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Designing for Persuasion: Mobile Services for Health Behavior Change

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  1. 1. + Designing for Persuasion Mobile Services for Health Behavior Change April 27, 2009 Persuasive 2009, Claremont, CA
  2. 2. + Panelists  Kendra Markle Kaiser Permanente/AlterActions  Kevin Patrick UCSD/Calit2  SonnyConsolvo Intel Research  KaraChanasyk, Moderator Stanford Persuasive Technology Lab White Lotus Design
  3. 3. +Agenda About the Panelists  Persuasive Techniques for Mobile  Examples:  Persuasive Design in Action Discussion  Q&A 
  4. 4. + Kendra Markle Kaiser Permanente/ I design tools that help people Nutrition make healthy changes in their behavior Exercise Kaiser Permanente's Stress Management Services Stress Management Text & email reminders, Weight screensavers, audio guided Management relaxations, etc Breathe Cognitive Behavior Relaxation Remindersvia Text Message Therapy (CBT)
  5. 5. + Kevin Patrick, MD, MS Professor of Family and Preventive Medicine University of California, San Diego Director, Center for Wireless and Population Health Systems, Calit2 University of California, San Diego Editor-in-Chief American Journal of Preventive Medicine Co-Founder, Santech, Inc UC San Diego Center for Wireless & Population Health Systems
  6. 6. + Kevin Patrick, MD, MS Exploring the use of mobile devices, sensors and related systems to promote improved health behaviors and outcomes SMS/MMS approach to reduce weight in obese adults; Pilotcomplete; Larger mDIET study pending incl. Spanish language (NIH/NCI) Mobile-phone based system supportingnear real-time capture of energy intake e/Balance & and expenditure; tools for researchers and for consumers (NIH/NCI SBIRs) my/Balance Measurement of physical activity time/space paths in context of Gene- environment exposure biology research (NIH/NIEHS) PALMS Social-Mobile approach to reduce weight in young adults SMS/MMS + Facebook apps (NIH/NHLBI; pending approval) SMART Mobile phone + sensors to provide near real-time feedback to users on environmental health factors plus collective data over time to third party users CitSense (public health, etc.) (NSF; under review; W. Griswold, PI) UC San Diego Center for Wireless & Population Health Systems
  7. 7. + Sonny Consolvo Houston + = + ? journal pedometer social influence increased step count? + = + ? UbiFit glanceable display journal fitness device regular & varied physical activity?
  8. 8. +
  9. 9. + Persuasive Design Goal Setting  Techniques Reminders  Tracking  Rewards  Social Support  ... among others 
  10. 10. + Tracking Transformed
  11. 11. + Reminders Redefined
  12. 12. Reminders Social Support Rewards Reminders Goal Setting + Reminders Social Support Tracking
  13. 13. + Reminders Kendra Markle
  14. 14. + Text Message Reminders for Stress Management Reminder & prompt to respond Response & tracking Reinforcement Social support
  15. 15. + Reminders are Triggers Break down new behaviors into small steps Reminders can teach, guide and reinforce these steps They’llbe asking Small steps should be Make them feel Fun/Interesting Is this worth it to me? Immediate Not Annoying gratification Easy/Achievable Can I do this? Like they rule* Fast Text messages are only 160 characters long *Kathy Sierra: 'Creating Passionate Users'
  16. 16. + Accommodate Personality Differences Relaxation Types: Physical tasks  Visualization tasks  Thought tasks, etc 
  17. 17. + Reinforcement  Positive reinforcementincreases motivation before next reminder (regardless of success)  Use surveillancelet them know you‟re paying attention to what they do  Reiteratewhat you want them to learn so they remember it
  18. 18. + Use Teams to Exert Social Influence  Reminders can communicate social dynamics and create friendly competition Brian is your rock  Use intermittent reinforcement star relaxer for Team Tension Tamers with full participation so Good job Lynn far. and Marcie! Can you help Marilyn relax? New Congratulations on full message coming participation this week, Team later today. Harmonious! You are in first place. New messages each day this week.
  19. 19. + Let Them Initiate Contact Too  Push remindersdeliver frequent, randomly timed text messages to them  Pull remindersallow them to ask for help when they need it Try this: Envision going down a slow escalator. Count from 10 to 1 as Help me you descend deeper Aurrgh! I‟m Relax now into relaxation. Text feeling tense back how effective this was for you (0-5)
  20. 20. + Lessons Learned about Reminders  Design for contextyour reminders enter their life in their context  Make160 characters memorable(Read „Made to Stick‟)  Give them options(how, when, how many, what type) upon sign up and in real time  Builda personal connectionby personalizing feedback to them based on their actions. (Don‟t say „Great job relaxing this week‟ to everyone regardless of their actual behavior)
  21. 21. + Text Messages Make Great Reminders Text message reminders: Reach people where ever they are  In their context  Real time (mostly)  Can interrupt (which can be good and bad)  Exerting influence at decisive moments: Before scheduled stressful events  When they‟re in traffic  By proximity, when they‟re near their friends or their gym or other triggering  locations When their friends are relaxing/engaging in the target behavior 
  22. 22. + Tracking Kevin Patrick, MD, MS
  23. 23. + Tracking & Self-Monitoring Volitional   Event-driven (e.g. after every meal)  Practiced art (mastery…) Prompted   Time of day (routine or tailored)  Event-driven - requires context/situation awareness via sensor. e/Balance and my/Balance do this via GPS  Learned (pattern recognition)** **Subject of current and proposed research UC San Diego Center for Wireless & Population Health Systems
  24. 24. + mDIET Intervention Components supporting tracking Daily Text & Picture Messages  Participant could choose the # of messages to receive & times to receive the messages  (2-5 messages per day) Daily messages are statements or questions  Printed Materials for recommended weekly reading  Behavioral Skills, Nutrition, and PA topics (e.g. Self-monitoring, Portion Control, Routine Physical  Activity) First half provided in Binder at baseline; Second half provided at mid-point measurement visit Monthly Brief Counseling Calls (5-15 minutes)  Progress and counseling calls from their Health Coach addressing strategies,  social support, problem solving, etc. Goals  Daily 500 calorie deficit (through calorie reduction and an increase in calories burned)  Self-Monitoring  Weekly weigh in (text weight) and daily food & exercise journal  Control group received mailed educational materials monthly on nutrition & physical activity.
  25. 25. + Types of mDIET Messages that support Tracking Type of Text or Picture Message Example Motivational Sayings Never say never, you can do it! Keep up the good work!) Nutrition & Physical Activity Tips Try 10 baby carrots and a tablespoon of fat-free dressing for a 100 calorie snack; Want extra steps? Take the stairs today Nutrition & Physical Activity Reminders Remember to move more today to reach your 12,000 step goal; Be sure to practice portion control strategies at your next meal Short-Term Goal Reminders Think about what you can do in the next 4 hours to be healthy Behavior Questions Have you practiced portion control strategies today? Have you reached your 12,000 step goal today? Weekly Weight Questions What is your weight? Weekly Weight Graphs Chart of weekly weights Portion Control Picture Messages Pictures of portion sizes
  26. 26. + MMS & SMS Feedback Nice progress! You're on your way to reaching your goal. It will take time, but you have the motivation to succeed.
  27. 27. + Rule-based Dialogues: Messages sent based on the user‟s previous responses UC San Diego
  28. 28. + Tracking & Self-Monitoring Volitional   Event-driven (e.g. after every meal)  Practiced art (mastery…) Prompted   Time of day (routine or tailored)  Event-driven - requires context/situation awareness via sensor. e/Balance and my/Balance do this via GPS  Learned (pattern recognition) Closely linked to reminders and “attention technologies” UC San Diego Center for Wireless & Population Health Systems
  29. 29. + Attention Technologies Proactive – best to know when it‟s most relevant (e.g., when you‟re  being exposed) Peripheral – shouldn‟t divert attention during “critical” tasks  Unobtrusive – shouldn‟t cause social problems   sound will be out in many cases Rich – don‟t have to get out phone to look at it  Adaptive – changes according to your task, etc.  Redundant – if you‟re busy, miss a notification, or don‟t understand  it From: William Griswold, PhD, UCSD
  30. 30. + Rewards Sunny Consolvo
  31. 31. Rewarding vs. Punishing + If your mobile phone rewarded or punished you based on  your physical activities, how would it likely affect your behavior?
  32. 32. Rewards & Punishment in Technologies + that Encourage Physical Activity Fish‘n’Steps(Lin et al.) Houston (Consolvo et al.) UbiFit(Consolvo et al.)
  33. 33. + Participants‟ reactions: Fish„n‟Steps Happy Fish => Happy Participants  Sad Fish => System avoidance/abandonment  Reactions caused researchers to rethink the use of punishment  as a motivator
  34. 34. + Participants‟ reactions: Houston  Small rewards felt surprisingly good “It was kind of cool to have that  [the „*‟]. It was like, oh, a star…gosh how the little things, you know. The little things that count, the star.” “It was like, yes, I rock!...and it was  fun to go back [in last 7 days] and go, yes, there’s my star for that day…”
  35. 35. Participant‟s reactions: UbiFit +  It was a “gentle reminder” to be active “It’s a nice, gentle reminder that getting off  my duff…every other day is not too much to ask.”  Barriers came up more frequently than participants realized “It was awful…I was like counting the days since I had  been to the gym or since I had done anything because I had some really sick days where just stretching made me want to throw up.”
  36. 36. + Reward, don‟t punish These are often intended to be long-term, discretionary  use technologies Use positive reinforcement or rewards to encourage  change. Do not punish the individual for lack of the desired  behavior, but try to keep her engaged in the behavior and the technology to help her get back on track.
  37. 37. + Social Support Opportunities for leveraging Social Support as a Persuasive Design technique Considerations when incorporating Social Support
  38. 38. Is there a + Recipe for Persuasion?
  39. 39. What are the + near future opportunities?
  40. 40. What challenges are keeping + mHealth from becoming mainstream?
  41. 41. + Q&A
  42. 42. + Thank you! Kara Chanasyk  Kendra Markle  We‟d be glad to talk with you if you have questions. Kevin Patrick  Sunny Consolvo  Slides are available at: suasive09