Mobile Health @Stanford


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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.

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  • Fact of life: Your microchoices are killing you.
  • Every microchoice counts.

    There is no goal too small.

    Data alone does not drive behavior change.

    Health IS social.

    “Cues to action” should not come from a health coach - they should come from people you know and love.
  • Forget ‘participatory medicine’ and ‘health 2.0’...

    My homerun: Talk with people who want to build systems that track what people are hoping for...and whether or not they get it.

    This is about reprogramming choice + control into personal disease management and individual wellness modification.
  • Now, about that “ecological assessment” data Vic mentioned this do we get it?

    And how do we understand what’s wheat and what’s chaff?
  • 2 types of data are important: clinical objective data, personal subjective data.

    IUX hierarchy paradigm (I-U-X) = me, you, everything else.

    We’re guilty of gathering a lot of TBU data (true but useless) in mobile health.

    I’m going to talk about how we can map at which point on this continuum a patient is operating based on his/her ‘journey’ details or sharing of an epiphany event.
  • “Me-metics” matter more than the ‘metrics’ forward-thinking mobile health folks are telling us are vital to collect and analyze...

    Phones are our personal identity extension platform.

    They enable complex ID creation and communication (id, ego, superego).

    Web based + social + movement data already captured by them (or can be captured).

  • Mirror = daily dose of visual input. Why doesn’t seeing a change in our weight DAILY (multiple times a day drive better decisions?

    Data alone does not drive behavior change.

    Ok genius, so how DO we drive behavior change?
  • Future tense verb use: “I wish, I will, I want to...”
    Present tense verb use: “I am, I do...”
    Past tense verb use: “I have done, I did...”

    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.

    Not so my friends.
  • Forget ‘predictive modeling’ (which tends to be a population-based health approach) for now...

    Here’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.

    Instead we need to maintain a micro-focus: We must concentrate instead on maximizing the value per INDIVIDUAL user.

    Have to focus on the PERSONAL health data set, sample size: n=1, before we focus on the SOCIAL data set n=1+1...
  • Zero effort applications...

    Like to suggest a new term for Ecological Momentary Interventions (EMI) = “microchoices.”

    We’re suffering from problem AND solution asymmetry in health:

    The solution(s) are often ‘smaller’ - 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).

    Here’s the bottom line...140 characters shouldn’t be able to change behavior. It shouldn’t be enought to build a professional reputation around, but it is.

    This is why social support for ‘microchoices’ is so successful a focus for ‘incentivizing healthier behavior.’

    You match asymmetry (solutions oriented) with asymmetry (impact oriented) and somehow it adds up.

    Depending on which study you read it takes 18 to 254 days to ‘cement’ sustainable behavior change.
  • Let’s try treating with social technology.

    Can I get a couple cc’s of social support, stat, rather than taking more pills?
  • What does a social health Rx look like?

    First we must answer: Is your health a personal asset or a community good?

    We don’t consider health a personal asset OR a community good until it’s a ‘debit’ - ie it’s gone; removed from our personal homeostatic balance sheet when something goes wrong.

    Then we suffer AND the community suffers (decrease in mood, increase in stress, loss of income earnings, etc).

  • Question: “What is the right kind of goal setting?”
    Answer: “Short term action with long term import, supported by contextual community structure and continual self-analysis.”

    Behavior change is the sum of a choice solution set (potential choices and choices made).

    Behavior change is not an automatic reaction. It’s a studied one.

    “Behavior” 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.

  • “How do we measure general patterns of an individual’s behavior change over time?”

    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.

    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.

    Depending on which study you read it takes 18 to 254 days to ‘cement’ sustainable behavior change.

    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).

    Lesson: Make it fun, and you won’t have to ask whether or not it’s working. Build verficiation into your backend and ease of use into your frontend.

    Constraints of designing for mobile health work in your favor here (small screen, gestural interfaces, cross platform compilers, etc).
  • Who is the best health coach? Clue, it’s NOT the one academics and providers prescribe for us.

    We’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.

    Why? Most of us just want an excuse to do the right thing...

    Most often we KNOW what the right choice is...

    But sometimes we just need a bit of an ‘excuse’ to make it.

    Social pressure provides that excuse.

    Light bulb: Even if you won’t do it for yourself, you’ll do it for others.

    We tend not to honor obligations to ourselves. But we’ll honor a promise made to another person we know.
  • Notice “data” appears nowhere.

    Guilty of overemphasizing motivation while underestimating power of ‘triggers.’

    You would have to manipulate motivation, measure ability, and then manufacture ‘effective’ triggers.

    Far easier to survey the individual’s online ‘habitat’ 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’t override (ie someone just challenged you to do a minute of pushups - quick! You should think “yeah, I can do that” without stopping to consider all the OTHER thousands of things you could be doing in that 60 seconds).

  • And we’re using the wrong triggers.

    Fight or flight is a very useful instinct for a 1x action or response, but it’s not very good at forming sustainable habits that stand the test of time.

    Eventually, the mouse gets tired.
  • Intrinsic results gained via extrinsic motivation (social support).

    We need longitudinal studies that measure the efficacy of each factor: I, R, and R.

    Unfortunately we tend to discount the 1x, individual action.
  • Design for transient and changing data and research.

    Biggest lesson = no such thing as a ‘standard’ use case. Banish “typical” from your vocab.
  • We wanted to build a social game, but we didn’t want to spam everyone Mafia Wars style.

    Our experiment: We wanted to build a social platform that becomes a bartering system or marketplace for completed activities (starting with ‘microfitness’). Health is the end result, not the primary goal.
  • It really is that simple.

    Reciprocal social contract.
  • Best way to see how it works...
  • But we designed with ‘mobile’ use in mind (literally and figuratively).

    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.

    The practical realities of a fragmented mobile market led us back to the web. And there should be no shame in this. I don’t consider GUAM any less mobile because we built it this way.

    Mobile health is not just about building a kicka#$ mobile application, although that’s a good place to start...

    Think about optimizing your desired outcomes for a specific audience through this channel. Because that’s all we’re talking about here. Another channel to research, plan, design, and deliver “care.”

    But because of access to mobile as a channel, we’re blowing the lid off traditional definitions of ‘care’ and ‘health.’
  • For one, we’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.

    Life is a finite asset, a non-renewable resource.

    However, from my experience at hackathons and recruiting developers, it’s hard to find a hacker who wants to work on health. Optimizing human performance over an individual lifeline just doesn’t sound that exciting.

    Unfortunately, there are no ‘rollover minutes.’

    You pay to enjoy the time you have (consumption-oriented culture) - you pay to personalize your experience along your personal chronology (“me-metics”).

    If you can pick your ringtone, why can’t you pay a copay with your mobile phone? Is there an app for that? Would you pay for it?

  • Mobile check ins.

    Biometric devices.

    Individual use of apps designed with personal + ‘microrelevance’ in mind.
  • Persuasive people + persuasive tech = delta in behavior(s) = desired outcomes.
  • With decision-support via motivation ‘carrots’ designed game-mechanic style.
  • Integration of biometric tracking device data.

    Social ‘proof’ of completed challenges (comments, video, SMS, photo, geolocation, etc).
  • Study behavioral economics, developmental/child psychlogy, gaming/sports theory, and goal attainment theory.
  • Health, however, is often a renewable resource. Let’s look at a ‘target’ demographic. People with IGT or ‘pre-diabetes.’

    People who lose weight and increase physical activity can prevent/delay diabetes and even return blood glucose levels to ‘normal.’

    Develop challenge set that has, as its goal, reduction of Susy’s A1C by 1% over 10 month period. Every reduction 1% reduction reduces microvascular *eye, kidney, nerve* complications by 40%.
  • Once we can track an individual’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.
  • Will the founders of these great behavior change platforms please stand up?

  • Mobile Health @Stanford

    1. 1. 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
    2. 2. Central Contagion dogma.
    3. 3. choice + control aware Mobile enabled care.
    4. 4. Best biometric Me! You! tracker(s)...
    5. 5. “Me-trics” and “Me-metics”
    6. 6. The loneliest number? n=1 “me-trics”
    7. 7. But the data! Exhibit A: The mirror effect
    8. 8. pre-action ----------> action ----------> post-action (intent) (do/buy) (reporting)
    9. 9. 1 person * 1 thing (differently) * 1 time
    10. 10. Small actions. Big impact. Dancing to 2 songs can rock your world.
    11. 11. Brief Solution-Focused Therapies (BSFT, BSOT) • Alcoholics Anonymous • Day treatment programs • Weight Watchers
    12. 12. Behavior. Change. Nuff said
    13. 13. Excuse to do something Do it for someone you love good.
    14. 14. Behavior change has 3 components • Motivation, ability, trigger (MAT, by Fogg). • Environment, emotion, logic (EEL, by Jen).
    15. 15. Triggers. Fear drives us
    16. 16. IRR Principle • Individual, 1x action • Repeat action (2x) • Routinized action (<2x)
    17. 17. 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).
    18. 18. Social games? Grow something good
    19. 19. Meet Get Up and Move: I will _____________ if you will ______________.
    20. 20. Challenge me!
    21. 21. Your health. Your hands
    22. 22. Takin’ care of business. Mobile apps = DTC biz model
    23. 23. What in the health is headed our way next?
    24. 24. Problem 1 (still). Data self entry
    25. 25. The solution(s). mobile + social
    26. 26. Geolocation integration. Hyperlocal challenges
    27. 27. Granular permissions. “Facebook” level controls
    28. 28. Challenges = connective From real --> ridiculous tissue.
    29. 29. Where there’s a will, there’s a weight...
    30. 30. What are we going to do with something the size of a Rice This is our platform. Krispie’s Treat?
    31. 31. Goal Mafia, Text & Play, Crohnology
    32. 32. Jen McCabe, CEO/Co-founder Andrey Petrov, CTO/Co-founder 301.904.5136 (iPhone)