Behavioural science offers fresh perspectives on how digital tools can support change
To what extent can we use digital apps to facilitate behaviour change? There has been an explosion in apps for all manner of behaviours: solutions such as Fitbit and Myfitnesspal have achieved considerable commercial success. Increasingly we are seeing growth in the use of online tools for therapeutics (DTx) and sustainability.
There is a huge literature in this space so we are limiting ourselves to some questions and challenges here: namely how effective are digital tools for behaviour change and what do we need be mindful of when embarking in this space?
Effectiveness of digital solutions
So just how effective are digital solutions at driving behaviour change? This is an area where there is inevitably a broad range of perspectives and can be difficult to get a big picture view. But we would suggest that there are grounds for being cautious. For example, around one third of people who buy fitness trackers cease using them within six months, and over half eventually stop them altogether. One well designed study found that after one year of use, an activity tracker had no overall impact on the 800 participants overall health and fitness. Another study examined whether combining a weight loss program with a fitness tracker could help participants lose more weight or improve their overall health. The results in fact showed that those without fitness trackers actually lost more weight than their counterparts and those with fitness trackers were no more active or fit than those without.
Similarly in the DTx space, there is no shortage of apps for users and physicians for treating, managing, and improving health functions across a diverse number of treatment areas. A recent paper suggests that while clinical research has demonstrated positive clinical outcomes in a range of areas, deriving definitive statements about the efficacy of DTx products is problematic as there is currently no gold standard for clinical trial conditions. As a result, it is suggested that the lack of rigour of DTx clinical trials at present may not always justify widespread adoption.
With this somewhat mixed background we need to understand what, as behavioural scientists, can we say about the conditions under which digital may be helpful for behaviour change. We think these tools have considerable promise but perhaps the way they are developed and deployed is not always with the benefit of strategic behavioural science thinking. At the very least, we surely need some fresh thinking.
We have identified a number of questions to ask when thinking about the design of digital tools for change:
Are people in the target group going to be attracted to, and start using, the solution? The danger is this is a solution that will be used by people who would be undertaking the behaviour change in any case.
Our advice here is to understand the way the target group understands the behaviour change challenge (or indeed even consider there to be an issue that needs addressing). This is critical, as if it seems to be offering a solution that is at odds with the way they understand the challenge then it is surely unlikely to be adopted. Work is therefore needed to understand their ‘mental model’ of the issue and find ways to work with that, demonstrating the means by which the app provides an effective good solution.
One example of this is the way in which some DTx apps are designed to address the issue of patients not adhering to their medication regime. This can often be thought of as the patient not remembering to do so: which may be part of the story but is unlikely to be the full picture. Indeed, the real issue can be that patients will create their own informal medication regimes due to their conception of what works, or to avoid side-effects of medication they are taking. An app which is designed to remind people to take their medication is therefore addressing the wrong ‘mental model’.
Taking care to ensure that the app is addressing the right problem in the eyes of the target group is our, perhaps obvious but nevertheless often over-looked, advice.
Next, we ask how the affordances (what a user understands can be done) of digital can be used to help ensure the proposed solution makes a difference in behaviour. To assist with this, we have drawn on two sources – the behaviour change framework, MAPPS and the writer and researcher Jane McGonigal, whose books on the value of gaming are a great resource to rethink the design of apps for behaviour change.
We pulled out some key tips from her recent book, ‘Reality Is Broken: Why Games Make Us Better and How They Can Change the World’ then organised these with the help of the MAPPS framework:
Social: Help people to be part of a like-minded community of people, often banding together and creating powerful communities from scratch
Emotion: Make dull daily chores more fun
Outcome expectations: Be part of something bigger– help people see how their own individual behaviours contribute to the bigger picture in a meaningful way. In addition, helping to reduce our fear of failure and improve our chances for success.
Internalised motivation: Encourage self-motivated and enthusiastic participation. Design in a way to help us feel more rewarded for making our best effort.
Capability: Help us imagine and invent the future together.
The guidance from McGonigal certainly feels consistent with the guidance we have recently been writing about concerning sustainability – and is perhaps a build to much of the advice that is more readily available on how to design digital solutions.
Making change happen In Real Life (IRL)
One final, but perhaps most important, challenge we need to address is the location of the behaviour change: does the focus of any behaviour change stay within the digital solution (or game) or does it translate into tangible changes IRL?
If they stay in digital without translating to ‘real life’ change, then it is somewhat pointless (although perhaps although there is some debate here as it may be about helping people to think and engage). Simply stacking up rewards in a game without any real impact on tangible change for the behaviour in question is clearly not what we are seeking. And yet, we suspect that there is not always enough consideration of this issue.
To make this translation happen we need to think about this interaction between the digital solution and ‘real life’. We have done work on peer support systems that suggest it works best when there is a combination of this. A good example here is WW, the weight management service. The model originally used was face-to-face; people would go to a local meeting place listen to a talk then get weighed. The people in the room are very supportive of each other and provide a caring community to be part of. The model has since evolved to incorporate an online presence offering a range of advice, ideas, recipes, and so on. There is also an online forum so you can interact with other people in the same situation.
This means there is a combination of ways that people interact, at progressive stages of their behaviour change journey, with digital and physical offering different but complementary ways in which people are able to engage.
The notion of IRL and digital being two distinct realms is not always helpful (see Nathan Jurgenson for more on this). Both are likely needed to help to make change work and there needs to be a greater focus on what this looks look. Retailers are good at this multichannel work – the grey literature from this can be drawn on to assist in thinking this through.
We need to think carefully about the way that any tool can support us to change behaviour: with digital it is all too easy to fall into the pitfalls of solutionism, the notion that complex issues can readily be addressed through simple tech based solutions.
As with any intervention, we need to understand the role of digital tools in changing behaviour, as well as assessing how this works alongside other activities that we might deploy. To this end we need to:
be thoughtful of the affordances of digital, what it is good at – the learnings from gaming that Jane McGonigal sets out perhaps challenge our understanding of what this might be
question what is actually needed to change behaviour – there can be a focus on attempting to create new behaviours through reward: again this may be part of the answer (gaming after all involves competing for reward, but as we have discussed elsewhere, this is not necessarily the full picture.
think through the way in which different interventions can work together: too often they are considered independently of each other which means we are missing a trick (we saw what is possible in the WW example)
This is a huge topic for which we are scratching the surface here – but the point is that we can use behavioural science to help think strategically and creatively about the way in which digital tools support behaviour change.
Want a dose of smart thinking on applied behavioural science delivered to your inbox each week? Subscribe here: