patients who fail to appear for dental and medical appointments are more than an inconvenience; they represent a considerable expense to the healthcare system.  This has been especially the case in the United Kingdom because, since there is no financial cost to the patient for the appointment, there is no financial penalty for missing it.  A standard practice designed reduce these no-shows involves calling patients the day before to remind them of the appointment.  In a study conducted by one of my coauthors, the calls reduced failures to appear by 3.5% in British medical clinics.  But, the reminders required valuable resources (time and money) to deliver and didn’t always reach their targets.  Consider what happened when, instead, a minor and costless alteration of standard procedure—based on the Commitment/Consistency principle—was tested.  If, at the end of a prior appointment, the receptionist asked the patient to fill in the hour and date of the next appointment on the card (instead of filling in the information for the patient), the subsequent no-show rate dropped by 18%.  Why?  Because, as considerable research documents, people are more likely to hold true to their commitments the more actively and visibly they make those commitments.3

Whenever I speak to health management groups and ask the question, “Which people in the system are most difficult to influence?”, the answer is invariably, “Practitioners!”  This becomes genuinely problematic when certain procedural safeguards exist that are underemployed by physicians and nurses.  One such safeguard involves hand washing before each patient examination.  In a U.S. hospital, researchers varied the signage underneath the soap and gel dispensers in each examination room.  One sign (in the control condition) said, “Gel in, Wash out;” it had no effect on hand washing frequency.  A second sign raised the possibility of adverse personal consequences to the practitioners.  It said, “Hand hygiene prevents you from catching diseases;” it also had no measurable effect.  But, a third sign that said, “Hand hygiene prevents patients from catching diseases,” increased hand washing by 45%.  Why?  Because the sign reminded doctors and nurses of their professional commitment to their patients.  Notice that this small alteration of procedure didn’t even require that a strong commitment be generated (as in the no-show study).  All that was necessary, with the change of a single word, was to put the practitioners in mind of a strong commitment they had already made.4

If practitioners are typically difficult to influence, consider a much more resistant group within the healthcare system—drug users in the throes of withdrawal.  Could a small public commitment get these individuals to undertake desirable action?  One study of hospitalized opiate drug addicts indicated that the answer is not just “Yes” but “Clearly yes,” provided the commitment is specific enough.  As part of a treatment program, the addicts were urged to prepare an employment history by the end of the day to help them get a job after their release.  In addition, some were asked to commit to a specific plan for compiling the history, whereas others (in a control group) were not asked to do so.  A relevant such plan might be, “When lunch is over and space has become available at the lunchroom table, then I will start writing my employment history there.”  By day’s end, not one person in the control group had performed the task, which might not seem surprising—after all, these were drug addicts in the process of opiate withdrawal.  Yet at the end of the same day, 80% of those in the specific public commitment group had turned in a completed job résumé. 5

Conclusion  

It is heartening to recognize that behavioral science is able to offer health management professionals procedures for significantly advancing health-related outcomes.  Moreover, those advances can come from changes in practice that are virtually costless, entirely ethical, and empirically grounded.  Worth noting is that the effective changes described in this piece had not emerged naturally as best practices within the industry.  A partnership with behavioral science was necessary for their conception and successful test.  It’s a partnership that stands to be both socially responsible and highly productive well into the future.

 

Cialdini is an expert in persuasion, compliance and negotiation who has spent his career researching the science of influence. He is the New York Times Best Selling author of Influence, recommended as one of Fortune Magazine’s most important books for business. Influence has appeared on CEO Read’s 100 Best Business Books of All Time and Best Marketing Books of All Time lists and has been translated into over 26 languages. Find his newest book, The small BIG: Small Changes that Spark Big Influence, here.

Cialdini is the president of INFLUENCE AT WORK, a global training, consulting, and speaking company focusing on the successful and ethical uses of persuasion science for business. Find him on Twitter at: @RobertCialdini.

 

References

1 Cialdini, R. B. (2009).  Influence: Science and Practice (5th ed.).  Boston:  Allyn & Bacon.

2 Martin, S. J., Goldstein, N. J., & Cialdini, R. B. (2014). The small BIG: Small Changes that Spark Big Influence. New York: Grand Central Publishers [Also published in the UK by Profile Books, London.]

3Martin, S. J., Bassi, S., & Dunbar-Rees, R. (2012). Commitments, norms and custard creams—a social influence approach to reducing did not attends (DNAs).  Journal of the Royal Society of Medicine, 105, 101-104.

4Grant, A. M., & Hofmann, D. A. (2011). It’s not about me: Motivating hand hygiene among health care professionals by focusing on patients.  Psychological Science, 22, 1494-1499.

5 Brandstätter, V., Lengfelder, A., & Gollwitzer, P. M. (2001). Implementation intentions and efficient action initiation. Journal of Personality and Social Psychology, 81, 946-960.

 


Really Small Changes That Make A Big Difference (Part I)


Robert B. Cialdini, Ph. D. presented at the RedBrick Health Client Summit last April, where he spoke on effective and persuasive communication in an uncertain health care environment. He is collaborating with RedBrick again to share insights from his new book The small BIG: Small Changes that Spark Big Influence in a two-part series. Find Part II here

Cialdini is an expert in persuasion, compliance and negotiation who has spent his career researching the science of influence. He is the New York Times Best Selling author of Influence, recommended as one of Fortune Magazine’s most important books for business. Influence has appeared on CEO Read’s 100 Best Business Books of All Time and Best Marketing Books of All Time lists and has been translated into over 28 languages.

Alongside his career as author, Cialdini is the president of INFLUENCE AT WORK, a global training, consulting, and speaking company focusing on the successful and ethical uses of persuasion science for business.

Robert B. Cialdini, Ph. D.

Robert B. Ciadini, Ph. D.

 

A while ago I wrote a book1 with a provocative thesis:  Highly successful persuasive appeals can be understood in terms of a very limited number of principles of social influence—those that are so powerful that they generate desirable change in the broadest range of circumstances.  In the book, I sought to support my claim with scientific evidence demonstrating that a wide variety of communicators who incorporate one or another of these principles into a proposal or recommendation can expect significantly greater agreement as a result.  I counted only six such “universal” principles of influence.

 

 

  • Reciprocation.  People are more willing to comply with requests (for favors, services, information, concessions, etc.) from those who have provided such things first.  For example, according to the American Disabled Veterans organization, mailing out a simple appeal for donations produces an 18% success rate; but, enclosing a small gift—personalized address labels—boosts the success rate to 35%
  • Authority.  People are more willing to follow the advice of a communicator to whom they attribute relevant authority or expertise.  One study showed that 3 times as many pedestrians were willing to follow a man into traffic against the red light when he was merely dressed authoritatively in a business suit and tie.
  • Scarcity. People find objects and opportunities more attractive to the degree that they are scarce, rare, or dwindling in availability.  Even information that is scarce (i.e., exclusive) is more effective.  A beef importer in the US informed his customers (honestly) that, because of weather conditions in Australia, there was likely to be a shortage of Australian beef.  His orders more than doubled.  However, when he added (also honestly) that this information came from his company’s exclusive contacts in the Australian National Weather Service, orders increased by 600%!
  • Liking/Friendship.  People prefer to say yes to those they know and like.  For example, research done on Tupperware Home Demonstration parties shows that guests are 3 times more likely to purchase products because they like the party’s hostess than because they like the products.
  • Social Proof.  People are more willing to take a recommended action if they see evidence that many others, especially similar others, are taking it.  One researcher went door to door collecting for charity and carrying a list of others in the area who had already contributed.  The longer he made the list, the more contributions it produced.
  • Commitment/Consistency.  People are more willing to be moved in a particular direction if they see it as consistent with an existing or recent commitment.  This is especially so if the commitment is visibly made.  Students who signed an honesty pledge at the beginning of an exam were less like to cheat than those who signed one at the end.

 

In the next post, Cialdini provides a summary of how the principles discussed in his book, Influence, can be combined with the small-steps behavior change model – the subject of his newest book The small BIG: Small Changes that Spark Big Influence – to influence the health care industry. Find Part II here.

Find Cialdini on Twitter: @RobertCialdini.

 

References

1 Cialdini, R. B. (2009).  Influence: Science and Practice (5th ed.).  Boston:  Allyn & Bacon.

2 Martin, S. J., Goldstein, N. J., & Cialdini, R. B. (2014). The small BIG: Small Changes that Spark Big Influence. New York: Grand Central Publishers [Also published in the UK by Profile Books, London.]

3Martin, S. J., Bassi, S., & Dunbar-Rees, R. (2012). Commitments, norms and custard creams—a social influence approach to reducing did not attends (DNAs).  Journal of the Royal Society of Medicine, 105, 101-104.

4Grant, A. M., & Hofmann, D. A. (2011). It’s not about me: Motivating hand hygiene among health care professionals by focusing on patients.  Psychological Science, 22, 1494-1499.

5 Brandstätter, V., Lengfelder, A., & Gollwitzer, P. M. (2001). Implementation intentions and efficient action initiation. Journal of Personality and Social Psychology, 81, 946-960.


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