Business up front, science out back
Human beings hate to change their behaviour. Even when their health is at risk they refuse to change
their ways because they think they know better than what the accepted medical wisdom suggests. They
can also be poor at receiving criticism and often lack the necessary self-discipline to live a healthier
lifestyle. Any combination of these issues (which can sometimes occur all at once) makes changing one’s
behavior a very difficult task.
Even when their health is at risk, they either think they know better than the general medical wisdom
and don't need to alter their ways; they take criticism really badly or have no self-discipline. Sometimes
it's all three.
The theory of changing people's behaviour and the reality of it are very different. The theory of how to
change people's behavior is very different from the challenges presented in reality. Even when faced
with imminent health failure, many patients struggle to change their behaviour or simply do not attempt
to at all. Despite the illogical nature of this, it seems to be universal and very hard to crack.
Behaviour change is a relatively new field, with roots in cognitive psychology, physiology and neurology.
Behaviour change scientists are honest about the infancy of their discipline. At this point in the field
temporary change, incremental change, and attitudinal shifts are considered as valuable as wholesale
alterations.
The doctor can see you now
In recent years, there has been a rapid increase in the ability to closely monitor the health of an
individual. This has led to huge changes in the delivery of behavior-reliant medicine. the explosion of
monitor-ability of individuals has led to huge changes in the delivery of behaviour-reliant medicine.
Patients can be monitored remotely and unobtrusively, yet accurately. Diabetics and asthma sufferers
can record their blood sugar or oxygen levels and other relevant symptoms on the go without specialist
equipment or time-consuming transcribing, overweight patients can scan the barcodes of products in
the supermarket to discover if they are a recommended option, and those trying to cut down alcohol or
cigarette consumption can measure their success (even against peers) and assist motivation as a way to
motivate themselves to continue their improvement. Below are a range of smoking cessation apps
currently available that monitor cost saving, days without smoking, oxygen levels, brain function and
heart rate.
These products and services have been purchased in the millions, creating a huge industry. The
healthcare and technology sectors therefore have an obvious cross-over point in behaviour change.
People want to reduce the level of responsibility and difficulty of changing their behaviour by purchasing
products or services that assist them, and the healthcare sector aims to keep people healthier for
longer. The health sector aims to keep people healthier and they now have the opportunity to do so on
a wider scale by working with the technology sector which can create these behavior changing services
and make them available to all. Despite the relatively recent emergence of behaviour change science,
we know one thing for sure: intervention is the key.
Throw money at the problem?
Those with a lifestyle-based issue such as smoking, drinking too much alcohol or being overweight know
that they need to change their behaviour, but habits are hard to break. They are even harder to break if
no one is chastising or encouraging you. Many people will attempt to make their transition to a healthier
lifestyle easier by purchasing assistive products or services, such as apps, recorded programmes or
devices designed to discourage their 'bad' behaviour.
The efficacy of these services can be limited in many ways, but the most important factor in maximising
their success rate is a good basis in behaviour change theory. Under that model, there is a triumvirate of
factors that must work together:
Money seems to be a problem at both ends of the development chain. Without sufficient clinical
research, the efficacy of any service is severely limited due to poor application of behaviour change
theory, and once that research is proven, the transition to market is often limited by a lack of exposure
to the right commercial partners.
Regulations involving health care innovation also make it very difficult to implement new technology in
the health sector. There are strict guidelines when it comes to manufacturing and distributing health
care products to ensure the safety of patients who will eventually use these tools. New technology must
not only be safe, but it also needs to be proven as both accurate and effective. This can greatly slow the
process of integrating behaviour change technology into standard medical care no matter how much
money is put behind it.
The missing link
Often the barrier between good academic research and a successful commercial product is good design.
If something doesn't look slick and up to date, how can it be reliable or serious?
However, the issue goes further than just design. Trust is also of vital importance. Respect and
adherence are rooted in our belief that the doctors know what's best for us. We do what they say
because they know better. They tell us we're ill, we believe them. They tell us to take a certain course of
action to get better, and we trust them more than we trust ourselves.
Sometimes all we have to do to solve a health issue is simply change our behaviour, but, ironically, this is
when we have the most trouble following a doctor’s orders. When the resolution solution is behaviour
change, we fight ourselves our bad habits perhaps only when a doctor tells us it's life or death. The
products or services we purchase to augment our attempts are supplementary to the information we've
been told by the medical profession. It's not just the expertise that we respect; it's the human being
delivering the expert opinion.
A human perspective is almost always the best motivator. According to a recent article in the Telegraph
the number of amputations due to diabetes has increased to 135 a week. This fact itself is staggering,
but even so, is this statistic alone enough to motivate the people to change their behvaiour? Perhaps
not.
To do something about this, the charity, Diabetes UK, urged its followers on Twitter to tweet at Health
Secretary Jeremy Hunt using the hashtag #135Shoes. The shoes are meant to signify the feet which are
especially at risk of amputation in those with diabetes. The hashtag took off and people also donated
physical shoes to Diabetes UK which they are planning to display as a reminder of the risk of diabetes
and that there are things that can be done to prevent some of it’s more negative effects. This human
intervention will likely have a much bigger impact than the initial number of 135 could’ve done on its
own. Patients with diabetes, and hopefully the health secretary, are much more likely to see the human
side of the issue when confronted with the real physical representation of a 135 shoes rather than just
seeing the number on paper.One element that behaviour change scientists have to be honest about is
the ineffectiveness of a non-human intervention. If all you have is an app on your phone, you are highly
unlikely to achieve sustained or significant results in your attempt to change your behaviour. At the very
least, a multi-channel approach is necessary with peer group support, phone calls, face to face contact
and emotional attachment. This cannot be replicated by digital interventions. Simply put, if you know
no-one is actually watching, you won't change.
Bupa GLIDHE
Bupa have partnered with UCL's Centre for Behaviour Change to make that matching process easier. By
working with some of the UK's most advanced researchers in behaviour change, Bupa are putting
themselves in the centre of healthcare innovation, and giving them the chance to make the most of
emerging technologies, theory-based design, and effective intervention.
We were proud to be a part of the team that launched GLIDHE earlier this year, and continue to see
huge potential in the partnership.
Conclusion
As behaviour change science becomes more refined it is likely to be implemented in the technology and
health sectors. Once this crossover is established it is important for the people developing this
monitoring and behaviour changing technology to be aware that the most important aspect of
convincing someone to change is to involve other humans in the process.