For years when we were measuring the effect of an intervention (examples include virtual coaching, the varied, automated messaging that improved blood pressure and led to the founding of Healthrageous, or our use of text messaging to promote sunscreen use) we did not appreciate that each of these would predictably do better than a control group. The commonality to all of these interventions is regular interaction with the study participants using some sort of changing messaging. This leads to conclusion number 2.
Feedback loops plus varied, contextual messaging are much more powerful than feedback loops alone.
Another thing we noticed repeatedly is that neither of these effects is 100%. This is also illustrated in the above figure. There are always 10% or so of individuals who keep up with the feedback loop alone (they don’t seem to habituate) and we can only get about 60-70% of folks to stay adherent with any given population-based approach.
That leads to the question: how do we keep more folks maximally engaged and responsive to their tracking data?
My sense is that we’re all wired to respond to different motivators. If we could learn enough about what motivates you to send you targeted, individualized, engaging messages on a regular basis that made your tracking data relevant, I think we’d achieve it. These messages would change over time as you grow and change in your quest for improved health.
We’re early in this journey, but I want to share two attempts to understand this phenomenon.
At the Center, we’re studying an algorithmic approach to engagement. Taking in information on an individual’s motivational state and matching that with their measured activity level and location data, the algorithm sends twice-daily, automated, motivational text messages. We’ve enrolled a panel of diabetics to test if such a tool can help them improve their activity level. I can’t say how it works because we’re in the midst of the trial right now.
Healthrageous combines tracking and other data to offer automated coaching to its participants as well as opportunities for them to use other motivational strategies such as social networking, challenges, games and incentives. I just saw an update on their progress the other day. They’ve enrolled over 12,000 individuals and have had great success in engagement (72% at week 16 and significant improvement in a number of health indicators such as activity and weight). Their combination of objective, biometric inputs and motivational messaging is proving to be a winner at scale.
It’s still early going. But we must figure out the engagement trick and individualize it. It will improve the health of our population greatly. We don’t have a choice but to act.