Wearables beware: Without health psychology, digital health design means nothing

What does psychology have to do with activity trackers, fitness apps and wearables? Everything. Or, at least it should. That’s because technology doesn’t change behavior -- people do.

When it comes to driving personal health management through technology, success relies on far more than simply tracking movement or activity. Success is rooted in a deep understanding of the psychology behind behavior change and a new approach to digital health design.

In a recent Journal of the American Medical Association (JAMA) study, contrary to popular belief, research showed that adults who wore activity monitors after successful weight loss ended up keeping less weight off over an 18-month period than those who did not wear them. One possible reason is that people are simply given feedback and not counseled through the process of changing habits. When you give people feedback that is hard to hear – for example, things are not on track -- it is natural for them to stop listening.

As a practicing health psychologist and head of health behavior change at one of the largest health technology companies in the world, I’m in the unique position to apply the behavior change psychology directly to technology design and innovation. I’ve seen the tangible impact it can have on people’s lives. With 25 years of experience in the field laying the groundwork, I have uncovered several key factors – The Five Pillars of Behavior Change -- that I believe ultimately drive people to take action. Changing behavior involves a PAUSE with intention to embrace personal health and modify unproductive habits:

· Personalization

· Autonomy

· Urgency

· Social Support

· Empower

It is vital that digital health developers understand how the psychology of behavior change contributes to a person’s likelihood and ability to make sustainable changes in their lives. Then, embed that knowledge directly into device or app design and in crafting the entire user experience. This involves building a device, app, platform or program that can be personalized, create a sense of urgency to make the change, capable of anticipating and providing social support how and when people need it, which can thereby build digital therapeutic relationships with users so they themselves – autonomously – become empowered with confidence to make the right choices at the right times, no matter how challenging the circumstances might be.

With this in mind, it becomes clear that personal health technology must be designed for both utility and user experience in order to stand a chance at long-term behavior change. For example, developers must consider how key health data can best be monitored, measured and delivered to the user along with determining the best design and interface for cultivating digital therapeutic relationships on an individual-level – ones that can effectively motivate real behavior change.

But poor health behaviors are perhaps the most critical reason why the psychology of behavior change needs to be at the forefront of health tech design. These behaviors resulted in a global health crisis and increasing chronic disease prevalence that quite simply mandates the facilitation of healthier lifestyles through personal health engagement. Taking a psychological approach to personal health technology development – from wearables to remote monitoring devices -- is not only optimal, but in a world that is fraught with chronic and comorbid diseases, such as heart disease, hypertension and obesity, it is now an absolute necessity.

Specifically, the World Health Organization (WHO) projects that chronic disease will account for 73 percent of worldwide deaths and 60 of the global healthcare burden by 2020. Add to that the skyrocketing costs of healthcare driven in large part by the high-utilization of resources by the costliest, sickest populations, and the opportunity for well-designed technology -- specifically wearables and other mobile health devices -- to help drive health engagement and improve chronic care management couldn’t be timelier.

And while the long-term impact of wearables and mobile health devices has yet to be determined – and in addition to the JAMA study, there is certainly no shortage of data painting an uncertain picture – this should by no means detract from the potential they have to drive healthy behaviors and ultimately improve disease management. Because when done right, we know that integrating behavior change protocols into health technology can make a difference.

For example, to improve patient use of CPAP (continuous positive airway pressure) therapy, a common treatment for sleep apnea, patients using an app with their CPAP device were shown to be more engaged with their therapy one year later. The systems work together and provide users with their data. In addition, the app provides tools such as goal setting and coaching. Together these motivating factors help drive behavior change and ultimately help support increased usage.

Making an impact in personal health engagement and improving chronic care management with wearables and related health technologies requires a deep understanding behind the psychology of behavior change. At the end of the day, it’s not the device or application that’s making the change, but the person. Embrace this approach, or be prepared to see wearable devices spending most of their time at the bottom of drawers – while losing out on a sea of opportunity for healthcare improvement.

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