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Technology and behavioral science can help us achieve long-term positive health changes
The steady rise of non-communicable diseases (NCDs) is one of our biggest challenges. The majority of NCDs are believed to stem from four key risk factors: tobacco smoking, poor diet, physical inactivity and alcohol consumption. The problems caused by the “four factors” are compounded by a further problem: even when provided with sound health advice and a treatment plan, many patients with chronic conditions choose not to follow it. An 50% of Americans don’t follow their treatment as recommended, costing over $300bn a year in healthcare costs, and 69% medicine-related hospitalizations.
For a behavioral scientist like me, this is interesting because I know that the “four factors” can be treated and prevented by modifying individual-level behaviors. Yet, as most people have probably found out by now, installing an app and providing people with tons of data and health insights doesn’t translate into that dream body or people living a much healthier life. Although dense personalized behavioral information summarized in nice charts might lead to a ‘Eureka’ moment – it does not impact our long-term behaviors as much as we might think it would.
Why is that?
For the last ten years, I have been working with governments, public bodies and companies that have a deeply vested interest in reducing the social and economic burden of disease and disability. In every single case the starting point has been the same: why do people not react as they ought to, when provided with information, advice and a plan? And in every single case, we have found the same answer: because humans do not always translate information and good intentions into action. We are a species that is easily distracted, unable to process information rationally, and often fooled when making simple choices.
Fortunately, behavioral science not only offers some explanation for our irrational choices, it also provides some strategies for improvement. The field has found that our behavior is often more a result of behavioral context, or ‘choice architecture’. Making systematic changes to our surroundings has become a crucial strategy for ‘nudging’ us into behavior change. And behavioral scientists have become quite good at it – at least when it comes to one-shot behavior changes.
I recently conducted a field experiment. We wanted to get conference participants to choose the healthy option of a vegetarian lunch, rather than the standard buffet. Unbeknownst to participants, their registration formulas had been randomized into two groups: in group one, they were asked if they’d like to go with the standard conference buffet, or have a separate vegetarian dish prepared especially for them. In group two, the default was changed so that people were asked if they’d like to go with the standard vegetarian buffet or have a separate meat dish prepared especially for them.
The result: In group one, 2% opted for vegetarian; in group two, it was 87%.
A key factor that swayed group two was the strong contextual cue provided by the default: the vegetarian option as a norm. To opt for a new behavior, we often need such contextual cues. Still, leaving the conference most participants probably continued their meat-filled diet back home. We didn’t make them vegetarians.
This posits an important consideration for sustainable lifestyle change. While we know how to create one-shot behavior changes, we are more uncertain about how to enable long-term behavioral change.
So, how can technology help?
Smartphones can easily provide a successful trigger for catching our attention, but in inspiring long-term behavioral change, a smartphone app falls short. Our phones are used for a hundred different tasks every day, so it’s not optimal to rely on an app notification to act as an effective contextual cue for a new habitual behavior. It’s probably more likely you’ll end up browsing Facebook, than going for that planned run.
The growing space of smart technology and IoT devices could offer a solution here. Such devices allow for gathering real-time data beyond the lab and are revolutionizing the art of measurement in behavioral science. What we need for effective long-term behavior change are specialized contextual cues. These cues work best if they can stimulate as many senses as possible. Think about how you feel, smell and look in the morning – that’s what makes it so easy to remember to shower every day.
Fortunately, this point seems to be getting through to the more innovative of tech-companies. Devices using more sophisticated contextual clues are starting to appear on the market. They go beyond the app by aspiring to become actual and designated sensory parts of our behavioral contexts. The physical presence of such devices provides sensory cues aimed at triggering long-term behavioral change through visual presence and sounds. They also provide a physical interaction each time a task is completed that is needed to effectively code new habits into human memory (as well as into data charts that your rational self may later enjoy). This has not only untellable implications for expanding the frontiers of behavioral science and measurement outside the lab, it also has the potential to bringing real value to the user by catalyzing behavioral change that sticks.
If a new technology is going to help us create sustainable behavior change and create that may help combat NCDs, we need for it to go beyond the limits of a smartphone app. We need technologies to seamlessly weave themselves into our everyday choice architectures – not in elegantly hidden ways, but in ways that call attention to themselves and actively fill out the psychological gaps that make it so difficult for humans to build new habits.