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The Art and Science of Applying Behavioral Economics to Digital Health Interventions

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If you design health behavior change interventions, you’ve probably heard of behavioral economics. Concepts from behavioral economics—often called “nudges”—can inform incentive design, participation strategies, and the feature sets of interventions with the goal of impacting behavior to achieve positive outcomes.

However, many behavioral economic-inspired features don’t achieve their desired goals. Reasons why not include:

*Not all practitioners share an evidence-based understanding of how behavioral economics works, and therefore may misapply concepts;

*Users are more responsive to different behavioral economics concepts at different points in the behavior change experience, so an experience map must be layered into the design process;

*And individual differences also influence which behavioral economics concepts most affect behavior, so a deep understanding of the user is required.

In this talk, we’ll review several of the core concepts in behavioral economics. We’ll share examples of how they can be misapplied in digital design and explain why they are not effective in those contexts.

But don’t fret; we’ll also share best practices for applying these concepts based on the evidence-based literature. We’ll dive into how human-centered design—understanding the user’s needs and context—can save the day. We consider the user’s experience with an intervention over time and identify critical milestones and touchpoints. At each stage, the user’s needs change, and as a result, the particular behavioral economics principles that most effectively influence behavior do too. We’ll add nuance by considering the different “flavors” of features that can be used depending on the user’s psychological and environmental status.

You’ll learn:
*Strategies for evaluating longitudinal user needs in health interventions
*Options for better understanding a user’s psychographic profile
*Tactics to select the most effective behavioral economics technique(s) to effect change for specific users at specific timepoints
*Best practices to translate concepts to intervention features

Presented at UXPA Boston, May 19, 2007.

Published in: Science
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The Art and Science of Applying Behavioral Economics to Digital Health Interventions

  1. 1. THE ART AND SCIENCE OF APPLYING BEHAVIORAL ECONOMICS TO DIGITAL HEALTH DESIGN Amy Bucher, Ph.D. Steven Schwartz, Ph.D
  2. 2. AGENDA Our story What is behavioral economics, anyway? And where do people go wrong? How do you effectively pull behavioral economics into design? Designing for the person Designing for the journey Questions and conversation
  3. 3. WHO WE ARE AND WHY WE’RE HERE Amy Bucher, Ph.D. Steve Schwartz, Ph.D.
  4. 4. WHAT IS BEHAVIORAL ECONOMICS, ANYWAY? And where do people go wrong?
  5. 5. HUMAN BEINGS ARE NOT RATIONAL.
  6. 6. ECONOMICS MAKE SENSE, BUT THEY DON’T EXPLAIN OUR REAL WORLD BEHAVIOR
  7. 7. THE DUAL PROCESS MODEL Cold Brain Hot Brain
  8. 8. HEDONISTIC BIASES Simplicity vs. complexity Information in context Bounded willpower Loss aversion
  9. 9. WE ARE EMOTIONAL AND BIASED TOWARD THE NOW.
  10. 10. ADVENTURES IN APPLYING BEHAVIORAL ECONOMICS TO DIGITAL HEALTH
  11. 11. BADGES & STATUS
  12. 12. BADGES & STATUS
  13. 13. BADGES & STATUS Endowed Progress Withering
  14. 14. PENALIZING NON- PARTICIPATIO N Ex: Health insurance deductibles Institutes the undermining effect Tie incentives to the right outcomes for maximum efficacy
  15. 15. FIXED-SCHEDULE BILLING Taking advantage of the discounting effect and the sunk cost fallacy Getting “stuck” in one course of action limits other possibilities
  16. 16. CONSISTENCY & THE DISCOUNTING EFFECT Pros and cons of personalization Reinforcing identities that no longer work The role of experimentation and tolerance for errors
  17. 17. WHY BOTHER? Recommended minutes of moderate or high intensity exercise per week 1500 Carl’s typical minutes of moderate or high intensity exercise per week 450 Ironman Dan’s typical minutes of moderate or high intensity exercise per week MISPLACED ANCHORS
  18. 18. APPLYING BEHAVIORAL ECONOMICS BETWEEN DIFFERENCES
  19. 19. BETWEEN DIFFERENCES ARE: The qualities and characteristics that make people different from each other
  20. 20. BETWEEN DIFFERENCES INCLUDE: Personality characteristics (OCEAN) Experiences and acquired learnings Skills and talents Individual circumstances like relationships, work status, housing situation, etc.
  21. 21. TOOLS FOR UNDERSTANDING Personas Behavioral archetypes Psychographic profiles Data-based segments
  22. 22. MEET MARY ELLEN BMI – 32 Recently diagnosed with hypertension Had gestational diabetes with all 3 of her kids Was diagnosed with Type 2 diabetes after the birth of her youngest Has moderate depression, which came on gradually
  23. 23. MEET MARY ELLEN 46 years old Works part-time in an auto shop as an office manager Primary caregiver for her 3 kids, ages 6- 14 Tech savvy
  24. 24. MEET SARAH BMI – 32 Recently diagnosed with hypertension Had gestational diabetes with all 3 of her kids Was diagnosed with Type 2 diabetes after the birth of her youngest Has moderate depression, which came on gradually
  25. 25. MEET MARY ELLEN Uses multiple devices each day; a work laptop, a shared family desktop, her iPhone, and a family iPad where she plays games at night. Has low confidence in her ability to understand the science of her health, so she relies on her doctors to tell her what to do and is not likely to do her own research Because she had gestational diabetes that went away after giving birth, she doesn’t feel too worried about this diagnosis With 3 busy kids, she spends most of her non-work hours attending to their needs rather than her own Mary Ellen is organized and conscientious about her work and her kids, but can’t seem to find that same level of investment in her own health. This makes her feel ashamed.
  26. 26. MEET SARAH After 20 years with T2D, she knows how to manage it well. Sarah stays on top of new advances in T2D thanks to her good friend who is a physician and regular conversations with her own care team, including her therapist. She works as a sculptor so doesn’t go online much as part of her job. She has a smartphone, but uses it mainly to talk and look at photos of her grandkids. Now that her kids are grown, Sarah has more time in the evenings to indulge her own hobbies and needs. She’s willing to spend some extra time on her health. After having T2D for so long, Sarah knows that new behaviors will be hard at first. She’s used to structuring very deliberate plans to make sure healthy changes stick, and feels confident based on some of her past successes.
  27. 27. APPLYING BEHAVIORAL ECONOMICS WITHIN DIFFERENCES
  28. 28. WITHIN DIFFERENCES ARE: The ways in which the same person might behave or react differently in different situations
  29. 29. WITHIN DIFFERENCES CAN COME FROM: Resource availability History, knowledge, and experience Newbie, seasoned player, expert Discovery, onboarding, scaffolding, endgame Contextual variables Environment Role requirements Other people
  30. 30. DETERMINING CRITICAL WITHIN DIFFERENCES Your toolkit might include: Journey map Experience map Use case Timeline or list of critical milestones
  31. 31. CASE STUDY: DIABETES MANAGEMENT Type 2 diabetes can be: Highly complex to manage Expensive and time- consuming Life-long Scary Different for everyone
  32. 32. CASE STUDY: DIABETES MANAGEMENT What are some of the critical milestones for a person with Type 2 diabetes? Diagnos is Treatme nt Decision Choosin g Devices Learnin g SMBG & Meds Setting Goals with HCP How To Handle Sick Days Figuring Out Diet & Exercise Sharing Your Diagnos is Find An Educato r Calibrati ng Treatme nt Dealing With Travel & Holiday s Find Your Speciali sts Logging Data Assembl e Your Kit
  33. 33. CASE STUDY: DIABETES MANAGEMENT And what might a typical day look like?
  34. 34. Wake Up Brea kfast Work out Lunc h Dinn er Bed Time WorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWork Sarah Work Snac k
  35. 35. Wake Up Brea kfast Dinn er Bed Time WorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWork Mary Ellen Famil y Time Snac k Snac k Snac k Famil y Time Famil y Time Famil y Time Famil y Time Famil y Time Famil y Time Famil y Time Erran ds Erran ds Erran ds
  36. 36. BUILDING AN INTERVENTION
  37. 37. In-the-moment feedback Badges! And the badges expire if you don’t keep it up! Compare everything the user does against guidelines Reinforce the user’s identity as someone who takes good care of her health
  38. 38. In-the-moment feedback Badges! And the badges expire if you don’t keep it up! Compare everything the user does against guidelines Reinforce the user’s identity as someone who takes good care of her health
  39. 39. Wake Up Brea kfast Work out Lunc h Dinn er Bed Time WorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWork Sarah Work Snac k Wake Up Brea kfast Dinn er Bed Time WorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWorkWork Mary Ellen Famil y Time Snac k Snac k Snac k Famil y Time Famil y Time Famil y Time Famil y Time Famil y Time Famil y Time Famil y Time Erran ds Erran ds Erran ds How do we design for both???
  40. 40. In-the-moment feedback Badges! And the badges expire if you don’t keep it up! Compare everything the user does against guidelines Reinforce the user’s identity as someone who takes good care of her health User determines feedback frequency Badge milestones based on user EXP level, and make them more resistant to expiry for veterans Users collaborate to select appropriate goals Language is consistent with history and experience
  41. 41. DESIGN DECISIONS PRIORITIZE: Understanding a user’s baseline status Calibrating guidelines and feedback to their level Offering users choice to optimize their experience Acknowledging individual differences as appropriate
  42. 42. A PROCESS FOR DESIGNING WITH BEHAVIORAL ECONOMICS 1. Identify behaviors to change and desired outcomes 2. Document who will use your intervention and when they will use it 3. Determine opportunities to baseline and personalize 4. Create visual artifacts to help your team visualize between and within differences at the same time (e.g. journey map + personas) 5. Map behavioral economics techniques to elicit the desired behavior from the specific user at the right milestones
  43. 43. BEST PRACTICES FOR DESIGNING WITH BEHAVIORAL ECONOMICS Think about systems, not rules  not what these tactics are, but why they work Put heuristics into context: Person Situation Take advantage of personalization tactics Technology Targeting
  44. 44. CONCLUSIONS AND CONVERSATION

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