Leveraging Goals to Drive Behavior Change
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Getting behavior change right is tough in any domain, but in Digital Health it's even more important. My 4 step framework walks you through how you can create effective digital goal programs that encourage lasting behavior change from users.
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Leveraging Goals to Drive Behavior Change
- 1. 1 Leveraging Goals to Drive Behavior Change A framework for creating successful goal programs Rob Gifford UX Design Lead
- 2. 2 Goal programs can effectively orchestrate different techniques to change behavior Tracking Badges Incentives Goals Social Education Points
- 3. 3 Why are goals effective? Goals Increase Motivation, Focus, and Persistence
- 4. 4 1. Recognizing the Need 2. Goal Selection 3. Goal Pursuit 4. Rewards Increase the effectiveness of goal programs by supporting users across the four steps of a goal program Adapted from: Cullen, Baranowski, Smith, 2001
- 5. 55 1. Establishing the Need 2. Goal Setting 3. Goal Pursuit 4. Rewards Establish the Need
- 6. 6 Three factors influence people’s belief about the need for a goal program Severity of a health risk Susceptibility of health risk Effectiveness of taking action Adapted from the Health Belief Model ! Establishing the Need
- 7. 7 Healthlines offers approachable content that helps users understand how COPD might affect their health Understanding the risk inherent in a health condition is the first step in recognizing the need to change
- 8. 8 COPD foundation helps users easily and anonymously get a COPD risk score by filling out an online screener Establishing the Need People also need to understand their own risk for the condition
- 9. 99 1. Establishing the Need 2. Goal Setting 3. Goal Pursuit 4. Rewards Setting the Right Goals
- 10. 10 Challenging, but achievable Self directed Clear Goal Setting Three characteristics of activating goals
- 11. 11 Challenging, but achievable, goals create more engagement Goal Setting Couch25K Intensity
- 12. 12 Runkeeper’s Goal Coach provides custom recommendations based on data user provide it about their priorities Self-directed goals improve persistence Goal Setting Runkeeper
- 13. 13 Clear goals are more effective than lofty and vague goals Goal Setting Couch25K Couch25K keeps users focused on a clear and achievable goal of running a 5K.
- 14. 1414 1. Establishing the Need 2. Goal Setting 3. Goal Pursuit 4. Rewards Goal Pursuit
- 15. 15 Trigger the action Make it easier Provide feedback Celebrate progress Goal Pursuit Four ways to support goals pursuit B.J. Fogg (2016); S. Wendall (2013)
- 16. 16 Goal Pursuit PillPack Employ noticeable, timely, and appropriate triggers to cue desired behavior Pill Pack helps users take their meds by providing cross channel notifications and lowering the effort of taking meds by pre-packaging daily doses
- 17. 17 Pill Pack provides cross channel triggers to improve medication adherence. Reduce physical, cognitive, and social effort to make it easier for users to perform the behavior Goal Pursuit
- 18. 18 ElevateProviding regular feedback on performance enables users to adjust effort Goal Pursuit Elevate provides timely feedback on performance so users can learn where they went wrong
- 19. 19 Celebrating meaningful progress towards goals creates empowerment & satisfaction Goal Pursuit TwineHealth enables users to share goals with their loved ones so they can help celebrate their accomplishments
- 20. 2020 1. Establishing the Need 2. Goal Setting 3. Goal Pursuit 4. Rewards Rewards
- 21. 21 Rewards exist on a continuum based on the type of motivation they satisfy Extrinsic Intrinsic Rewards Most user exist here
- 22. 22 Beware of overreliance on extrinsic rewards Ariely, Kamenica, Prelec (2008) Rewards
- 23. 23 Intrinsic Rewards Build intrinsic motivation to create sustained engagement Sustained Engagement Extrinsic
- 24. 24 Leverage these three strategies to build intrinsic motivation Build a Sense of Mastery Create a Sense of Identity Emphasize Future Benefits Rewards
- 25. 25 Build a sense of mastery by showing users their progress acquiring new skills Headspace visualizes how a user progresses in mastering different types of mindfulness training.
- 26. 26 Reinforce a Positive Self Identity Spartan lets their participants know that they’re part of an elite group of Roman warriors. Rewards
- 27. 27 Increase Value Placed on Future Benefits Rewards
- 28. 28 Support users through each step of their journey Support an understanding of : • Severity of a health risk • Susceptibility to risk • Effectiveness of taking action • Trigger the action • Make it easier • Provide feedback • Celebrate success Build intrinsic motivation by providing: • Feelings of mastery • Sense of identity • Emphasize future benefits • Set challenging, but achievable goals • Provide opportunity for self- direction • Set clear goals and outcomes 1. Recognizing the Need 2. Goal Selection 3. Goal Pursuit 4. Rewards
- 29. 29 Hi, I’m Rob Gifford I’m a versatile Experience Design Lead with a passion for leveraging psychology to create engaging digital experiences. I combine a decade’s experience in UX with an undergraduate training in Psychology and an MBA from Bentley University to lead teams and design innovative products and services. Feel free to connect to discuss design, behavior change or opportunities to collaborate. Email: robgifford9@gmail.com Linkedin: linkedin.com/in/robertgifford9
Editor's Notes
- I’d like to thank everyone for attending this webinar I’m really excited to talk to you about a simple and effective method to create behavior change. This webinar will last about 30 mins. If you have any questions, you can submit them on the GoToWebinar dashboard and we’ll answer as many as we can at the end.
- Let me start out by saying that nailing behavior change is extremely important. We have 38% adult obesity. Diabetes risk and heart disease are climbing while healthcare costs are increasing exponentially. On the bright side, mobile health apps and wearable are gaining adoption. By some measures wearable adoption is increasing 100% year on year. However, simply offering users the ability to track and receive points or badges isn’t enough. Fitness trackers and wearables struggle with long term engagement. There are lots of fragmented Behavior Change techniques, how to user goals to to organize many of these techniques to for creating sustained behavior change
- Three reason Goals create are effective to change health behavior change method: Motivation - goals build motivation by setting a tangible vision which inspires people to make a change. Focus- Goals focus us. They help us to prioritize the all the vague health behaviors we think should probably do, giving us concrete steps things towards improving our health. Persistence - Having a concrete end point helps us to move past momentary surges in motivation to actually stick with behaviors longer.
- I’m going to walk you through a step by step framework that you can use to create effective goal programs It outlines the key phases people experience when setting & pursuing goals Examples focused is on health goals like improving diet, exercise, and smoking cessation but this framework could really be applied to any type of goals As people involved in behavior change, we have the opportunity to support users through each phase of their goal “journey”. Recognizing Need - The first step in any process is for users to understand their need for a health goal or intervention. As digital health experts we’re often more biased towards the solution or creating interventions themselves. Its important to anchor our programs to the core needs that have been established and reinforce them throughout our intervention. Goal Selection - Once a users has recognized the need, there are many goals they can pursue. If users don’t set the right type of goals, they can find themselves flailing. Goal Pursuit- After we help a user select an appropriate goal, supporting them in their pursuit is critical. Rather than trusting users simply go full steam ahead, we can help support them in their goal pursuit by triggering the desired actions, providing feedback and celebrating their progress. Rewards - Finally, its important to consider how users will be rewarded for their achievement. It’s very hard to build motivation without users feeling rewarded. However, many goal programs over rely on extrinsic motivators like monetary incentives, failing to create lasting motivation. In the rest of this webinar, I’ll walk you through some details of each of these phases and so you can optimize adoption for around each component of your goal program.
- There are many individuals at risk (individuals who struggle with smoking, obesity, or inactivity) but not all of them are candidates for your goal program. In order for people to engage in the pursuit of a goal, they first need to be activated by understanding their need for the health goal (risk for diabetes, heart disease, or COPD). Important not to gloss over In fact, the most effective goal programs are informed by the “why” behind individuals engagement - why people arrived at them and what they’re trying to get out of them. You can accomplish this through users and modeling before you start designing details of your program so we can make the experience more effective by reinforcing their motivation for pursuing.
- How are users catalyzed to realize they have a need to create a health goal? It turns out that people’s likelihood of adopting a health intervention or behavior comes down to a few beliefs they have (coming from Health Belief Model). Perceived Severity First users need to understand the severity of a risk – are they aware of what the condition is and how it could impact their lives Unfortunately many Americans lack health literacy [see stat from Ahmed’s webinar] Susceptibility - How likely am I, in particular, to have that risk. Need to internalize the risk. Ex: I smoke cigarettes but I probably won’t get lung cancer because my grandfather smoked his whole life Strategies: Online screeners, content that describes specific risky behavior or symptoms, most importantly conversations with medical professional Effectiveness of taking action - how effective will changing my behavior be? What is the particular effectiveness of this health intervention? Strategies: Social endorsements, referral from a trusted sources like a doctor, etc..
- When a user builds the understanding to make a change, they now need to set a goal… This is where a lot of goal programs start But its not only important that people set a goal, but that it’s the right type of goal… goals that are activating. The risk is that we offer up goals that miss the mark: fail to motivate a users [slide of frustrated user] fail to incite long term commitment or leave them lost as to what to do (NY Res example, 90% failure rate)
- It turns out there are a few characteristics of activating goals, ones that inspire long term commitment. Challenging - Research shows that goals that are challenge actually inspire better performance. Self Directed - Level of autonomy in choosing or participating in their goal. Clear - User understand what accomplishing their goals look like
- Challenging - It is important to set goals that are appropriately challenging in order for users to feel engaged and achieve a meaningful health outcome. Goals that are too easy to achieve will not be meaningful or inspiring. However, goals that are too aggressive, like running a marathon or loosing 20 lbs in a month will be dismissed because users don’t believe they can accomplish them. The sweet spot is recommending goals that are challenging and identifiably attainable. Important to understand the type of “recognized need” and ability users are arriving with. Are they trying to optimize their fitness or have a better annual physical?
- 2nd characteristic of activating goals is Autonomy. A sense of choice has been shown to actually improve the persistence in pursuing a goal because: Goals that others generate can easily be dismissed when things get hard. If users feel pressured into something or don’t fully understand why I’m pursuing it it’s much easier to rationalize giving up. More likely to reflect values, preferences and ability. RunKeeper has a great example of providing users with a certain level of autonomy. Their Goal Coach interview users about what’s important to them, their abilities, and then suggests a goal.
- Finally, Activating Goals need to be clear… Couch25K – Really good example of setting a clear goal of running a particular distance Providing a workout plan each type of user (ability) Clear goals like this help users measure progress & inspire
- Once we’ve helped users set clear and inspiring goals, we need to consider how to support users in their pursuit of them. Caveat: Dense body of research on this… so I’ll give you a bit of a drive by on it but would be happy to connect more about other strategies.
- Four key strategies you can use in your goal program to actively support users’s goal directed behavior. Triggering - Cuing user to the action you want them to. Make it easier - lower friction and barriers to behavior across different dimensions of effort Provider feedback - as users progress let them know how they’re doing so users can adjust their technique and effort Celebrate progress - help users to experience small, ongoing victories throughout their pursuit of a goal.
- Medication adherence is a serious issue… reduces efficacy of the drug and results in hospitalizations. Many people are multiple meds treating different conditions further complicating things… Triggering the right action with notifications and reminders is critical here (like Pill Pack is doing with their platform) The key here is that we need to deliver triggers that are Noticeable - cut through the noise of daily life Right level of urgency Timely - delivered at the point when they’re most actionable
- Engagement in goal directed behavior is often related to effort. One of the ways to improve success is to lower effort require from users. Physical effort - such as exercise Cognitive - is hard to remember what to do or think through what I need to do Time - spending time sorting my meds in the morning Pill Pack innovative actually lower all three dimensions of efforts to make it easier for users to take their meds. By pre-packaging them in single day doses, user don’t need to take the time or effort to open all their pill bottles and count all their meds for the day
- As users take steps towards their goals, they need to understand how effective their effort is so that they can make adjustments if necessary. This is where users get most value from the typical wearables and tracking functionality in Fitbit etc… Again, frequent feedback at the point of actionably is key here When users aren’t making progress, make sure that we’re framing feedback in a way that isn’t discouraging.
- Celebrating the progress that user makes. Leaving them with a series of successive small victories will build a sense of confidence in their own ability to control their behavior and achieve their goals. TwineHealth - A chronic condition management platform takes an interesting approach. Enables users to share goals with a select group of loved ones, rather than receiving standard system notifications like badges and progress indicators, employs the social dynamics that already exist in someone’s life to enables users’ loved ones to cheer them on (they’re often the motivation behind improving health).
- Once a person has established their need, set a goal, and engaged in pursuing that goal they need to be rewarded to stay engaged.
- There are two distinct poles that rewards sit on, ones that satisfy extrinsic and intrinsic motivation... Extrinsic Rewards are things like points, money, and prizes. Things that are totally removed from the behavior itself. Intrinsic Rewards- inherent to the activity or behavior itself. Most people require rewards somewhat in the middle of the spectrum, because their motivation is mixed. People that are purely intrinsically are rare… not likely to need goals. On other end, folks that are completely unmotivated need to be rewarded entirely extrinsically Luckily, most users should have some intrinsic motivation. So they’ll fall closer to there middle. At some point they’ve decided to engage in a program because they've established the need based on the impact on their health. Choosing the right type of rewards for your goal program is really important and should reflect where your users are likely at on this continuum.
- However, we need to be careful about overdoing extrinsic rewards. Though they’re often powerful motivators in the short-term, relying on them excessively can often rob people of the drive to engage in the health behavior in the absence of rewards. Dan Ariely’s (Duke) interesting shows that over reliance on extrinsic rewards can actually decrease inherent performance / enjoyment around tasks, they previously did without incentives. Participants where asked to build Lego figures, something they were happy to do on their own, when they where paid to assemble them they actually produced more, but when there pay went away they produced far less.
- As much as possible we want to harness intrinsic rewards in order to create more lasting engagement, even beyond our app and program.
- How doe we do this? A sense of mastery is rewarding. Being able to see your ability improve over time is incredibly motivating. You can imagine how empowering its for users engaged in a jogging goal is to count the amount of miles they run increase, or watch your time go down. Sense of identity around a behavior. Reinforce that a person is the type of person that participates in healthy behaviors. Identity exist w/in a social construct. Develop feeling of being a part of a group… the better. Improving the salience of the benefits of a fitness goal. There are often costs and benefits of engaging in any health behavior. Decision theory says that engagement in any action, is a function of an internal costs / benefits calculation. Problem is benefits for health behavior often exist far into the future. Costs, such as not eating certain foods or the discomfort of going to the gym are immediate. As designers of behavioral systems, we can help build intrinsic motivation (shift the equation) by bringing attention to some of these future benefits. Tying it back to first phase of a goal program, we are helping users connect with the reason they set these goals in the first place.
- Talk about yourself and what you do at Medullan.