Healthcare Has a Participation Problem

Across healthcare, insurance and workplace wellbeing, there is no shortage of services.

There are clinicians, treatment pathways, wellbeing programmes, digital tools and health information resources available in almost every developed healthcare system.

Yet despite this, many organisations continue to face the same challenges:

  • Rising healthcare demand.
  • Increasing musculoskeletal complaints.
  • Growing mental health pressures.
  • Persistent sickness absence.
  • Workforce shortages.
  • Escalating costs.

The question is no longer whether support exists.

The question is whether people are able and willing to engage with support early enough for it to make a meaningful difference.

This distinction matters.

Many health interventions are designed around what happens after a problem becomes significant enough to require treatment.

We became interested in a different question.

What happens before that point?

How do we help people stay engaged with their own health before they become patients?

That question ultimately became one of the foundations of Trigo.

The answer did not come from a single research paper, a single technology platform or a single healthcare discipline.

Instead, it emerged from a growing body of evidence spanning digital wellbeing, behaviour change, self-management, telehealth, workforce health and organisational performance.

Over time, we realised something important.

The most effective solutions rarely rely on a single intervention.

They combine multiple evidence-based principles into one coherent experience.

That observation sits at the heart of the Trigo platform.

The Shift from Digital Health to Digital Wellbeing

One of the most influential concepts shaping our thinking came from the growing literature on digital wellbeing.

In their systematic scoping review, Smits and colleagues (2022) describe an evolution from traditional digital health towards a broader concept of digital wellbeing.

Historically, digital health has focused primarily on healthcare delivery:

  • Diagnosis.
  • Treatment.
  • Disease management.
  • Clinical monitoring.

Digital wellbeing expands that perspective.

The focus shifts towards:

  • Prevention.
  • Self-management.
  • Behaviour.
  • Lifestyle.
  • Quality of life.
  • Ongoing participation in health.

This distinction may appear subtle, but it has profound implications.

If healthcare is organised primarily around illness, most interventions occur after problems emerge.

If healthcare is organised around wellbeing, support can begin much earlier.

The Trigo platform was shaped by this philosophy.

We did not want to build another appointment-management system.

We wanted to create infrastructure that supports healthier decisions, healthier behaviours and easier access to support when people need it.

In other words, we became less interested in managing episodes of care and more interested in supporting ongoing participation in health.

Why Engagement Matters More Than Access

Once we began exploring wellbeing and prevention, another question emerged.

Why do some programmes succeed while others struggle?

The answer appears repeatedly throughout the literature.

Engagement.

Research by Howarth et al. (2018), Sevic et al. (2023) and Shiri et al. (2023) consistently highlights participation as a critical determinant of success within workplace health programmes.

Providing access does not automatically create outcomes.

People must engage.

This sounds obvious.

Yet many wellbeing initiatives continue to be evaluated according to what is available rather than what people actually use.

The evidence suggests that participation is not simply a by-product of good intentions.

It can be influenced by design.

Milne-Ives and colleagues (2023) reviewed behaviour change techniques associated with engagement in digital health interventions.

Their findings repeatedly identified:

  • Goal setting.
  • Self-monitoring.
  • Feedback.
  • Progress visibility.
  • Social support.

These mechanisms appear consistently in successful interventions.

The implication is important.

Engagement should not be treated as a marketing objective.

It should be viewed as a clinical and behavioural objective.

If people disengage, the likelihood of sustained behaviour change decreases.

This observation influenced many aspects of the Trigo platform.

Tracking tools, progress indicators, reminders, communication pathways and structured journeys were not added because they are fashionable features.

They were added because the evidence suggests they help people remain involved long enough for meaningful behaviour change to occur.

The Science Behind Motivation

One of the most misunderstood concepts in digital wellbeing is gamification.

The term often creates images of points, badges and leaderboards.

The academic literature paints a much more sophisticated picture.

Edwards and colleagues (2016) examined gamification within health applications and found that many successful systems incorporate recognised behaviour change techniques.

More recently, Alzghoul and colleagues (2024) conducted a systematic review and meta-analysis and found evidence that gamification can improve engagement, participation and physical activity outcomes when integrated into broader behaviour change programmes.

The important point is that gamification is not really about games.

It is about motivation.

People are more likely to maintain healthy behaviours when they receive:

  • Feedback.
  • Recognition.
  • Reinforcement.
  • Evidence of progress.

The strongest interventions combine these mechanisms with meaningful goals and practical support.

This is precisely how we view engagement within Trigo.

The objective is not to make health feel like a game.

The objective is to make healthy behaviour easier to sustain.

Why We Believe in Supported Self-Care

Engagement alone is not enough.

People need something meaningful to engage with.

This is where supported self-care becomes important.

A recurring theme across healthcare research is the value of active participation.

Baumbach and colleagues (2024) found that physiotherapy interventions focused on active rehabilitation, education and self-management frequently provide strong value.

The message emerging from the literature is remarkably consistent.

People often achieve better outcomes when they become active participants in their own health rather than passive recipients of care.

However, there is an important distinction.

Self-care is not the same as unsupported self-care.

Simply providing information and hoping for the best rarely creates sustainable change.

People need guidance.

They need structure.

They need access to professional support when required.

That is why we prefer the term supported self-care.

At Trigo, we see self-care and professional care as complementary rather than competing concepts.

The objective is not to replace clinicians.

The objective is to help people access the right level of support at the right time.

Rethinking Access to Professional Support

The next question naturally follows.

If professional support remains important, how should it be delivered?

This is where telehealth becomes relevant.

Research by Marks et al. (2023) and Bargeri et al. (2024) provides strong evidence that telehealth and telemedicine can effectively support many musculoskeletal presentations.

Both reviews found that digital delivery can often achieve outcomes comparable to traditional face-to-face care while improving accessibility and convenience.

This finding has significant implications.

The future of healthcare is unlikely to be defined by replacing clinicians with technology.

The evidence does not support that conclusion.

Instead, the evidence suggests that technology can help clinicians deliver support differently.

More efficiently.

More accessibly.

More consistently.

This perspective strongly influenced the Trigo model.

Digital tools support engagement.

Self-care supports participation.

Professional support remains available when needed.

The platform acts as the connective infrastructure between these elements.

From Individual Health to Workforce Health

Much of the research discussed so far focuses on individuals.

Employers, however, face a different question.

How do these principles translate into workforce outcomes?

This is where another important body of evidence emerges.

Odeen et al. (2013) found evidence that workplace interventions can reduce sickness absence.

Tarro et al. (2020) identified positive effects on work ability and productivity.

Cancelliere et al. (2011) demonstrated that workplace health promotion programmes can positively influence presenteeism and workplace performance.

Collectively, these studies suggest that wellbeing is not simply a healthcare issue.

It is also a workforce issue.

A productivity issue.

A resilience issue.

An organisational performance issue.

Importantly, none of these papers prove that a specific platform will reduce absence or improve productivity.

That would be an inappropriate interpretation.

What they do show is that interventions built around participation, activity, support and behaviour change can positively influence outcomes that matter to organisations.

That distinction is important.

The evidence supports the principles.

Our responsibility is to apply those principles responsibly.

Why Trigo Brings These Elements Together

When we step back and look across the evidence base, a pattern becomes clear.

No single intervention solves the problem.

Digital wellbeing alone is not enough.

Engagement alone is not enough.

Gamification alone is not enough.

Self-management alone is not enough.

Telehealth alone is not enough.

Workplace programmes alone are not enough.

The strongest evidence points towards integration.

Participation supported by engagement.

Self-care supported by professionals.

Technology supporting human expertise.

Prevention supported by infrastructure.

This realisation shaped the architecture of Trigo.

The platform is not intended to be a collection of disconnected features.

It is intended to be a practical expression of what the evidence suggests works best.

A place where:

  • Behaviour change principles support engagement.
  • Supported self-care encourages participation.
  • Telehealth improves access.
  • Professional guidance remains available.
  • Employers and insurers gain visibility.
  • Individuals receive practical support.

Looking Forward

Healthcare systems continue to face significant pressures.

Demand is increasing.

Resources remain constrained.

Workforces are under strain.

The solution is unlikely to come from a single innovation.

More likely, it will emerge from combining what we already know.

The evidence reviewed over the past decade points towards several recurring principles:

  • Prevention matters.
  • Engagement matters.
  • Participation matters.
  • Self-management matters.
  • Professional support matters.
  • Access matters.

At Trigo, these principles have influenced how we think about health, wellbeing and support.

Not because the research proves Trigo works.

It does not.

Rather, because the research provides a credible foundation for the decisions we have made.

Our belief is simple.

When evidence-informed design, professional expertise and human-centred technology are brought together effectively, it becomes easier for people to participate in their own health.

And participation, ultimately, is where meaningful change begins.

References

Smits et al. (2022). From Digital Health to Digital Well-being: Systematic Scoping Review.

Milne-Ives et al. (2023). Potential Associations Between Behaviour Change Techniques and Engagement With Mobile Health Apps.

Edwards et al. (2016). Gamification for Health Promotion.

Alzghoul et al. (2024). The Effectiveness of Gamification in Health and Wellbeing.

Baumbach et al. (2024). Cost-Effectiveness of Treatments for Musculoskeletal Conditions Offered by Physiotherapists.

Marks et al. (2023). The Health Economic Impact of Musculoskeletal Physiotherapy Delivered by Telehealth.

Bargeri et al. (2024). Effectiveness of Telemedicine for Musculoskeletal Disorders.

Howarth et al. (2018). The Impact of Digital Health Interventions on Health-Related Outcomes in the Workplace.

Sevic et al. (2023). Effectiveness of eHealth Interventions Targeting Employee Health Behaviors.

Shiri et al. (2023). Workplace Interventions to Improve Health and Wellbeing of Health and Social Service Workers.

Odeen et al. (2013). Systematic Review of Active Workplace Interventions to Reduce Sickness Absence.

Tarro et al. (2020). Workplace Interventions for Improving Absenteeism, Productivity and Work Ability.

Cancelliere et al. (2011). Workplace Health Promotion Programs and Presenteeism.