The biopsychosociotechnical model: a systems-based framework for human-centered health improvement

Figures & data

Figure 1. The biopsychosocial model(used by permission, Engel (1981)).

Table 1. Examples of how technology can affect health.

Examples of how technology can affect health
Home monitoring devices
Home blood pressure measurement can provide more useful data to guide hypertension treatment, and reduced systolic and diastolic blood pressure (Stergiou & Bliziotis, 2011; A. M. A. M. Ward et al., 2012) Health apps are rarely evidence-based and may increase the risk of serious health hazards (Subhi et al., 2015)
Robotics
Robots can provide benefits across a broad range of healthcare settings and health conditions, but may also introduce new risks (Moharana et al., 2019; Riek, 2015, Riek, 2017; Wachter, 2015) Training with expressive robots that mimic human facial expressions/pathologies could help improve diagnosis and clinical communication (M. Moosaei et al., 2019; Maryam Moosaei et al., 2017; Riek & Robinson, 2011) Robotic prehabilitation and rehabilitation coaches can adapt to patient behavior and preferences, potentially leading to improved adherence (Banh et al., 2021; Woodworth et al., 2018)
Home-based robots tailored to the needs of people dementia and mild cognitive impairment (and their caregivers) may extend their ability to manage the activities of daily living (Astorga et al., 2021; Banh et al., 2021; Guan et al., 2021; Kubota & Riek, 2021)
Assistive technology
Use of cochlear implants or hearing aids is associated with reduced depressive symptoms among those with age-related hearing loss (Choi et al., 2016) Use or non-use of assistive devices can be associated with stigma and lead to avoidance of healthcare providers (Virdi, 2017) Devices with design features that impair privacy/trust, are too costly, or result in stigma may not be used, and therefore fail to deliver benefit (Yusif et al., 2016)
Communities built around shared use of assistive technologies (like prosthetic limbs) may be more acceptable and more beneficial to participants’ health than support groups based on health identities (e.g., “amputees”) (Schairer, 2011)
Built environment
In psychiatric settings, rooms that provide more privacy are associated with a greater risk of suicide/self-harm than more public areas (Bayramzadeh, 2017) Single-patient hospital rooms are associated with reduced healthcare-acquired infections, improved patient-clinician communication, reduced noise, and improvements in perceived sleep quality (Taylor et al., 2018)
The built environment of communities may significantly impact health behaviors related to active recreation and active transportation (Sallis et al., 2012)
Binary gender segregation is a common theme in the design of the built environment (e.g., restrooms, school locker rooms, custodial facilities, etc.), which can lead to both psychological and physical health problems for trangender and gender non-conforming people (Herman, 2013)
Electronic health record systems (EHRs)
Clerical burden associated with EHR use may increase the risk of physician burnout (Shanafelt et al., 2016) Direct online access to doctors’ clinical notes may improve patients’ understanding, adherence, and self-care (Walker et al., 2015)
Although they were adopted in part to improve safety, EHRs can also contribute to patient harm (P Carayon et al., 2017; Graber et al., 2019; Meeks et al., 2014; Menon et al., 2014)
Other computer and audiovisual technologies
Virtual reality stimuli may reduce the experience of pain (Malloy & Milling, 2010) Electronic communication tools may help clinicians better meet the information needs of patients with cancer (Gonzales & Riek, 2012, Gonzales & Riek, 2013; Waljee et al., 2007)
The Internet can serve as a powerful delivery mechanism for health improvement interventions (Hou et al., 2014; Saddichha et al., 2014), but can also enable such problems as Internet addiction (Leung, 2014) or pro-eating disorder online support groups (Rodgers et al., 2012) Telehealth interventions can help to deliver routine care while maintaining social distancing during a pandemic (Card & Riek, 2009; Hom & Chous, 2007; Koonin et al., 2020; Kun, 2007; Lai et al., 2020; Mulder et al., 2009)

Table 2. Heuristic approaches for biopsychosocial care.

Habits of mind (Epstein & Borrell-Carrió, 2005)	Seven pillars (Francesc Borrell-Carrió et al., 2004)	Three dicta(Freudenreich et al., 2010)
•Attentiveness •Peripheral vision •Curiosity •Informed flexibility	•Self-awareness •Active cultivation of trust •Empathic curiosity •Self-calibration to reduce bias •Educating the emotions •Using informed intuition •Communicating clinical evidence to foster dialogue	•Think neuro-anatomically •Think existentially •Think “dirty” (i.e., “ … understand that patients and physicians sometimes work toward different goals”.)

Figure 2. The SEIPS 2.0 Model, from (Holden et al., 2013) (used by permission).

Figure 3. The Biopsychosociotechnical (BPST) Model.

Figure 4. Hypothetical biopsychosociotechnical analysis of under-immunisation in an immigrant community.

Table 3. Potential biopsychosociotechnical considerations for selecting a CPAP interface.

Bio	Moderate-to-severe obstructive sleep apnea Wears a beard; intends to keep it Primarily a back sleeper
Psycho	Moderate level of motivation to adhere to treatment Does not want to “have to get an engineering degree” to use the mask
Socio	Married, shares bed with spouse Concerned about “looking ridiculous” and “unsexy” Insurance covers all standard types of CPAP interface
Technical	Oronasal mask likely “too much” and would make it hard to respond to spouse's conversation Oronasal mask (especially) and nasal mask may leak with beard Nasal pillow may leak less with beard, is less bulky and less obstructive
Recommendation	Trial of nasal pillow

Figure 5. Five key components of the BPST model that “show the work” of participatory systems improvement for health.

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