Daryl Foy, Doctoral research candidate in digital health, and co-founder of web app service dialog.fit on making a habit of health apps
Some way, somehow, that is the ultimate aim, for digital health app vendors; to become something others feel compelled to use because it not only has value but it may actually be fun and habit-forming. Wikipedia has an excellent page devoted to the definition of habit formation and the role of cues and triggers.
A habit is an automated response by an individual to cues or triggers. They are more likely to form if the target behaviour is consistently repeated in a stable context. This repetition should evolve an association between the task and its cues. Fogg (2009) in his behavioural model for persuasive design insists that for an individual to enact a behaviour they need to have motivation, the ability to do the task and have a trigger present. App-based triggers may be as simple as a reminder notice with a login link because “We have not seen you in a while”.
Offline, an external trigger for exercise may be as simple as making sure your running shoes are near your front door. Fogg gives a well worked example of the Facebook re-involvement trigger. Certainly, those tasks that have an association with an event e.g. taking glucometer readings pre and or post meal are generally easier to remember and become routine than those needing to occur based on a specific time.
In explaining the role of motivators in his model, Fogg identifies three; Sensation (Pleasure vs Pain), Anticipation (Hope vs Fear) and Belonging (Social Acceptance vs Social Rejection). The trick for designers is to understand that when individuals have high motivation facing difficult task accomplishment they feel no real impediment to getting it done but when their motivation wanes, persuading the same people to complete the easiest of tasks becomes the focus. Your app must cater for both possibilities. When it comes to accommodating the varying abilities of users, designers must make the target behaviour as easy as possible to perform. If for example you want to talk to an exercise physiologist on dialog.fit you should be able to find the clinician, see the EP’s calendar and make a booking, receive a confirmation and on the day of the call select Consult-Talk-End Call with a single button push.
Of course, trying to design a web app that becomes compulsive enough to use regularly and in doing so be regarded with favour is no easy matter. Google Play is awash with goal management and “habit apps” to guide you through improving your sleep patterns or to more effectively manage a healthy diet plan. Recently, Stewart, Cox & Blindfold (2015), conducted an extensive examination of 115 of such apps in a bid to better understand how they go about the habit-forming process with their users. The authors believe that reminders and trigger events influence habit formation. While reminders support repetition and help users remember to complete the task, they impede habit development. In contrast, reliance on trigger events to cue task completion increases the automaticity of the new behaviour. They criticise the apps they examined for not being sufficiently grounded in the habit literature. Another consistent finding was the failure of these apps to support habit formation by helping users associate their new behaviour with a trigger event.
They rely instead on extensive implementations of self-monitoring and tracking functionality which although they have been found support behaviour change, may not necessarily encourage new habit formation.
Interestingly, the same authors discovered that although those apps with trigger-event features effectively supported automaticity of habit, as a cue mechanism they tended to be forgotten easily. On the other hand, stock-standard reminder functions encouraged adherence well but fell down on their ability to increase automaticity. Out of this work, the authors devised a three-point guide for apps developers:
- Support Trigger Events Ask them to select trigger events. In dialog.fit we provide you with a simple step by step way to create, alter and share your exercise PLANS. Monitor their behaviour to see if the task is completed; we enable this through our track and notify systems.
- Use Reminders to Reinforce Implementation Intentions. This is interesting and we won’t know how valuable it is to you until we build it and try it with you. The thinking here is that we should send a reminder out to you before you start your exercise plan.
- Don’t encourage features that create an over-reliance on the technology. This is an interesting recommendation. In effect, the authors’ concerns are that a total dependence on the technology may obfuscate the crucial associations that need to develop between contextual cues and tasks. Certainly when it comes to exercise as medicine all of our users should be aiming to be sufficiently autonomously motivated, socially supported and task capable enough to go and exercise regularly without external reminders.
References
[1] B. J. Fogg, “A behavior model for persuasive design,” in Proceedings of the 4th International Conference on Persuasive Technology – Persuasive ’09, Claremont, California, 2009, p. 1. [2] K. Stawarz, A. L. Cox, and A. Blandford, “Beyond Self-Tracking and Reminders: Designing Smartphone Apps That Support Habit Formation,” in Proceedings of the 33rd Annual ACM Conference on Human Factors in Computing Systems – CHI ’15, Seoul, Republic of Korea, 2015, pp. 2653–2662.
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