Cognitive and Behavioral Patterns of Thinking and ActionSocial Cognitive Theory • Albert Bandera • Individual as active participant • Triadic reciprocality. . Directing health

www.pathinstitute.comDirecting health practice to serve health priorities

Cognitive and Behavioral Patterns of Thinking and Action:

Health Personas Driving Consumer Preferences and Health Care Demand

Frederick H. NavarroPATH Institute Corporation

Directing health practice to serve health priorities


Consumer Subtype Prevalences and SpendingU.S. Adult Population (210 million)

$29

$93$112

$130 $138 $139$157 $162

$245

$250

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

20.0%

Type 1

Type 4

Type 2

Type 6

Type 8

Type 9

Type 5

Unass

igned

Type 7

Type 3

% o

f US

Adu

lts

$0

$50

$100

$150

$200

$250

$300

Billi

ons

Per

Yea

r

% SizeSpending


exercise

HealthLeaders “Fact File” December, 2006


Social Cognitive Theory

• Albert Bandera• Individual as active participant• Triadic reciprocality


Social Cognitive Theory• Triadic reciprocality

– Personal factors• Cognition (perceptions, expectations, preferences,

priorities, intentions)• Biology (age, gender, weight, blood pressure,

genetics)– Environmental factors

• Family, accessibility, communications, information, finances, wellness promotion

– Behavioral factors• Physical capabilities, exercise, diet, care seeking


Environmental factors



$29

$93$112

$130 $138 $139$157 $162

$245

$250

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

20.0%

Type 1

Type 4

Type 2

Type 6

Type 8

Type 9

Type 5

Unass

igned

Type 7

Type 3

% o

f US

Adu

lts

$0

$50

$100

$150

$200

$250

$300

Billi

ons

Per

Yea

r

% SizeSpending



–Personal factors• Cognitions, perceptions, expectations, preferences, priorities,

intentions

• Age, gender, weight, blood pressure, risk factors

– Environmental factors• Family, accessibility, communications, information, finances, wellness

promotion– Behavioral factors

• Physical capabilities, skills, diet, exercise, care seeking


Cognitive examples

Family members responsible for their own health

Deal with health only when problems come up


Cognitive examplesFamily members responsible for their own health

Visited pediatrician in past year (adults with children, N=36,877)

39.7%

24.7%

9.4% 7.6% 6.3%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

Stronglydisagree

Somewhatdisagree

Neither Somewhatagree

Strongly agree

Family responsible for own health

% Y

es


Cognitive examplesFamily members responsible for their own health

Dependent Claims (N=2,201 adults with at least one dependent claim)

$-

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

$3,000,000

$3,500,000

Stronglydisagree

Somewhatdisagree

Neither Somewhatagree

Stronglyagree

Family members take care of own health

Tota

l ave

rage

cla

ims Rx

MDHosp

$2.3 million


Cognitive examples“Only deal with health problems when they come up”

Response Countstrongly agree 756somehwat agree 1647neither 1016somewhat disagree 1930strongly disagree 2948Total 8297



Statement: Deal with health only when problems come up

Response Count Rx claims Prof_claimsInpatient claims

Total Claims Per Response

strongly agree 756 602.00$ 2,634.00$ 3,061.00$ 6,297.00$ somehwat agree 1647 626.00$ 2,316.00$ 3,085.00$ 6,027.00$ neither 1016 649.00$ 2,288.00$ 2,773.00$ 5,710.00$ somewhat disagree 1930 801.00$ 2,793.00$ 3,701.00$ 7,295.00$ strongly disagree 2948 964.00$ 3,417.00$ 3,806.00$ 8,187.00$ Total 8297

Statistical Sig. p<0.000 p=0.000 ns DifferenceDollar spread at extreme attitudes 362.00$ 783.00$ 745.00$ 1,890.00$



"Deal with health only when problems come up"

2948

19301647

1016756

0

500

1000

1500

2000

2500

3000

3500

strongly disagree

somewhat disagree

somehwat agreeneither

strongly agree

Cou

nt

$3,000,000

$8,000,000

$13,000,000

$18,000,000

$23,000,000

$28,000,000

Tota

l Spe

ndin

g

Count

Total Demand

$19.3 million



–Personal factors• Cognitions, perceptions, expectations,

preferences, priorities, intentions• Age, gender, weight, blood pressure

– Environmental factors• Family, accessibility, communications, information, finances, wellness

promotion– Behavioral factors

• Physical capabilities, skills, diet, exercise, care seeking


Path type®

• Cognitive interactive patterns • Health psycho-social domain• Perceptions, preferences, priorities

– Self– Family– Health care environment


• Focus on physical fitness • Focus on nutritional fitness • Commitment to the health of family members• Tendency to put off seeking health care• Degree of active healthcare information seeking and review• Confidence in medical professionals to do the right thing• Independent use of alternatives to medicine• Planning for future health benefits• Attentiveness to healthcare advertising• Willingness to pay more for quality• Concern with saving healthcare dollars

Cognitive factors


Unconscious cognitive structure (UCS)PATH Type 2 UCS

1.001.502.002.503.003.504.004.505.00

do no

t see

k care

avoid

care

due t

o exp

ense

family

takes

care

of he

alth

satis

fiied w

ith av

erage

family

h...

I like

to de

cide a

bout

family

healt

h

activ

e com

petiti

ve sp

orts

top ph

ysica

l sha

pe

very

involv

ed in

my h

ealth

use v

itamins

, herb

s ins

tead o

f ...

seek

nutrit

ion di

et inf

ormati

on

do w

hat p

arents

did

take t

hings

as th

ey co

me

info t

o cho

ose o

ption

s

compa

re ho

spita

ls

I cou

nt on

othe

rs

other

makes

family

healt

h dec

i...

I mak

e own d

ecisio

ns

tried t

o sav

e mon

ey

shop

more

by pr

ice

pay f

or hig

h qua

lity

neve

r use

low pr

iced d

octor

not w

orried

abou

t adv

ertise

d se..

.

pay a

ttenti

on to

ads

docto

rs nu

rses n

ot go

od

docto

rs do

n't kn

ow si

de ef

fects

path type measures

5 =

Stro

ngly

agr

ee



1.001.502.002.503.003.504.004.505.00

do no

t see

k care

avoid

care

due t

o exp

ense

family

takes

care

of he

alth

satis

fiied w

ith av

erage

family

he...

I like

to de

cide a

bout

family

healt

h

activ

e com

petiti

ve sp

orts

top ph

ysica

l sha

pe

very

involv

ed in

my h

ealth

use v

itamins

, herb

s ins

tead o

f ...

seek

nutrit

ion di

et inf

ormati

on

do w

hat p

arents

did

take t

hings

as th

ey co

me

info t

o cho

ose o

ption

s

compa

re ho

spita

ls

I cou

nt on

othe

rs

other

makes

family

healt

h dec

i...

I mak

e own d

ecisio

ns

tried t

o sav

e mon

ey

shop

more

by pr

ice

pay f

or hig

h qua

lity

neve

r use

low pr

iced d

octor

not w

orried

abou

t adv

ertise

d se..

.

pay a

ttenti

on to

ads

docto

rs nu

rses n

ot go

od

docto

rs do

n't kn

ow si

de ef

fects

path type measures

5 =

Stro

ngly

agr

ee



1.001.502.002.503.003.504.004.505.00

do no

t see

k care

avoid

care

due t

o exp

ense

family

take

s care

of he

alth

satis

fiied w

ith av

erage

family

he...

I like

to de

cide a

bout

family

healt

h

activ

e com

petiti

ve sp

orts

top ph

ysica

l sha

pe

very

involv

ed in

my h

ealth

use v

itamins

, herb

s ins

tead o

f d...

seek

nutrit

ion di

et inf

ormati

on

do w

hat p

arents

did

take t

hings

as th

ey co

me

info t

o cho

ose o

ption

s

compa

re ho

spita

ls

I cou

nt on

othe

rs

other

makes

family

healt

h dec

is...

I mak

e own d

ecisio

ns

tried t

o sav

e mon

ey

shop

more

by pr

ice

pay f

or hig

h qua

lity

neve

r use

low pr

iced d

octor

not w

orried

abou

t adv

ertise

d se..

.

pay a

ttenti

on to

ads

docto

rs nu

rses n

ot go

od

docto

rs do

n't kn

ow si

de ef

fects

path type measures

5 =

stro

ngly

agr

ee


PATH Type 7 and PATH Type 8

1.001.502.002.503.003.504.004.505.00

do no

t see

k care

avoid

care

due t

o exp

ense

family

takes

care

of he

alth

satis

fiied w

ith av

erag

e fam

ily he

alth

I like

to de

cide a

bout

family

healt

h

activ

e com

petiti

ve sp

orts

top ph

ysica

l sha

pe

very

involv

ed in

my h

ealth

use v

itamins

, herb

s ins

tead o

f drug

s

seek

nutrit

ion di

et inf

ormati

on

do w

hat p

arents

did

take t

hings

as th

ey co

me

info t

o cho

ose o

ption

s

compa

re ho

spita

ls

I cou

nt on

othe

rs

other

makes

family

healt

h dec

isions

I mak

e own d

ecisio

ns

tried t

o sav

e mon

ey

shop

mor

e by p

rice

pay f

or hig

h qua

lity

neve

r use

low pr

iced d

octor

not w

orried

abou

t adv

ertise

d ser.

..

pay a

ttenti

on to

ads

docto

rs nu

rses n

ot go

od

docto

rs do

n't kn

ow si

de ef

fects

path type measures

5 =

stro

ngly

agr

ee

Unconscious cognitive structure (UCS)



$29

$93$112

$130 $138 $139$157 $162

$245

$250

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

20.0%

Type 1

Type 4

Type 2

Type 6

Type 8

Type 9

Type 5

Unass

igned

Type 7

Type 3

% o

f US

Adu

lts

$0

$50

$100

$150

$200

$250

$300

Billi

ons

Per

Yea

r

% SizeSpending


• Cognitive/ psychological view of person


• Dynamics within person• Cognitions that shape perception

= sub type


Path types

• Health behaviors• Health risks and disease• Patient satisfaction • Health care demand and spending


Wellness Activities by PATH Type

0%

50%

100%

150%

200%

250%

300%

350%

400%

PATH Type 8

PATH Type 7

PATH Type 9

PATH Type 6

PATH Type 4

PATH Type 5

PATH Type 3

PATH Type 1

Unass

ignedPATH Typ

e 2

Mul

tipe

Res

pons

e

Health Screening

Routine Physical

Attended Health Ed Class

Attended Wellness/ Fitnessclass

I am very involved in my health(Strongly Agree)

I don't plan ahead, I deal withhealth issues when they comeup (Strongly Disagree)Only seek care when really sickor injured (Strongly Disagree)

Attention to Nutrition & HealthyDiet (Strongly Agree)

Active or Competitive sports(Strongly Agree)

Exercise 4+ days per week


Health Risk Conditions and PATH Types Sach/Scarborough HealthPlus, 2001, N=93,400

0%

50%

100%

150%

200%

250%

300%

350%

PATH Type 2

PATH Type 4

PATH Type 9

PATH Type 7

PATH Type 1

PATH Type 5

PATH Type 3

PATH Type 6

PATH Type 8

% e

xcee

d 10

0 du

e to

mul

tiple

resp

onse

Poor attention to nutritionLow physical activityMigrainesWeight ProblemChronic back painDepressionSmoking (4+ days per weekSleeping ProblemsHigh CholesterolHypertension


Reported Disease Conditions by PATH Type Sachs/Scarborough HealthPlus USA Survey, 2000, N=61,000

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

140.0%

PATH Type 7

PATH Type 4

PATH Type 9

PATH Type 3

PATH Type 6

PATH Type 1

PATH Type 5

PATH Type 2

PATH Type 8

% e

xcee

d 10

0 du

e to

mul

tiple

resp

onse

s

DermatitisOsteoporosisRespiratory conditionsArthritis/ rhematismAlzheimer'sChronic AllergiesHeart DiseaseAll CancersSkin CancerBreast CancerKidney Disease


Specialty Care Demand

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

PATH Type 7

PATH Type 4

PATH Type 1

PATH Type 9

PATH Type 6

PATH Type 8

PATH Type 3

PATH Type 5

Unass

igned

PATH Type 2 Tota

l

PATH Types

Gastro- entorologistENTAllergistCosmetic SurgeryNeurologistOrthopedicsOncologistCardiologist


Health Plan Loyalty/Retention Index(membership length, satisfaction, intent to switch, intent to recommend)

139

131

109 108

97 96 96 93 90

100

80

90

100

110

120

130

140

150

PATHType 4

PATHType 7

PATHType 6

PATHType 1

PATHType 5

PATHType 8

PATHType 2

PATHType 9

PATHType 3

Total

Inde

x of

Loy

alty

(100

=ave

rage

)


Est. Medical Costs Per Adult by PATH Type (N=51,000+, four health plan composite, adults)

$6,252$6,124

$8,457

$8,188

$7,262$7,122

$6,936

$6,469 $6,363 $6,358

$7,000

$6,000

$6,500

$7,000

$7,500

$8,000

$8,500

$9,000

Type 4

Type 7

Type 9

Unass

ignedTyp

e 6Typ

e 3Typ

e 8Typ

e 1Typ

e 2Typ

e 5 Total

Ave

rage

Pro

ject

ed S

pend

ing


Rx Reimbursements by PATH Type N=13,296 Commerical Plan Members

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

PATH Type 7

PATH Type 9

PATH Type 6

PATH Type 5

PATH Type 8

Unass

igned

PATH Type 3

PATH Type 4

PATH Type 1

PATH Type 2

% o

f adu

lt po

pula

tion

$300

$400

$500

$600

$700

$800

$900

$1,000

Ave

rage

cla

im p

mpy

%PMPY


HealthLeaders “Fact File” September, 2008

CDHP enrollees use more services:

especially diagnostic


Disease Management & Health Outcomes, 2007

Parente, S., Christianson, J., & Feldman, R. (2007, August). Consumer-Directed Health Plans and the Chronically Ill. Disease Management & Health Outcomes, 15(4), 239-248.

• CDHP enrollees with chronic illnesses assign higher ratings to their plan than do other CDHP enrollees (p < 0.07).

• They are more likely than other CDHP enrollees to use informational tools (p < 0.05),

• more likely to anticipate spending all of their savings account dollars (p < 0.05),

• and more likely actually to spend more than the deductible (particularly for prescription drug expenditures [p < 0.05]).

• Compared with other CDHP enrollees whose spending exceeds the deductible, enrollees with chronic illnesses spend significantly more on prescription drugs.

From Abstract:


HealthLeaders “Fact File” September, 2008

Beginning recognition of cognitive impacts on health and demand


Summary• CDH fails to understand health consumers

Empowerment = management CDH primary focus = environment, not consumers SCT: health behavior is driven by many factors CDH ignores individual differences Path type psychology reveals UCS structure UCS patterns shape risk, demand CDH promise will require recognition of UCS CDH on verge! A focus on changing just three UCS


Questions/Comments

Frederick H. NavarroPATH Institute Corporation

Directing health practice to serve health priorities

[email protected]

http://www.pathinstitute.com/

mailto:[email protected]

Documents

Cognitive and Behavioral Patterns of Thinking and ActionSocial Cognitive Theory • Albert Bandera • Individual as active participant • Triadic reciprocality. . Directing health