Can Health Apps Help Patients Change Their Behavior?

Do Health Apps Live Up to Their Hype?

There are said to be over 40,000 health, fitness, and medical apps. They range from references to calculators to diaries to tracker apps, such as diabetes managers and heart rate monitors. Although they generate much "gee-whiz" fanfare, evidence that smartphone applications actually work to promote healthy behaviors in users is scant.^[1]

Some medical researchers are reaching the same conclusion. For example, a study of iPhone® apps for smoking cessation found that these apps "rarely adhere to established guidelines for smoking cessation."^[2]

A not-yet-published study of 222 smartphone apps that offer tips, advice, and treatment for pain found that many of these apps lacked a scientific foundation,^[3] and that most showed no evidence of healthcare professional involvement.

Nor are health app users oblivious to app shortcomings. According to one report, 26% of people who download health apps use them only once.^[4]

For psychologist BJ Fogg, PhD, improving their content is not what would make health apps more effective. What would make them more effective is designing apps from the ground up to change specific behaviors from bad to good, using what he terms "persuasive technology," a marriage of mobile technology and the psychological theories and techniques of behavior modification. For Fogg, an app that evokes the desired behavior change is an app that works.

A pioneer in the use of technology to change human behavior, Fogg is listed as one of "10 new gurus you should know" by Fortune.^[5] He has one foot in academia and the other in industry. He's Founder and Director of the Persuasive Technology Lab at Stanford University and the author of Persuasive Technology: Using Computers to Change What We Think and Do (Morgan Kaufmann, 2002).

Fogg says it isn't technology that's holding back the design of apps that could help patients (particularly those with chronic conditions) adopt healthy behaviors. The capability is here. Evidence-based data on how behavior change works is also here. What's needed, he says, is for the possessors of these 2 disparate fields of knowledge -- software engineers and cognitive scientists, whose paths don't normally cross -- to seek each other out and collaborate.

If they did, how would apps change? What would they do? Medscape interviewed Fogg to find out.

3 Keys to Changing Behavior

Medscape: You have a theoretical model that can be expressed as an equation: Behavior equals motivation plus ability plus a trigger occurring at the same moment. What does this mean? How could it inform health app design?

Dr. Fogg: The real key to changing behavior, not just in healthcare but in any consumer experience, is to help people do what they already want to do. That's motivation. There's no way you can browbeat someone to do something they don't want to do. You can just take that one off the table. To help them to do what they want to do, you have to make it really easy to do that thing. That's ability. And then you need a trigger, a reminder, to prompt behavior.

That's the overall recipe. If you don't have any one of those things -- motivation, ability, and trigger -- I guarantee the app will fail. You have to do them all.

Now, there are a number of other things that you have to take into consideration too. For example, people think, "Oh wow, we've got people who aren't testing their blood sugar, so we're going to create an app, and suddenly, magically, the app will measure their blood sugar." That's not how it works. Just because it's an app on a smartphone, it doesn't magically make people want to take time out to help themselves. An app needs to somehow make it easier.

Going on a diet is hard. It's a classic problem. But if an app made that really simple -- I'm talking about 1 click, not turn on your phone, launch the app, and take a picture. That's 5 or 6 clicks. One click. Then you have a really good chance of helping people who want to track their food intake to actually track it.

A big emphasis in my work is tied to understanding motivation, making it really easy to act, and then having a trigger to remind people to do the behavior. That's pretty tricky to do. Not very many apps are getting that right, because the way notifications work on mobile devices, they're very interruptive. They'll get better because they'll have to. But right now, notifications are not very location-aware or context-sensitive.

Mobile technology is getting better at understanding where we are, how busy we are, and what our current goal is. In the future, it will get a lot better at prompting us to do the behaviors needed to follow a diet or a medication regimen at a context-sensitive time, not in the middle of us giving a talk at a business meeting.

But until then, a lot of behavioral interventions won't work because app designers are thinking not of people's everyday lives, but rather, "We're sitting here in an office, and we're engineers. And what we're designing is really great. How can people not do this?"

There's this disconnect between the reality of people's lives and the sort of idealized interactions app designers think of when designing their apps.

Medscape Business of Medicine © 2013  WebMD, LLC

Cite this: Neil Chesanow, BJ Fogg. Can Health Apps Help Patients Change Their Behavior? - Medscape - Jun 27, 2013.