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Pervasive, Persuasive Health Challenges: Individual Differences

The role of individual differences in persuasive technology is an exciting research area, one in which I believe our community is making — or about to make — quite a bit of progress. Since it’s getting a lot of attention, I had not included it my review of challenges.

On reflection, though, I believe that our progress here will shortly present us with a substantial new challenge: what do we do when an individual’s preferences are different from what actually works for that individual?

From all sorts of research, we know that people are not very good at predicting what features they actually want over the long term or what will work for them. It’s why Halko and Kientz’s work on personality differences and individuals’ receptiveness to different proposed persuasive systems is great, but the actual efficacy needs to be tested in the field. It’s why people who viewed prototypes of our GoalPost app loved trophies and medals in theory, but found them unmotivating — or even demotivating — in actual use.

This probably isn’t a problem when designers use detected or reported personality differences to make small adjustments to messages within an application. It does, however, present a dilemma if people choose applications with bundles of features that are appealing to them but that do not actually help them achieve their goals, or that help somewhat but not as nearly well as a different bundle of features would. Rosa Ariaga brought this issue to mind at Pervasive Health by asking “why don’t we just create a completely customizable app, and let people choose the features that will motivate them?” My reaction was that, oh, gosh, it seems like many would pick the wrong features and, rather than adapting, just get more discouraged.

Thus, it seems like there are additional questions that should be part of the agenda for people working on individual differences and persuasive systems:

  • What personality (and other) attributes predict different individual preferences for adopting persuasive systems, and what attributes predict individual differences in efficacy of persuasive systems?
  • When do people pick systems that are well matched for their actual needs, and when do they pick systems that are poorly matched?

  • What can, or for that matter, should designers of systems do when people are inclined to pick systems that are not actually helpful for them while neglecting systems that would help?

Pervasive, Persuasive Health Challenges: Designing for Cessation of Use of the Intervention

A second area that has received too little attention is whether we, as designers, intend for people to stop using everyday health and wellness systems, and if so, what the optimal process for that is. In my own work (e.g., [1, 2]), I have focused largely on systems that people might use indefinitely, potentially for the rest of their lives. In doing so, I have focused on making applications that are simple and fast to use, so that people would have an easier time starting and continuing to use them. Given common issues and challenges with adoption and initial adherence, as well as reduced use after the novelty effect wears off, it is no wonder that this particular challenge has thus far received little attention. More cynically, another barrier to this issue receiving much attention is the competing interest of the individual and commercial application/system providers: an individual may prefer to some day no longer need an application, but it is potentially much more lucrative for companies to have a customer for life.

It is, nevertheless, important. First, there may be times when designing systems to support temporary use may actually help some of the initial adoption and adherence problems: people might be willing to put up with a tedious process or a somewhat intrusive device if an application promises to teach them new skills and then be gone from their lives. Second, if we consider what it is like to live with persuasive systems, how many of us would want people to have lives that are carefully regulated and nudged by a myriad of systems, until the day we die [3]? And finally, might some persuasive health systems create an effect of learned helplessness in which applications, assuming the role of determining and recommending the most appropriate choices, actually reduce individuals’ competency to make these decisions in the absence of that support?

Anecdotally, many researchers have described high recidivism rates after the conclusion of an intervention, when the fitness sensor or diary, or the calorie counting tool, is no longer available to the former subjects (this has been observed with other types of interventions as well [4]). Why are these applications not helping individuals to develop good, robust fitness habits or competencies for health eating and at least keeping approximate track of calories? Would a study actually find worse post-intervention health habits among some participants?

To help imagine what we might build if we had a better understanding of how to create temporary health and wellness interventions, consider Schwanda et al’s study of the Wii Fit [5]. Some stopped using the system when it no longer fit into their household arrangement or routine, others when they had unlocked all of the content and its activities became boring or repetitive, and others stopped using it because they switched to another, often more serious, fitness routine. From a fitness perspective, the first two reasons might be considered failures: the system was not robust to changes in life priorities or in living space, or it suffered a novelty effect. The third, though, is a fitness success (though possibly not a success for Nintendo, if the hope is that they would go on to buy the latest/greatest gaming product): participants “graduated” to other activities that potentially were more fulfilling or had still better health and wellness effects. Imagine if the design of the system had helped more users to graduate to these other activities before they became bored with it or before it no longer fit into their daily lives.

Returning to the examples of exercise and calorie diaries, what changes might make them better at instilling healthy habits? In the case of a pedometer application, could it start hiding activity data until participants guessed how many steps that had taking that day? Would such an interface change help people learn to better be aware of their activity level without a device’s constant feedback? What if, after some period of use, users of calorie counters started not getting feedback on the calories they had consumed per food until they end of the day? Would such activities support development of individuals’ health competencies better than tools that offer both ubiquitous sensing and feedback? How would such changes affect the locus of control and sense of self-efficacy of applications’ users?

These are some rough ideas – the medical community, perhaps because of a focus on controlling costs and/or lower ability to integrate the interventions they design into daily life, has more history of evaluating interventions for the post-intervention efficacy (e.g., [6], [7]). Other communities have deeper understanding of what it takes to develop habit (e.g., [8], [9]) or to promote development. What does the HCI community stand to learn from these studies, and to what extent should or community conduct them as well?

  1. Munson SA, Consolvo S. 2012. Exploring Goal-setting, Rewards, Self-monitoring, and Sharing to Motivate Physical Activity, Pervasive Health 2012. [pdf]
  2. Munson SA, Lauterbach D, Newman MW, Resnick P. 2010. Happier Together: Integrating a Wellness Application Into a Social Network Site, Persuasive 2010. [pdf]
  3. Purpura S, Schwanda V, Williams K, Stubler W, Sengers P. 2011. Fit4Life: The Design of a Persuasive Technology Promoting Healthy Behavior and Ideal Weight, Proceedings of CHI 2011. [pdf]
  4. Harland J, White M, Drinkwater C, Chinn D, Farr L, Howel D. 1999. The Newcastle exercise project: a randomised controlled trial of methods to promote physical activity in primary care, BMJ 319: 829-832. [pubmed]
  5. Schwanda V, Ibara S, Reynolds L, Cosley D. 2011. Side effects and ‘gateway’ tools: advocating a broader look at evaluating persuasive systems, Proceedings of CHI 2011. [pdf]
  6. Bock BC, Marcus BH, Pinto BM, Forsyth LH. 2001. Maintenance of physical activity following an individualized motivationally tailored intervention, Annals of Behavioral Medicine 23(2): 79-87. [pubmed]
  7. Moore SM, Charvat JM, Gordon NH, Roberts BL, Pashkow F, Ribisl P, Rocco M. 2006. Effects of a CHANGE intervention to increase exercise maintenance following cardiac events, Annals of Behavioral Medicine 31(1): 53-62. [pubmed]
  8. Rothman AJ, Sheeran P, Wood W. 2009. Reflective and Automatic Processes in the Initiation and Maintenance of Dietary Change, Annals of Behavioral Medicine 38(S1): S4-S17. [pdf]
  9. Verplanken B. 2010. Beyond Frequency: Habit as Mental Construct,
    British Journal of Social Psychology 45(3): 639-656.

Pervasive, Persuasive Health: Some Challenges

From a paper for the Wellness Interventions and HCI workshop at Pervasive Health 2012.

As a community, or perhaps more accurately, as communities, health and persuasive technology researchers have made considerable progress on understanding the opportunities, challenges, and some best practices for designing technology to support health and wellness. There is an incredibly rich stream of current and past research, as well as commercially available applications to support a variety of health behaviors.

I think that there remain some under-researched challenges, and I question whether our existing knowledge and research directions can sufficiently address these challenges. If not, what else we should be including in our research discussions and plans. In particular, are doing enough to study one-time interventions and the process for tapering, weaning, or graduating people off of the interventions we build and deploy?

Over the next few days, I’ll be posting my thoughts on the challenges of one-time use and designing for tapered use. I’d love your feedback and your thoughts on other areas that are under-explored or studied in the persuasive health system communities.

3GT is back

Just a quick note that 3GT, our Facebook app based on the positive psychology exercise Three Good Things, is back online after some time at the spa. The new version is based on some of what I learned from the last release. Some of the social and feedback lessons still need to be applied, so look for that in new features over the next couple of weeks.

You can access it as a standalone app or on Facebook. I’m just doing friends and family testing and some refinements on it for now, so feedback is welcome.