One concept has taught 40,000 Danes how to tackle their unhappiness

All people are essentially relatively similar. This is a fundamental belief at the Danish Committee for Health Information. They built the 'Learn to Tackle' concept, which is used in two out of three Danish municipalities and has been completed by more than 40,000 Danes. INVI spoke to the Director of the Committee about the method behind the concept.

"One size doesn't fit all, but it fits most," says Charan Nelander. He is the director of the Danish Health Information Committee.

While it sounds good that everyone is different and shouldn't be put into boxes, most people have a lot in common. And when it comes to spending taxpayers' money on major healthcare initiatives, you owe it to them to get the most for their money. 

As an economist, Charan Nelander is interested in how to create the greatest possible effect for the most citizens for the least amount of money. This is the formula that the Committee for Health Information works according to, and to realize it, they work to create concepts that can be used in many different contexts.

"Think of the efficiency when 7-Eleven builds new stores," says Nelander.

"They're all designed the same way. If they had to get an architect to redesign the stores every time, it would cost a lot of money. 7-eleven can build a store in four days because they know just conceptually where things should be, what materials they should use and how it should look," he says. 

A franchise like 7-eleven typically has three main fixed modules for (i) how to place the goods, (ii) what materials to use and (iii) the store's technological equipment.

Under each main module, they have some options that can be put together in different ways. Different display cases, different tiles and different cash registers. By combining the sub-categories of the three modules in different ways, you can customize 7-Eleven franchises to suit many different premises and locations, but with the same look and feel.

Learn to Tackle is basically built around free courses where several people with the same challenge meet either in person or online. Here, a volunteer who has experienced the same problem gives the participants tools to believe in their own abilities and helps them, for example, to handle challenges and achieve personal goals. The concept is based on a social-cognitive theory developed at Stanford University.

To achieve this goal, like 7-eleven, they have a set of standards around which they build the concept, regardless of the challenges of the target groups.

Firstly, the program is always based on peer-to-peer teaching, where the courses are led by people who have personal experience with the topic, such as anxiety and depression or chronic pain. Secondly, a fixed script is prepared for the trainers to follow to strengthen the participants' belief in their own abilities - promoting their sense of mastery over life and control over what is difficult. And then the program can be designed to take place in either face-to-face group sessions or online courses.

Bent Flyvbjerg, professor at ITU and Oxford and one of the world's most cited project management researchers, writes in his highly regarded book How big things get done that modularity is "faster, cheaper and better, making it valuable for all projects and sizes."

So modularization is functional for everything from setting up 7-eleven stores to tackling healthcare challenges, as exemplified by the Committee for Health Information.

Rolled out nationally and close to reality
The Danish Health Information Committee has over 200 partners, and Learn to Tackle is just one of many programs and initiatives they have launched. 

When they start a project, they look at two things: Can it be implemented nationally and does it work in the real world? If it can't be implemented nationally, they drop it. Economies of scale are paramount. And if it doesn't work in practice, they make adjustments. 

"It's crucial that the effort can work in reality and not just in a lab," says Charan Nelander.  

To find out if it works in reality, they test the models in a group context. That way, they find out what works and what needs to be changed. It's an iterative process where they gather new knowledge and make changes until they have a finished product that they can send out to the people who will operate it. In the case of Learn to Tackle, it's the instructors who are thoroughly trained based on a strictly organized program. 

The program is structured around a series of actions that help across different personal challenges. These include teaching participants to master skills through action plans, reassessing personal challenges, reflecting on positive role models and engaging in supportive group dynamics. These approaches are supported by research from psychology professor Albert Bandura, and they help participants strengthen their sense of control, thereby improving their quality of life.

The carefully designed playbook means it's quick to implement and cheap to run. 

"Because you have a fixed script, lay volunteers can teach without getting into situations where they can't answer questions or are unsure. And it has the advantage that municipalities don't have to reinvent the wheel. It's plug and play," says Charan Nelander.

Resistance to modules
The Committee for Health Information is more concerned with making a small but positive difference for many than a big difference for few.  

"I believe that if we can move a lot of people a little, it actually has a bigger effect than if we move a few people a lot," says Nelander, pointing out that this has been a hugely unpopular position that has often put him at odds and led to him being accused of having the wrong angle on things.

One size doesn't fit all, has been the counter argument. 

"It just contrasts with the fact that we basically love concepts as humans. Think of IKEA, 7-Eleven, H&M. Everything has become concepts today. So somehow that resistance is a bit contradictory," he says.

"Because there is so much that suits so many citizens. And in terms of cost, we need to look at how low can we go in order to get maximum effect for the least amount of money. It's true that one size doesn't fit all, because people are different. My opinion is that you can make one model that fits most people - and if you can hit 80 percent with one method, then let's go for it."