Nudges & Prompts: The Key to Boosting Digital Health Engagement

Our groundbreaking 3-arm randomized controlled trial, soon to be published in JMIR Publications , provides the first rigorous evidence that nudges and prompts significantly increase engagement in digital health.

According to AI-based research assistant Elicit , current research?suggests?that nudges and prompts should be used to increase engagement and decrease attrition - but there have been no randomized controlled trials to test if they work.

Here is the output from Elicit (highlight added):

We see three reasons why this hasn’t been done.

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1.?????????Lack of Academic Precedent

In his letter to Robert Hooke in 1675, Newton famously wrote, “if I have seen further, it is by standing on the shoulders of giants.”

Engagement / dropout / attrition issue is a 20-year-old problem in digital health, first brought to the research community’s attention by Gunther Eysenbach in his seminal paper The Law of Attrition. To our knowledge (and Elicit's) no one has ventured ahead and designed a randomized experiment to test the use of nudges and prompts in digital health.

Good science is supposed to build on previous science, and truthfully, it took some time to design and execute our experiment. The fields of digital health and behavioral economics are disconnected, and our study bridges that gap.

This isn’t the first time that we conducted an experiment that combined two fields, and the study did not have academic precedent.

When we submitted our 2014 paper The 1% Rule in Four Digital Health Social Networks: An Observational Study the response we got back from the journal was “Major Revision or Resubmit Elsewhere” – the scholarly equivalent of “thanks but no thanks”. ??

In digital marketing, the 1% rule was (and still is) a well-known rule of thumb – only 1% of members posted in online communities while the other 99% lurk. We saw this in our data and wanted to share it. But, in healthcare, there was no academic precedent for the study.

We thought the study was important, so instead of giving up we persevered, answered the reviewers as best we could, and resubmitted. The editor of the special edition was Heleen Riper , a trailblazer in digital health. We can’t be sure, but we have a sneaking suspicion that Professor Riper recognized the value of the paper.

We’re glad we persevered because according to 谷歌 Scholar, the paper has so far been cited by 395 academic works, many of them outside of healthcare, like Journal of Knowledge Management, Computers & Education; Long Range Planning, Technological Forecasting and Social Change; Electronic Commerce Research and Applications; Journal of Business Ethics; Journal of Simulation, etc. ?

So, in summary, being entrepreneurial in academic research is difficult.

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2.?????????Little Technical Precedent

There was no off-the-shelf software for the design and workflow of our experiment. From the creation of content to database design to the running of reports we had to start from scratch.?

Fortunately, we had a great team and by letting experts be experts, we were able to design an application to deliver and track nudges and prompts. Renante Rondina oversaw the adherence to theoretical constructs of behavioral economics, Dmytro Ivanchenko policed the accuracy of the technical workflow and reporting, and Rachel Fournier ensured accurate data reporting and alignment to business outcomes.

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3.?????????Statistical Power and Recruitment

A lot of work goes into building an experiment – but the experiment will only work if you recruit enough study subjects.

We designed the Evolution Health platform to enable several experiments to run concurrently. The architecture was purposely engineered to enable ad libitum experimentation so we can randomize subsets of members into specific experiment arms.

The platform is active, so we can avoid the hassle of recruitment.

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What’s Next?

• Replication: We'll replicate this experiment with our addiction courses.
• Tailored Nudges: We'll analyze which nudges are most effective for specific users.

If this research excites you, let's collaborate! Contact Us to help evolve digital health. Let’s get better faster.

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If you or a loved one are struggling through mental health or addiction issues, please check out our free interactive tools at https://EvolutionHealth.care

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