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The Science Behind Behavior
Change

@ehekler

Dr. Eric Hekler
Arizona State University
Welltok Health Optimization Leadership
Summit
March 7, 2014
Flickr -Espen_Faugstad
Why now?
Consumer-driven health

Image courtesy of Jawbone

@ehekler

Healthcare incentives shifting

Flickr - echo0101
Technology is becoming very
powerful
Deep Blue

Watson

Flickr - jntolva

@ehekler
Just in Time Adaptive Interventions

@ehekler
The DIY Self-Experimentation Toolkit

Home-based
Sensing/feedback

Selftracking

?
Design Portal
@ehekler
Married male, 47
• Symptoms
– Tired
– Lack of concentration
– listlessness

• Self-reported
behaviors
–
–
–
–
@ehekler

Smokes
Inactive
Eats only fast food
Not sleeping very
much
Flickr – DES Daughter
Scenario

Flickr – DES Daughter
What drives behavior?

@ehekler

Flickr - JHTNS-
Image courtesy of Dr. BJ Fogg
@ehekler

http://iprofs.files.wordpress.com/2013/07/elephant_rider_path
Image courtesy of Dr. BJ Fogg
The COM-B system: Behaviour occurs as an
interaction between three necessary conditions
Psychological or physical ability
to enact the behaviour

Reflective and automatic mechanisms
that activate or inhibit behaviour

Physical and social environment
that enables the behaviour

Michie et al (2011) Implementation Science

Slide courtesy of Dr. Susan Michie
Slide courtesy of Dr. Susan Michie
Interventions

Interventions:
activities
designed to
change
behaviours

Slide courtesy of Dr. Susan Michie
Intervention functions

Policies:
decisions
made by
authorities
concerning
interventions

Michie et al (2011) The Behaviour Change Wheel: a new method for characterising and
designing behaviour change interventions Implementation Science
Slide courtesy of Dr. Susan Michie
Behaviour-change
techniques taxonomy

@ehekler
Married male, 47
• Symptoms
– Tired
– Lack of concentration
– listlessness

• Self-reported
behaviors
–
–
–
–
@ehekler

Smokes
Inactive
Eats only fast food
Not sleeping very
much
Flickr – DES Daughter
What behaviors would you
prescribe?
• 30 minutes of
physical activity per
day
• 5 Fruits & Veggies per
day
• Avoid processed
foods
@ehekler

• Stop smoking

Flickr – DES Daughter
How might you help him to enact
the prescribed behaviors?
• Refer to evidencebased/informed
program

• If doesn’t exist…
– Identify the driver
of the behavior
– Use appropriate
techniques
@ehekler

Flickr – DES Daughter
• Rider
– Define destination
– Script critical moves

• Elephant
– Focus on the feeling
– Shrink the change

• Path
– Build habit chains
@ehekler

http://iprofs.files.wordpress.com/2013/07/elephant_rider_path
@ehekler

http://iprofs.files.wordpress.com/2013/07/elephant_rider_path
Define the destination

@ehekler

Flickr - lamont_cranston
Script critical actions

@ehekler

Flickr- Infidelic
@ehekler

http://iprofs.files.wordpress.com/2013/07/elephant_rider_path
Focus on the feeling

@ehekler
Shrink the change

@ehekler

Flickr - fisheye.at
@ehekler

http://iprofs.files.wordpress.com/2013/07/elephant_rider_path
Build habit chains

@ehekler

Flickr - Vanhap
• Trigger
– “Hot” Triggers

• Ability
– Tiny Habits®

• Motivation
– Ride the “Wave”

@ehekler

Image courtesy of Dr. BJ Fogg
Image courtesy of Dr. BJ Fogg
Hot triggers

@ehekler

Flickr - Waffles n'Nanas
Image courtesy of Dr. BJ Fogg
Tiny habits®
After I [existing routine or anchor],
I will [new tiny behavior].

@ehekler

Flickr - Awesome Joolie
Image courtesy of Dr. BJ Fogg
Ride the wave

@ehekler

http://images.cdn.fotopedia.com/flickr-7704358846-hd.jpg
• Motivation
– Incentivize
– Persuade
– Support Choice (not too
much)

• Capability
– Educate
– Tighten the feedback loop
– Model

• Opportunity
– Choice architecture
– Restructure environment
– Use Social Norms

Michie et al (2011) The Behaviour Change Wheel: a new method for characterising and
designing behaviour change interventions Implementation Science
Michie et al (2011) The Behaviour Change Wheel: a new method for characterising and
designing behaviour change interventions Implementation Science
Incentivize

@ehekler

Flickr -Pewari
Consistency

Persuade

Authority
Social Proof

Scarcity
Reciprocit
y

@ehekler

Robert Cialdini et al, Persuasion
Support choice

@ehekler

William Miller et al, Motivational Interviewing

Flickr - doctorhandshake
Remember the paradox of choice

@ehekler
Michie et al (2011) The Behaviour Change Wheel: a new method for characterising and
designing behaviour change interventions Implementation Science
Educate

@ehekler

Flickr giulia.forsythe
Tighten the feedback loop

@ehekler
Model

@ehekler

Flickr colemama
Michie et al (2011) The Behaviour Change Wheel: a new method for characterising and
designing behaviour change interventions Implementation Science
Build effective choice architectures

@ehekler
Restructure the environment
Social

http://www.mfauscette.com/enterprise-social-network.jpg

@ehekler

Built

Flickr - MyWheelsareTurning
Use social norms
Descriptive

Injunctive

Flickr - thatmushroom

@ehekler

Flickr - Leo_Reynolds
Robert Cialdini et al, Social Norms
Behaviour-change
techniques taxonomy

@ehekler
How to promote behavior change?
• Define the behavior and specific actions
• Identify what drives that behavior
• Find the right technique(s)

• Iterate and support changes over time
@ehekler

Flickr -Espen_Faugstad
• Rider
– Define destination
– Script critical moves

• Elephant
– Focus on the feeling
– Shrink the change

• Path
– Build habit chains
@ehekler

http://iprofs.files.wordpress.com/2013/07/elephant_rider_path
• Trigger
– “Hot” Triggers

• Ability
– Tiny Habits®

• Motivation
– Ride the “Wave”

@ehekler

Image courtesy of Dr. BJ Fogg
• Motivation
– Incentivize
– Persuade
– Support choice (not too
much)

• Capability
– Educate
– Tighten the feedback loop
– Model

• Opportunity
– Choice architecture
– Restructure environment
– Use social norms

Michie et al (2011) The Behaviour Change Wheel: a new method for characterising and
designing behaviour change interventions Implementation Science
Why now?

We have the need.

@ehekler

We have the means.
Thank you

Dr. Eric Hekler
Arizona State University
ehekler@asu.edu
@ehekler
Flickr -Espen_Faugstad

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The Science Behind Behavior Change: Keynote talk given at the Welltok Health Optimization Summit

Editor's Notes

  1. What’s the problem here?What are solutions?What’s the normal medical solution? Tell them what to do.
  2. Are they going to do it?
  3. What’s the problem here?What are solutions?What’s the normal medical solution? Tell them what to do.
  4. What’s the problem here? Big thing to talk about in WellTok – it is all about creating personalized itineraries; the actions you need to take; if you take these small actions, hopefully we will change your behavior. What are solutions?What’s the normal medical solution? Tell them what to do.
  5. Goal
  6. Big thing to talk about in WellTok – it is all about creating personalizeditineries; the actions you need to take; if you take these small actions, hopefully we will change your behavior.
  7. Touch on changing motivation – It will be iterative, my motivation will suddenly change compared.
  8. Big thing to talk about in WellTok – it is all about creating personalizeditineries; the actions you need to take; if you take these small actions, hopefully we will change your behavior.
  9. Touch on changing motivation – It will be iterative, my motivation will suddenly change compared.
  10. Mention the art and the science of it. Intrinsic vs. extrinsic motivation ; Self determination theory - Incentive design and reward platform ; theirs is mostly extrinsic motivation; particularly a way to offer them money; we are trying to analyze those data to predict if we offer this amount of money or a gift card vs. cash vs. paycheck; what will get an action; in our Café Well platform, we are building more of the intrinsic motivators; earning badges, and getting recognition, and what not; building on what people’s motivations are, there are a mix of different rewards; some might require a monetary reward; will get more from intrinsic motivation. Immediate behaviors vs. more long-term behaviors for incentive and reward; lose 5% of BMI.
  11. Get into Cialdini’s rules of persuasion