The ‘E’ in ePatients Stands for ‘Emotional’, it Seems

How to make your Facebook friends your health coaches

Posted Oct 22, 2010

What's a psychologist doing at Philadelphia's super cool ePatient Connection conference, you might wonder. I had my own doubts, I have to admit. But then master-organizer Kevin Kruse opened the conference with a slide of an elephant and someone riding it, which is a metaphor from Jonathan Haidt's book ‘The Hypothesis of Happiness' the elephant being the emotion and the rider being logic. I actually own an autographed copy of this book, which Haidt gave me when visiting Princeton University. The metaphor speaks for itself - while we may pride ourselves on being rational creatures, we are, in fact, hugely emotional. The rider, you will notice, at least as portrayed in the slide, is external to the vast emotional body. It embodies the effort involved at making people behave as they , or someone else who has their best interest in mind, for that matter, think they should.
From that moment on, it all made sense. Because the conference, though presenting every gadget at the forefront of technology, from the Zeo Sleep Coach to the QR Code, was really more about the psychology behind all this. In this posting I'll go over some glaring success stories, and in the next one, I'll highlight some of the challenges.

So - lessons from psychology to eHealth developers: 
1. Make it personally relevant
This was exemplified by Health Media's founder and chief visionary officer, Victor Strecher - who managed to deliver a charismatic talk through Skype (!). Through insurers in Detroit and Seattle, Strecher sent out smoking cessation messages to 1000 people, who also got nicotine patches. Some of the participants only received minimally tailored messages, matching their x and perhaps another detail such as length of time they have been smoking. Others, however, received the haute couture deal, of custom made messages such as "as a woman who smokes a packet a day and has been smoking for over ten years, and also raises 3 children..." these messages yielded a cessation rate of 39%, compared with around 28% when no tailoring was involved. More relevant messages achieve more elaborate processing, with less cognitive effort, and greater likelihood of long term behavior change. Not bad for an intervention that requires some programming and embedding information that the participant provided about herself in the messages she received. The lesson: when people feel you took the trouble to get to know then, and that you are actually talking to them rather than to some prototypical person, they listen.
2. Create immediate, real life consequences
What if our New Year resolutions came back to haunt us? Frightening thought...Thing is they don't, and so we seldom keep up with what we promised to ourselves we'd do. The apps we buy, for weight loss, fitness management etc., might yet prove are an updated version of New Year's resolution, then they too might end up deserted on virtual equivalents of a mantle or drawer. Because, resolved as we may be, if we neglect to follow our resolution, no negative outcome follows, and with time, we forget. Except Margaret (Margie) Morris, a psychologist and health technology researcher has found a way to make forgetfulness painful, thereby effectively driving us to stick with our resolutions and achieve our lifestyle goals. Margie developed the "With a little help from my friends" Facebook application" with colleagues at Intel and Cognitive Media, and the insight is based on ethnographic observations on how important relationships are in people's lives, and what a strong motivator these relationships can be. It works so that you set up a goal, such as to go outside even if it's raining - even though Margie lives in Seattle. Whenever she does not register going out, her friends' pictures all faded and in order to bring them back, she needs to report keeping up with her resolution. She cannot even see her friend's posting - instead it says "don't forget your resolution". Arrrr. Makes you want to kick the computer, or go out and get the exercise and fresh air over with, so you can go back to Facebook... This is such a cool idea because it creates immediate real life implications, whereas the implications associated with unhealthy lifestyle may take longer to creep up on you and motivate action.
3. Make it fun
Type 1 diabetes is no fun, right? Wrong. David Reim of Influence Partners presented a brilliant idea - a Nintendo interface that combines with a glucose meter to then feed into the game and give the patient ‘strength' points when playing Nintendo. Kids love it, and Bayer recently bought it to use with children suffering from Type 1 diabetes. Imagine the bummer measurement turning to something one really wants to do, something instantly rewarding. Imagine having the glucose meter become the envy of your friends, rather than something you wish to hide. How gratifying is that.
All these effective lessons serve to explain why even more psychologists and decision scientists should be on R&D teams. Psychology is key - not a decoration. The winning ideas I just described are just that - winning - because they had the end user's wants, needs and personality in mind, from the start.