Over the past decade or so we’ve seen an explosion of digital health care advice, providing patients with ever expanding ways of investigating, managing and even diagnosing their own health concerns. For pharma, effecting digital health behaviour change can be a double-edged sword.
On one side, there is the potential to reach many more patients, influence their choice of treatment or medication, and help them make sense of the medical issues in their lives. On the opposite side is the complexity of human behaviour and the myriad of influencers that determine digital interaction and engagement.
There’s an app for that
The digital world changes almost daily, becoming ever more sophisticated and ‘smart’. It’s no longer enough to throw together a quiz or questionnaire, or upgrade to a flashy website design to engage patients.
With internet access increasingly coming via mobile devices and wearables, pharma is finding new ways to effect behaviour change through medical/health apps. Wearables are increasingly varied, going far beyond the smartwatch, into clothing that monitors heart rate or breathing to insoles designed to help correct posture and balance.
The problem with apps or wearables, however, is that while it’s easy to measure how often an app is downloaded, measuring its usage is altogether trickier.
We still don’t know much about the effectiveness of digital interventions. And while it’s accepted that there’s around an 80% loss of users of apps, a review of such interventions revealed no effect or even a negative effect in a third of users. This is despite the ability for designers to programme in a high degree of personalisation.
We’re only human
Human interaction and behaviour is complex. There are many different perspectives, including intergroup, individual and societal. We need deeper interdisciplinary evaluations of digital health interventions, taking into account aspects of behavioural and computer science, engineering, and human/computer interaction.
Humans will also ‘game the system’ if they can, for instance finding ways to inflate the number of steps taken per day, which adds to the general unreliability of user-centered data. Further, while we realise that reward systems don’t always work, we also don’t know enough about how cues work.
Basic instructions and goal setting, while sounding simplistic, have proven effective, and if the desired behavioural change involves ‘losing’ something, then an equal or stronger gain needs to replace the loss. A good example is in digital initiatives intended to help people quit smoking.
Matching content to user
What is needed is a way to capture people at the right moment in their lives. In this respect, digital initiatives are most effective when they are part of a wider health approach rather than added on as an optional extra. Support systems for digital intervention initiatives should ideally align patients’ incentives with those of health care providers, working alongside both so routines are not disrupted. Time saving is also an ideal.
A useful model to determine the factors involved in user engagement of digital or online interventions brings together research from different disciplines. Digital health behaviour change is most likely when all external and internal factors are blended together.
- First is the users’ environment: their time availability, their internet access and the environment they find when accessing the information. Environment relates to tone and function, and how it complements or contradicts similar information elsewhere.
- The next consideration is the user’s personal characteristics in terms of demographics, expectations and beliefs, self-efficacy and their current and previous health behaviour.
- Finally comes intervention, which determines how successful the initiative will ultimately be in effecting behaviour change. Persuasive design features such as praise and reward systems, strong arguments, a novelty factor, or peripheral cues such as aesthetic appeal or computer tailoring can help to encourage stronger engagement.
Current approaches rely largely on influencing what determines behaviour change, but future digital health initiatives must look just as deeply into what stimulates engagement. Without engagement, digital initiatives don’t harness the full power of their potential.