Mobile Health @Stanford
Upcoming SlideShare
Loading in...5

Mobile Health @Stanford



My presentation for the first Mobile Health @Stanford. Thanks to BJ Fogg for the invite. ...

My presentation for the first Mobile Health @Stanford. Thanks to BJ Fogg for the invite.

Without a doubt the best mobile health/behavior change event I've attended this year.

Health folks, put this on your calendar for next year.



Total Views
Views on SlideShare
Embed Views



4 Embeds 242 237 3 1 1



Upload Details

Uploaded via as Apple Keynote

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
Post Comment
Edit your comment
  • Fact of life: Your microchoices are killing you. <br />
  • Every microchoice counts. <br /> <br /> There is no goal too small. <br /> <br /> Data alone does not drive behavior change. <br /> <br /> Health IS social. <br /> <br /> &#x201C;Cues to action&#x201D; should not come from a health coach - they should come from people you know and love. <br />
  • Forget &#x2018;participatory medicine&#x2019; and &#x2018;health 2.0&#x2019;... <br /> <br /> My homerun: Talk with people who want to build systems that track what people are hoping for...and whether or not they get it. <br /> <br /> This is about reprogramming choice + control into personal disease management and individual wellness modification. <br />
  • Now, about that &#x201C;ecological assessment&#x201D; data Vic mentioned this do we get it? <br /> <br /> And how do we understand what&#x2019;s wheat and what&#x2019;s chaff? <br />
  • 2 types of data are important: clinical objective data, personal subjective data. <br /> <br /> IUX hierarchy paradigm (I-U-X) = me, you, everything else. <br /> <br /> We&#x2019;re guilty of gathering a lot of TBU data (true but useless) in mobile health. <br /> <br /> I&#x2019;m going to talk about how we can map at which point on this continuum a patient is operating based on his/her &#x2018;journey&#x2019; details or sharing of an epiphany event. <br />
  • &#x201C;Me-metics&#x201D; matter more than the &#x2018;metrics&#x2019; forward-thinking mobile health folks are telling us are vital to collect and analyze... <br /> <br /> Phones are our personal identity extension platform. <br /> <br /> They enable complex ID creation and communication (id, ego, superego). <br /> <br /> Web based + social + movement data already captured by them (or can be captured). <br /> <br />
  • Mirror = daily dose of visual input. Why doesn&#x2019;t seeing a change in our weight DAILY (multiple times a day drive better decisions? <br /> <br /> Data alone does not drive behavior change. <br /> <br /> Ok genius, so how DO we drive behavior change? <br /> <br /> <br /> <br /> <br />
  • Future tense verb use: &#x201C;I wish, I will, I want to...&#x201D; <br /> Present tense verb use: &#x201C;I am, I do...&#x201D; <br /> Past tense verb use: &#x201C;I have done, I did...&#x201D; <br /> <br /> We assume merely by reporting data generated during the action phase (in the post-action phase) that a magical self-awareness develops and the person makes the right decision automatically next time. <br /> <br /> Not so my friends. <br />
  • Forget &#x2018;predictive modeling&#x2019; (which tends to be a population-based health approach) for now... <br /> <br /> Here&#x2019;s where healthcare + social technologies and mobile health are misaligned: Both health and social focus on user growth (ie number of users) and increasing the viral coefficient of the PLATFORM. <br /> <br /> Instead we need to maintain a micro-focus: We must concentrate instead on maximizing the value per INDIVIDUAL user. <br /> <br /> Have to focus on the PERSONAL health data set, sample size: n=1, before we focus on the SOCIAL data set n=1+1... <br />
  • Zero effort applications... <br /> <br /> Like to suggest a new term for Ecological Momentary Interventions (EMI) = &#x201C;microchoices.&#x201D; <br /> <br /> We&#x2019;re suffering from problem AND solution asymmetry in health: <br /> <br /> The solution(s) are often &#x2018;smaller&#x2019; - and seem very disproportionate to the problem (save lives by washing your hands while humming happy birthday in your seems almost ridiculous that this could have such a big impact). <br /> <br /> Here&#x2019;s the bottom line...140 characters shouldn&#x2019;t be able to change behavior. It shouldn&#x2019;t be enought to build a professional reputation around, but it is. <br /> <br /> This is why social support for &#x2018;microchoices&#x2019; is so successful a focus for &#x2018;incentivizing healthier behavior.&#x2019; <br /> <br /> You match asymmetry (solutions oriented) with asymmetry (impact oriented) and somehow it adds up. <br /> <br /> Depending on which study you read it takes 18 to 254 days to &#x2018;cement&#x2019; sustainable behavior change. <br />
  • Let&#x2019;s try treating with social technology. <br /> <br /> Can I get a couple cc&#x2019;s of social support, stat, rather than taking more pills? <br />
  • What does a social health Rx look like? <br /> <br /> First we must answer: Is your health a personal asset or a community good? <br /> <br /> We don&#x2019;t consider health a personal asset OR a community good until it&#x2019;s a &#x2018;debit&#x2019; - ie it&#x2019;s gone; removed from our personal homeostatic balance sheet when something goes wrong. <br /> <br /> Then we suffer AND the community suffers (decrease in mood, increase in stress, loss of income earnings, etc). <br /> <br /> <br />
  • Question: &#x201C;What is the right kind of goal setting?&#x201D; <br /> Answer: &#x201C;Short term action with long term import, supported by contextual community structure and continual self-analysis.&#x201D; <br /> <br /> Behavior change is the sum of a choice solution set (potential choices and choices made). <br /> <br /> Behavior change is not an automatic reaction. It&#x2019;s a studied one. <br /> <br /> &#x201C;Behavior&#x201D; is a choice. Or, more accurately, a series of choices that diverge from an older mean (where we WERE) and ideally work towards a new median (where we WANT TO BE) over time. <br /> <br /> <br /> <br />
  • &#x201C;How do we measure general patterns of an individual&#x2019;s behavior change over time?&#x201D; <br /> <br /> Simple. Use mobile + social technologies to let the USER establish a baseline and report it, then build in functions and features that allow them to easily (3 clicks) report when a change occurs. <br /> <br /> Let the user perform active data inputs and combine it with passive data capture, then let them share it AT WILL to garner social support. <br /> <br /> Depending on which study you read it takes 18 to 254 days to &#x2018;cement&#x2019; sustainable behavior change. <br /> <br /> This alpha guammie took less than 2 weeks of use to be lighting things on fire in her backyard and dancing to movie soundtrack songs (and SHARING the PROOF on Facebook). <br /> <br /> Lesson: Make it fun, and you won&#x2019;t have to ask whether or not it&#x2019;s working. Build verficiation into your backend and ease of use into your frontend. <br /> <br /> Constraints of designing for mobile health work in your favor here (small screen, gestural interfaces, cross platform compilers, etc). <br />
  • Who is the best health coach? Clue, it&#x2019;s NOT the one academics and providers prescribe for us. <br /> <br /> We&#x2019;re already acting as those microfranchise owners Vic mentioned...when a mobile app works for us we share it. We tell people about it. We challenge them to healthier behavior using it. <br /> <br /> Why? Most of us just want an excuse to do the right thing... <br /> <br /> Most often we KNOW what the right choice is... <br /> <br /> But sometimes we just need a bit of an &#x2018;excuse&#x2019; to make it. <br /> <br /> Social pressure provides that excuse. <br /> <br /> Light bulb: Even if you won&#x2019;t do it for yourself, you&#x2019;ll do it for others. <br /> <br /> We tend not to honor obligations to ourselves. But we&#x2019;ll honor a promise made to another person we know. <br />
  • Notice &#x201C;data&#x201D; appears nowhere. <br /> <br /> Guilty of overemphasizing motivation while underestimating power of &#x2018;triggers.&#x2019; <br /> <br /> You would have to manipulate motivation, measure ability, and then manufacture &#x2018;effective&#x2019; triggers. <br /> <br /> Far easier to survey the individual&#x2019;s online &#x2018;habitat&#x2019; or environment (do they use Twitter? Facebook? Foursquare?), measure the relative scale of their emotive output (via content generated, use of first vs. second person pronouns, time/duration of login, whom within the network they post to most often, etc), and then build a solution that logic doesn&#x2019;t override (ie someone just challenged you to do a minute of pushups - quick! You should think &#x201C;yeah, I can do that&#x201D; without stopping to consider all the OTHER thousands of things you could be doing in that 60 seconds). <br /> <br />
  • And we&#x2019;re using the wrong triggers. <br /> <br /> Fight or flight is a very useful instinct for a 1x action or response, but it&#x2019;s not very good at forming sustainable habits that stand the test of time. <br /> <br /> Eventually, the mouse gets tired. <br />
  • Intrinsic results gained via extrinsic motivation (social support). <br /> <br /> We need longitudinal studies that measure the efficacy of each factor: I, R, and R. <br /> <br /> Unfortunately we tend to discount the 1x, individual action. <br />
  • Design for transient and changing data and research. <br /> <br /> Biggest lesson = no such thing as a &#x2018;standard&#x2019; use case. Banish &#x201C;typical&#x201D; from your vocab. <br />
  • We wanted to build a social game, but we didn&#x2019;t want to spam everyone Mafia Wars style. <br /> <br /> Our experiment: We wanted to build a social platform that becomes a bartering system or marketplace for completed activities (starting with &#x2018;microfitness&#x2019;). Health is the end result, not the primary goal. <br />
  • It really is that simple. <br /> <br /> Reciprocal social contract. <br />
  • Best way to see how it works... <br />
  • But we designed with &#x2018;mobile&#x2019; use in mind (literally and figuratively). <br /> <br /> We built a web-based application first, accessible/easy to use via your mobile browser, because not everyone in our early 40 person alpha had the same mobile phone model/plan. <br /> <br /> The practical realities of a fragmented mobile market led us back to the web. And there should be no shame in this. I don&#x2019;t consider GUAM any less mobile because we built it this way. <br /> <br /> Mobile health is not just about building a kicka#$ mobile application, although that&#x2019;s a good place to start... <br /> <br /> Think about optimizing your desired outcomes for a specific audience through this channel. Because that&#x2019;s all we&#x2019;re talking about here. Another channel to research, plan, design, and deliver &#x201C;care.&#x201D; <br /> <br /> But because of access to mobile as a channel, we&#x2019;re blowing the lid off traditional definitions of &#x2018;care&#x2019; and &#x2018;health.&#x2019; <br />
  • For one, we&#x2019;ve democratized health design. Any developer who learns Objective C/Cocoa or Javascript (or even HTML with a compiler like Titanium App Engine) can now participate in the Health 2.0 boom. <br /> <br /> Life is a finite asset, a non-renewable resource. <br /> <br /> However, from my experience at hackathons and recruiting developers, it&#x2019;s hard to find a hacker who wants to work on health. Optimizing human performance over an individual lifeline just doesn&#x2019;t sound that exciting. <br /> <br /> Unfortunately, there are no &#x2018;rollover minutes.&#x2019; <br /> <br /> You pay to enjoy the time you have (consumption-oriented culture) - you pay to personalize your experience along your personal chronology (&#x201C;me-metics&#x201D;). <br /> <br /> If you can pick your ringtone, why can&#x2019;t you pay a copay with your mobile phone? Is there an app for that? Would you pay for it? <br />
  • <br />
  • Mobile check ins. <br /> <br /> Biometric devices. <br /> <br /> Individual use of apps designed with personal + &#x2018;microrelevance&#x2019; in mind. <br />
  • Persuasive people + persuasive tech = delta in behavior(s) = desired outcomes. <br />
  • With decision-support via motivation &#x2018;carrots&#x2019; designed game-mechanic style. <br />
  • Integration of biometric tracking device data. <br /> <br /> Social &#x2018;proof&#x2019; of completed challenges (comments, video, SMS, photo, geolocation, etc). <br />
  • Study behavioral economics, developmental/child psychlogy, gaming/sports theory, and goal attainment theory. <br />
  • Health, however, is often a renewable resource. Let&#x2019;s look at a &#x2018;target&#x2019; demographic. People with IGT or &#x2018;pre-diabetes.&#x2019; <br /> <br /> People who lose weight and increase physical activity can prevent/delay diabetes and even return blood glucose levels to &#x2018;normal.&#x2019; <br /> <br /> Develop challenge set that has, as its goal, reduction of Susy&#x2019;s A1C by 1% over 10 month period. Every reduction 1% reduction reduces microvascular *eye, kidney, nerve* complications by 40%. <br />
  • Once we can track an individual&#x2019;s behavior and decision-making patterns over time, we will be in a better position to understand how to incentivize healthier choices in a way that WORKS. <br />
  • Will the founders of these great behavior change platforms please stand up? <br />
  • <br />

Mobile Health @Stanford Mobile Health @Stanford Presentation Transcript

  • Your lifestyle is killing you. *Or, how social + mobile will save healthcare. Oh yeah, and you. Jen McCabe * Contagion Health ** Get Up and Move @jensmccabe * ** 301.904.5136
  • Central Contagion dogma.
  • choice + control aware Mobile enabled care.
  • Best biometric Me! You! tracker(s)...
  • “Me-trics” and “Me-metics”
  • The loneliest number? n=1 “me-trics”
  • But the data! Exhibit A: The mirror effect
  • pre-action ----------> action ----------> post-action (intent) (do/buy) (reporting)
  • 1 person * 1 thing (differently) * 1 time
  • Small actions. Big impact. Dancing to 2 songs can rock your world.
  • Brief Solution-Focused Therapies (BSFT, BSOT) • Alcoholics Anonymous • Day treatment programs • Weight Watchers
  • Behavior. Change. Nuff said
  • Excuse to do something Do it for someone you love good.
  • Behavior change has 3 components • Motivation, ability, trigger (MAT, by Fogg). • Environment, emotion, logic (EEL, by Jen).
  • Triggers. Fear drives us
  • IRR Principle • Individual, 1x action • Repeat action (2x) • Routinized action (<2x)
  • Designing for behavior change has 3 components • Purpose, audience, desired outcomes (PAD, by Jen). • Flexible architecture, relevant to the individual, analytics “core,” tech enabled microactivity (FRAT, by Jen).
  • Social games? Grow something good
  • Meet Get Up and Move: I will _____________ if you will ______________.
  • Challenge me!
  • Your health. Your hands
  • Takin’ care of business. Mobile apps = DTC biz model
  • What in the health is headed our way next?
  • Problem 1 (still). Data self entry
  • The solution(s). mobile + social
  • Geolocation integration. Hyperlocal challenges
  • Granular permissions. “Facebook” level controls
  • Challenges = connective From real --> ridiculous tissue.
  • Where there’s a will, there’s a weight...
  • What are we going to do with something the size of a Rice This is our platform. Krispie’s Treat?
  • Goal Mafia, Text & Play, Crohnology
  • Jen McCabe, CEO/Co-founder Andrey Petrov, CTO/Co-founder 301.904.5136 (iPhone)