Using Behavior Change Science to Improve Health

For many years I've worked with many of you--members of my LinkedIn community--on enabling digital access to health information for patients and families. And we're getting there, albeit more slowly than I'd like.

We understand, though, that information and data is necessary, but not sufficient, in changing health behaviors and outcomes. I've been exploring the topic of behavior change science and health, most recently in a South by Southwest (SXSW) panel and blog post, reposted here from Tincture:

You influence your own health more than anyone else. Decisions you make every day about diet, exercise, taking medications (or not), and when to seek professional medical help matter much more, over the course of your lifetime, than anything a doctor or hospital does for you. Of course, other things matter, too — like where you live, and the genes you inherited. But considering how much attention (and money!) we put into health and healthcare, I don’t think we focus enough on helping people successfully adopt healthy behaviors, which can be a lot less expensive and painful than surgery, medications, illness, or even early death.

I’ve spent more than a decade trying to help patients and families get access to their own medical records and other health information. Although information helps, it’s not usually enough on its own. Knowing that the salad is better for you than the potato chips doesn’t guarantee that you’ll choose the salad.

At South by Southwest (SXSW) in Austin, Texas last week I moderated a panel on applying behavior change science to health. I invited two experts to explore the topic with me: Michael Dermer and Dan Goldstein. Michael, who runs a community to support entrepreneurs, pioneered the use of monetary incentives for health via his company IncentOne, which was acquired by Welltok in 2013. Dan, Principal Researcher at Microsoft Research, is an internationally-recognized authority on economic behavior and decision making.

As Dan explained (and we’ve all experienced), a big challenge is that short-term gratification is hard to resist — it’s hard to imagine, let alone prioritize — the needs of our “future selves” months or even years from now if it means giving something up right now. When there’s a financial tradeoff, such as saving for retirement vs. spending money today on a movie, new clothes, or even a house, most people are tempted by immediate gratification. Though other factors (including the rising costs of healthcare) contribute, 38% of American households carry credit card debt. In health, the same temptation of immediate gratification applies. Can your resolution to get in shape overpower the comfort of the couch, a movie you love, and a bowl of popcorn?

Michael, who comes from a banking background, started testing monetary incentives to drive health behavior because they are so effective in other areas — bonuses, coupons, and sales shape consumer buying behavior in everything from candy to cars. He found that dollars could make a difference in health behavior, if pegged appropriately to income levels and the level of effort a desired change requires (smoking cessation is much harder than getting a one-time flu shot). Monetary incentives can drive immediate return on investment (for example, by steering people toward a lower-cost health clinic), intermediate returns (by reminding people to take their medications), and longer term impact through improvements in areas like weight management and nutrition.

Dan, who has a PhD in Cognitive Psychology, has developed and tested tools that use virtual reality to change behavior, including an adjustable digital interface that helps people to visualize themselves in old age reacting to their current decisions to save or spend money. If you’re like most people, a realistic image of your own face aged years or decades into the future, smiling or grimacing based on your behavior today, motivates you to save money — and the same tools can be applied to health-related behaviors.

Dan and Michael agree that a combination of financial incentives and virtual reality could be powerful in shaping health behaviors, and that they can be further levereged with other tools, such as the positive peer pressure you get from exercising regularly with a group.

So, do you want some simple ways to apply behavior change science to your own health and life? Here are a few:

• Restructure your environment so it’s easier to achieve your goal (why not fill the bowl of candy on your desk with fruit, instead?)
• Tell friends about your goal so they can help to hold you accountable (maybe you can commit to exercising together?)
• Associate a new healthy behavior with something you already do regularly (for example, you could take a medication just after brushing your teeth every day to help you remember)
• Be patient with yourself and adjust if needed when you make a mistake — adopting a new behavior takes time, and, usually, a long process of trying and tinkering until it works
• Read a book to keep you motivated and give you more ideas (I recommend Well Designed Life by my friend Dr. Kyra Bobinet)
• Try using a digital tool — here are a few suggestions:

Beeminder — holds you accountable to your goals with frequent reminders and penalties if you’re not making progress

Whil — provides video lessons in short, manageable bites that help you train your brain to reduce stress and accomplish goals in health and other areas of your life

StickK — leverages the fact that we hate losing money even more than we enjoy winning it: you set a goal, and if you fail to meet it, StickK donates your money to the cause you like least

Do you have any effective — or not so effective — tactics or tools you have used to improve your health?