Behaviour change apps – do they really work?
Why people behave the way they do is one of the biggest issues in most industries and when it comes to information technology and healthcare, this is probably the holy grail. The world of gaming has been able to tap into the tenets of engaging their users for the long term when we see the sheer numbers that play games like “Angry birds” and even more so, in online MMORPGs (Massively Multiplayer Online Role Play Games) such as World of Warcraft. The latter is a great example of appropriating several behaviour change theories when engaging their users, resulting in long-term loyalty and repeated game play. Some of the tactics employed relate to gamification – an issue already discussed on Salus Digital. Over and beyond this, however, are the social connections that are created as a part of playing these games – bringing people together with like-minded pursuits and motivations, which encourage users to play every day, week, month and year and it is this aspect that other successful systems share in in order to increase uptake with their users.
At this year’s D.I.C.E. (Design, Innovate, Communicate & Entertain) summit in February, Dr Jesse Schell from Carnegie Mellon’s Entertainment Technology Centre, who has extensively studied the reasons why people play such “addictive” games, has said that whether people are made to feel obligated or invited to play a game, seems to be what makes “the difference between work and play … slavery and freedom … efficiency and pleasure.”
He quotes the “Self-Determination Theory” (Edward Deci and Richard Ryan) in regard to the concept that being able to choose for oneself is key in order to affect and maintain behaviour change. He uses the terms “hafta” and “wanna” for the polarities concerned. Psychologists also reinforce this by describing “reactance” as the automatic response to any threat to one’s autonomy and it is this accentuated reaction which can actively change a non-motivated person into a negatively motivated one – someone who is turned off from and refuses (whether subconsciously or not) to participate further, thus making developers of systems wanting to convert these particular users into motivated ones even harder to achieve.
Thus apps such as MyFitnessPal which require repeated and diligent logging of food eaten by the user – in the form of a food diary, soon become tedious to users who would not keep such a detailed account of their eating habits anyway, whereas an app such as Fitocracy, which by incorporating social support and encouragement into their app usage structure and provision of in-app connection with real people, have – like the MMORPGs – appropriated this type of behaviour change theory to improve the motivation to help log progress because there was another more compelling reason (their social network) to do so – thus replacing the “hafta” for the “wanna”.
- J. Fogg, director of the Persuasive Technology Lab at Stanford University has developed a model of behaviour change which also applies. His view, which is shared by many clinicians, is that behaviour change cannot be achieved by just one piece of technological kit alone and that there are three aspects of behaviour change that are involved:
Motivation: including fear, pleasure, pain, hope, social acceptance and rejection.
Ability: one’s capability – which is itself adaptable to training
Trigger: a kind of “call to action”
He also describes 3 steps to use when developing an app for behaviour change:
Step 1: Be specific: tailor the approach as much as possible and provide realistic suggestions
Step 2: Make it easy – as Fogg describes that too difficult a task risks the user to abandoning altogether.
Step 3: Trigger behaviour: direct appeal, social trigger/support, gamification, rewards, data visualisation, multimodal design, etc.
Mirroring this to the apps already mentioned, Fitocracy provides personalised/specific information – which other studies have shown to be effective as well as highly engaging. The app provides an easy and uncomplicated/hassle-free way to manage the change in behaviour and utilises social prompting and connections to trigger the behaviour into “wanna” haves rather than “hafta” haves.
A similar approach is being launched by Omada Health in the states – a company who had rolled out successful workplace wellness programs and who have started the difficult task of offering a similar connected service to Medicaid diabetic/pre-diabetic patients in which personalisation comes in the form of regionally allocated real-live health coaches who are assigned to each regional group offering localised/personalised guidance.
If Omada Health follow the tenets of behaviour change as touched on above whilst rolling out their first trial to the 300 Medicaid patients they have targeted, the chances are high in regard to improving diabetes self-management by using social support, personalised tracking, and ease of access to locally sourced affordable alternatives to help keep the target users motivated to do and choose healthier activities and options and with technology already being used by those on Medicaid – usually those patients in the poorer income bracket but the most to gain from such programs/tools.