Should doctors use peer pressure to their advantage? It could lead to better outcomes for patients, according to an article in the New England Journal of Medicine.

“Even patients with chronic illness may spend only a few hours a year with a physician,” it says, “as compared with the thousands of waking hours … out of clinicians’ reach,” doing things that may affect their health. Authors Dr. David Asch and Roy Rosin, of the University of Pennsylvania School of Medicine, suggest doctors leverage their patients’ existing social relationships, including friends and family, to bring out habits with positive health benefits. That could work, they write, because many people are influenced by others and may change their behavior based on what others think about them. Those who spend time around others with bad habits, like smoking, tend to pick up those negative habits, but the idea also works in reverse. For example, “You might be more likely to go to a gym if your friend also goes — and even more likely if you go together.”

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Much of their strategy for leveraging those social relationships involves making health-related behavior less private, like moving a prescription medication from the bathroom into the kitchen, “where you’re more likely to be witnessed taking (or not taking) your medication.” It also involves patients explicitly asking a friend or partner to help them do things like eat healthier and exercise regularly. The shift in ideas about privacy is not as big as it seems, the article notes, because even if they are not broadcasting their medical information on social media sites like Facebook, people often already share it with friends and family.

The co-authors are currently working on a trial to see if that medication strategy will make patients more likely to stick to their medication following a heart attack.

Various studies have shown that peer support can improve medical outcomes. In one, black veterans who were paired with a mentor as they tried to control their diabetes did a better job than those who were not paired with a mentor, as well as those who were offered a financial incentive for good performance.

“Although we don't normally think of competition or collaboration among patients are part of managing chronic diseases like high blood pressure, heart failure, or diabetes, research shows that behavior is contagious, and programs that take advantage of these naturally occurring relationships can be very effective,” Rosin said in a statement from the university.

While many health care strategies are designed for individuals, the two authors suggest relying on social interaction.

“Concerns about privacy are often the reason doctors and hospitals avoid organizing social support,” Asch said in the statement. “But while privacy is very important to some patients under some circumstances, more often patients would love if their friends and family helped them manage their diabetes, and those friends and family want to help people get their health under control.”

Source: Asch DA, Rosin R. Engineering Social Incentives for Health. New England Journal of Medicine. 2016.

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