(Part 1) The PEAR Framework: The Secret Sauce for Behavior Change

Is dance a sport or an art? Is a hot dog considered a sandwich? Does the weekend begin on Friday or Saturday?!

When it comes to patient engagement, we all know it’s more of an art than a science—but what if it could be both? 

Enter the PEAR Framework, a simple, structured approach to behavior change—invented by yours truly—and focuses on four key elements: 

• Priming

• Educating

• Activating

• Reiterating

Why PEAR Works

The beauty of the PEAR Framework is its simplicity. It’s like the 3-ingredient olive oil, salt, and pepper dressing on a salad that knocks it out of the park. 

It’s adaptable, patient-centered, and crafted to create lasting change by focusing on the how of behavior, not just the what. 🤌

So, whether you directly treat patients or work on patient engagement initiatives in health tech, the PEAR Framework can help you make meaningful, sustainable connections.

This is part 1 of a mini-series where we’ll explore each part of the framework over the next four weeks. This week, we’re starting with “P” for priming.

Priming: Setting the Stage for Change

The information we are exposed to can affect our actions and behavior. 

This is known as priming, which occurs when our exposure to a particular stimulus influences our response to a subsequent prompt without awareness of the connection. 

Think of priming as prepping the soil before planting the seeds. 🪴

The priming effect is happening all the time—often without us realizing it. Small, subconscious nudges shape our behaviors, decisions, and habits daily. It’s in words, color choices, design, smells, positioning, product placement, and visual cues. 

Stores (we see you, HomeGoods) flank you with goodies in the checkout line that prime you to make impulsive purchases. (Or is it just me?) Reading words like “kind,” “respect,” and “courteous” before a meeting may make you more likely to be patient and polite in discussions.

Health goal priming is a cueing intervention that activates a health goal in a tempting situation, thus facilitating behavior that aligns with the health goal. For example, people are more likely to eat more fruit when a bowl with fresh fruit is placed in a high-traffic area and is looked at routinely, compared to when fruit is placed in a more hidden space.

This is why I’m a fierce advocate for “romanticizing” your habits and routines to make them “stickier," 🍯🍯🍯 like using aesthetic glasses only for smoothies and having a smoothie bar with all the items I need readily accessible.

These little tricks lay down the foundation for motivation that leads to execution. 

Priming is also a big part of vision-boarding—it IS the vision board. I pull the most inspiring Pinterest pictures into Canva each year and craft the year’s vision board wallpaper for my phone and desktop. These pictures center my aspirations: running, health, family, a luxurious lifestyle, reading, career success, etc.

My curated wallpaper is with me everywhere I go—as long as my phone is with me (it’s wild to think that we are never away from our phones), so I am never far from reminders of the person I aspire to be and become. ✨

Priming in Digital Health

In a digital environment, nudges fulfill the priming effect. Nudging interventions use resources that remove the need for effortful attention. 

It’s kind of like the bumper rails on a bowling lane. Nudging steers you toward a decision-making path around desired behaviors that are more appealing and rewarding. 🎳

Priming your patients creates an environment where they feel empowered, ready, and motivated to take action. 

Here are some ideas and examples:

• Surface a patient’s “why” to reinforce their commitment to completing the desired action—such as following their exercise program or getting the flu shot. 

• Before a telehealth visit, sending a short video of a healthcare provider greeting patients warmly or testimonials from other patients can help them feel more comfortable and engaged.

• Instead of saying, “Don’t forget to take your medication,” a push notification could say, “You're one step closer to your health goal—time for your next dose.”

• A chronic disease management app could use wording like “You are a healthy eater” instead of “Try to eat healthy.”

• Using calming blues and greens in a mental health app rather than alarming reds or yellows can prime a sense of relaxation and safety.

• When a user completes a week of tracking symptoms in a patient engagement app, the app could display a “milestone unlocked” badge with congratulatory language.

•  Showing “85% of patients in your group have completed their health survey this month” can encourage users to follow suit.

• When scheduling a follow-up appointment online, pre-selecting an earlier available date can nudge patients toward sooner care rather than delaying.

• A digital assistant in a patient portal could greet users with, “I see you’re making great progress! How can I support you today?” instead of “What do you need help with?”

In the patient education materials I design at Medbridge, I incorporate many of the strategies listed above to help patients achieve success.

By embedding priming techniques into digital health experiences, we can increase engagement, adherence, and patient empowerment without feeling pushy. Which of these strategies do you think would be most impactful in your work? 💡

Stay tuned for the rest of the series! Next week, we are covering “E” for educating. 🍐

🧠 Unhinged: Thoughts

I am struggling to find a balance between reading for business and reading for pleasure. Last year, I experimented with reading for both at the same time. I crawled on both fronts.

But in November and December of last year, I committed to reading one book at a time and zoomed through two professional development books. My heads-down approach paid off because then I was back to reading for pleasure and could fully commit to that.

But now, I waffle. 🧇 🧇 🧇 

I am an ambitious reader and want to return to doing both at once. I am no stranger to setting grand expectations for myself and almost always falling short of them. That is my toxic trait.

I’ve accepted that almost every part of my life will be an experiment. There is no failing if you reframe your outcomes as “research and development.” I have found benefits to both ways—reading two books at once vs. reading one book at a time- but they both come with trade-offs.

And it’s ok. Like it’s really ok. It depends on my energy and how much time I am willing to invest in reading more to make reading two books concurrently feasible. Because I’ve recently come to the humbling realization, it’s less about time management and more about energy management for me.

Anyway, here is a picture of my office with a professional development book I continue to dabble in but haven’t committed to reading from book cover to book cover. Not yet, at least.

Take care, and see you next week.

Erika