Understanding Patient Behavior to Improve Home Exercise Program Adherence

Understanding Patient Behavior to Improve Home Exercise Program Adherence

Adhering to home exercise programs is a challenging task that physical therapists and their patients have faced for years. Despite advances in evidenced-based physical therapy, research estimates that greater than 70% of patients fail to adhere to their programs. Designing an effective and achievable home exercise program (HEP) can be improved upon by having an understanding of human behavior. This blog will share a new way of understanding the drivers of patient behavior, a model referred to as the Fogg Behavior Model, designed by Dr. BJ Fogg. 

Three Factors in The Behavior Model

The Fogg Behavior Model has three principle factors: motivation, ability and triggers. In order for a patient to complete a prescribed home exercise program, they need to have sufficient motivation, sufficient ability and an effective trigger. Additionally, all three factors need to happen simultaneously in order for the behavior to occur. 


Using the Fogg Behavior Model in Physical Therapy


Motivation: This is directly linked to a physical therapist’s ability to educate their patient on their injury, prognosis and home exercise program. It’s imperative to not only find the root cause of their condition, but also be able to clearly articulate this information and how a customized and skilled physical therapy plan of care will help manage it. If you are able to successfully connect with your patients and create a treatment plan they buy into, then you’ll be able to motivate your patients to complete their prescribed programs.

Ability: One of the biggest fears patients have upon leaving physical therapy is that they will perform some behavior that will make their condition worse. Despite our best efforts to ensure that patients understand how to properly perform their exercises, the reality is that 90% of patient education is forgotten. Bottom line, patients require a tangible resource in order to properly recall their program.

Triggers: The third factor in the behavioral change model is an effective trigger. Without an effective trigger, a behavior will not occur even if motivation and ability are high. An example of this commonly seen in healthcare is when gynecologists encourage patients on birth control to set an alarm to prevent patients from “forgetting” to take their medication – a phrase commonly heard by physical therapists regarding home exercise program completion.

Using Technology Rooted in Behavioral Change to Improve Adherence

Having a thorough understanding of human behavior will improve your ability to get patients to adhere to their HEPs. Several technology platforms have emerged in the last 2-3 years to assist in the process, however many have failed because people creating the technology don’t understand what factors lead to behavior change. After spending years as the Director of Rehabilitation at an outpatient private practice, I quickly learned that as a profession we need a better way to empower our patients and instill confidence that they are completing their programs correctly. As a result, I leveraged my bachelor’s degree in Human Development and Co-Founded a physical therapy software company called Healigo, with healthcare and behavioral change experts. The platform we collectively designed utilizes the Fogg Behavior Model to help patients stay on track with their recovery.

In closing, using platforms rooted in theories of behavioral change can help improve patient adherence and improve outcomes. A patient who was evaluated in my CashPT practice had the following feedback on using technology as part of her physical therapy. “I left my evaluation thinking I would remember my exercises -- but was I wrong. There's so much information to take in. By the time I got home, I had completely forgotten 1 of them and I wasn't sure if I was doing the other 2 exercises correctly. That app is awesome! If I didn't have the videos, I wouldn't have done anything until I saw you again."

About The Author: Hollan Oliver, DPT, OCS, SCS is the owner of Coastline Physical Therapy & Performance. She is also a Co-Founder of Healigo, a physical therapy patient adherence platform.