Joe Wheeler

Reminders in User-Generated Health

They’re getting called so many different things now but I wanted to share my thoughts on personal notifications, reminders, nudges as it relates to peoples daily activities and in particular something Chris Hogg refers to as User-Generated Health. Today our lives are filled with notifications and reminders from every angle but I think there is so much more room for improving how and when individuals are presented with reminders as it relates to their health.

I’d say each one of us has the desire to improve something about themselves related to their health, but turning new behaviors into permanent habits is extremely hard to do.

Why?
Because new habits, especially the ones that are good for you are generally not fun and don’t solve our need for instant gratification. We’re human and we need help.

So most people who are trying to make permanent behavior changes related to their health need help, just like when we went to school as kids and had help from teachers for 7 hrs a day, we need this kind of attention with health behaviors as well. We need to be consistently engaged to learn new things. Since none of us have the time and money to have 7 hr a day health coaching, I think software combined with “others like you” is a combination that could work. Again, not really a new concept, but one that I think could be improved. 

In particular I think mobile and web applications with intelligent reminders is key to making the biggest impact on peoples long term behavior changes.

Intelligent Reminders

Intelligent reminders have the greatest potential for improvement based on behavior and data patterns alone. It requires a user provided baseline, or close estimation based on a large pool of already engaged users, but the point is that once you know a few data points about a person, you should be able to systematically start reminding them at key times to help them eventually form a new habit.

An example is someone that wants to eat better throughout the day. This actually translates to someone who wants to lose weight, but giving them the choice of “eating better throughout the day” is much more appealing than the roller coaster of losing weight. Eating better throughout the day also sounds like a habit that can be obtained. 

So you know someone is focused on eating better/losing weight. Using a variety of methods/social services/sign-up processes you could learn where the person lives, so you know their time-zone. The time-zone allows you to make some initial assumptions about what times they generally eat food throughout the day, which allows you to schedule some half-way intelligent reminders to them just before they eat. Something like this reminder to start off with: “Hey I know you are getting ready to dig in at lunch soon, try to cut your normal portion in half and eat the rest around 3pm.” It could be that simple.

This simple reminder does three key things:
- It’s delivered at just the right time…right before I dig in
- It says, hey, I’m here to help and here is something you can try right now
- It makes the person aware/conscious/accountable of the food decision they are about to make

Do these three things force me to do the right thing? No, but they surely don’t hurt and in addition if I actually take the advice then I’ve taken a step to change behavior. These types of reminders over time could have a positive impact on my longer term goal of eating better throughout the day.

Also, if there is a mechanism in an application for the person to respond to these reminders, through a note, checking a box or even snapping a photo, then it further increases the potential of changing the behavior. The more involved a person is with changing the behavior, the increase in likelihood that the behavior change will become more permanent.

Why not take it a step further and let the person schedule their own reminders based on when they think they need them most? It makes sense.

The feedback loop for the “intelligent” portion of the reminders is the persons interaction with the application. In other words, the more a person interacts with an application that is sending them reminders about eating better, then the more intelligent those reminders and interactions with the user should get. I equate this to a person seeing a physician….the first visit there isn’t much trust there, but with each subsequent visit, the physician earns the trust of the patient by helping them and the interactions naturally become more intelligent. This is how any application that is trying to help people with their own health should act.

1. Provide initial advice
2. Listen
3. Gather input
4. Tweak algorithm
5. Provide better advice

With each pass through these steps the accuracy and frequency of advice (reminders) should improve and also should help drive positive outcomes for the user. 

Others Like You

Others like you is the 2nd half of the “intelligent reminders” + “others like you” combo for influencing behavior change.  Others like you is a simple concept, probably one that PhDs have spent time and money researching but I’ve yet to see it applied successfully in apps that are focused on health behavior changes. Others like you is the idea that there is a high likelihood that some of your existing social connections (email, Twitter, Facebook, etc) have the desire to change the same health behavior that you do.

Example: The probability of you already sharing a social connection with someone who wants to improve their eating habits throughout the day (lose weight) is high. Grouping you and your friend along with all your other connections focused on that behavior change in an application is probably a good thing and will lead to ideas being generated and outcomes improving.

I’m not talking about friends creating challenges between one another…that’s seems complicated and proven difficult to do. I am suggesting that bringing existing social connections together around a behavior each is interested in changing and letting them see is what is working for others seems to be something that works in other applications so why not health.

Mobile and web apps combined with intelligent reminders and others like you….these are some of the ideas I’m exploring, let me know if they interest you.