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Mar 16, 2012

Bob Merberg has been providing thoughtful commentary on ShapeUp’s recently released survey data in an excellent series on his blog. His most recent post in the series, Engagement vs. Participation: Shaping Up or Just Showing Up?, ponders whether it’s enough for employers to merely strive for participation:

When I first started hearing about health engagement, the very purpose of the phrase was to set engagement apart from participation. Engagement referred to having a genuine and emotionally influenced connection to health and, in many cases, health behavior change. Participation meant merely taking some sort of action — regardless of sincerity or value (completing a program, getting a biometric screening, and so forth).

Some employees participate in programs exclusively to obtain an incentive. Are they engaged?”

Wellness vs. compliance

I agree with Bob about there being a difference between participation and engagement. That difference, as I see it, is the degree to which someone is actually invested in his or her health. By that I mean actively educating him or herself about it and taking pains to improve and manage it versus checking a box to get something done — merely participating — without care or mindfulness for what health benefits it may deliver.

Bob continues his argument about whether it’s enough for employers to concentrate on and calculate participation as if it matters until he reaches this final point:

In our environment of incentive-laced wellness programs, embodied by the proliferation of so-called outcomes-based programs, the distinction between participation and true engagement becomes even more significant. When an employee enrolls in a program (or, I’ll argue, even achieves a biometric improvement) exclusively to reduce their insurance premium or access a better medical plan, it may not be because they are engaged. Heck, it’s barely participation. I’d use a completely different word to describe it: compliance.

And I’m not sure compliance is wellness, at all.”

Behavior change isn’t easy

Here’s where I veer from Bob’s line of thought. If behavior change were easy and people did what they (and we) knew was best for their health, compliance wouldn’t be enough. But in our real world, neither of those is true, and so compliance becomes a matter of grave importance.

Here’s an example: Yesterday a friend updated me about her brother-in-law’s health condition. At 42 years-old, he had a serious heart attack. His mother flew to his side to help him with recovery and to manage his business, and she’s been aghast as she’s watched him resume smoking, continue his excessive drinking, and in all other ways be non-compliant with his recommended recovery. While my friend was shocked at his behavior, I informed her that going back to old habits, even after a heart attack, was quite normal, unfortunately.

In this case, were my friend’s brother-in-law to be compliant, he’d be back on the road to wellness. In fact, he’d be on a better road than he was before the heart attack.

I see this, too, with employees and their stories of complying with biometric screenings, or complying with preventive checkups, or complying with tobacco-free workplace policies. or really, even nudging people through behavioral cues and the built environment. There’s no intrinsic motivation involved. It’s pure requiring, guiding or steering.

We may not have their hearts and minds when we start with compliance and participation, but we do start influencing what they do with their bodies. With that, the hope is their hearts and minds may follow.

Note: This post doesn’t extend to outcome-based wellness efforts, for which I have reservations.

This was originally published on Fran Melmed’s free-range communication blog.