Can Positive “Illness Mindsets” Set the Stage for Better Prediabetes Management?
For the nearly 1.4 million Americans who are newly diagnosed with diabetes every year*, feeling confused, overwhelmed and under-supported is all too common. The thought of managing their new condition may seem daunting, and it’s easy to understand why.
Dr. Alia Crum, a clinical psychologist and principal investigator at the Stanford University Mind & Body Lab, has found that mindsets about diabetes tend to be particularly negative.
“Often we see more adaptive mindsets in patients with cancer than we do with diabetes patients,” Crum says. “Ironically, people with cancer end up coming out of it with a more positive mindset about their lives moving forward.”
Crum accounts for the negative mindsets about diabetes due to cultural messaging around the illness, which is linked to the negative stigma of obesity and feelings of blame and shame that people attach to it.
Can reframing the typical mindset that sets in for those dealing with a prediabetes diagnosis shift the paradigm for condition management?
Dr. Crum certainly believes so. She has been leading efforts to research mindset change as it relates to health for the past decade. In 2021, Dr. Crum partnered with the Omada Insights Lab to evaluate whether, among Omada members at risk for developing type 2 diabetes, the way Omada’s care teams interacted with Omada members showed a change in Members’ mindsets and whether improved outcomes resulted. Dr. Crum was particularly interested in assessing the types of mindsets that members displayed, including whether any indicated an “Illness Mindset,” which reflects a person’s assumptions about what an illness is and how it works.
“We’ve shown in different studies that mindsets are relatively easy to change,” Crum said. “It’s really hard to get people to change behavioral patterns, but if we can inspire them to think differently about something, those changes can have downstream effects.”
What is Illness Mindset?
Illness Mindset can influence how a patient responds to a diagnosis, manages the challenges of their care, and navigates their post-treatment life. Clinical research by Crum and others shows that Illness Mindset falls into three categories:
- Catastrophic: “Illness is a catastrophe”
- Manageable: “Illness is manageable”
- Opportunistic: “Illness can be an opportunity for positive change”
Starting in October 2021, Crum and her team asked every new enrollee in the Omada for Prevention program to complete a 28-question survey designed to measure their mindset as well as their behaviors and health metrics. By the end of November, they had collected initial data from 4,776 participants on several key metrics, including Illness Mindset. After surveying these 4,776 people, we tracked the attitudes of this group of people as they progressed through the Omada for Prevention program.
Over a six-week period, we monitored how this group of 4,776 people were thinking about the possibility of diabetes. During that time, the number of surveyed Omada for Prevention program participants who saw diabetes as catastrophic decreased. The number of those who saw it as manageable remained steady, while the number of those who saw it as an opportunity to change and improve their lives increased. Due to the negativity Crum encountered in her previous work, this was a particularly important outcome.
Omada Insights Lab has begun leveraging this data with program coaches to evolve coach-member interactions and how we deliver curated program content and education to our members. For example, we are now teaching coaches about mindset theory, setting mindset change as a quarterly target variable, and encouraging them to try out new strategies.
Crum and Omada are partnering on additional work in 2022 to learn what specific coaching styles, practices and messaging yield the most impact in shifting mindsets. “We’re asking coaches directly to come up with their best ideas on how to induce this outcome,” Ryan Quan, director of data science at Omada Insights Lab, said. “We’ll then codify all the strategies that they’ve developed, continue to monitor our outcomes as we always do and provide feedback and training to the coaches on which strategies are working best.”
“As a researcher, we do [mindset] research because we want to help people,” Crum added. “We want to find ways to help people be healthier and happier in their lives.”
Dr. Crum’s contribution to this publication was as a paid consultant and was not part of her Stanford University duties or responsibilities.