Learnings and Applications of Behavioral Design for Digital Health
Humans are far from rational. Decision-making often predictably departs from what is traditionally considered “rational” or based on a careful weighing of costs and benefits. Rather, behavior is greatly impacted by our emotions, identity and environment. Behavioral science aims to understand human behaviors, drawing on cognitive science, behavioral economics, and heuristics, or rules of thumb, to predict how someone will act when confronted with a decision.
Behavioral design applies learnings from behavioral science to product design to help influence human behavior. Knowing the shortcuts that people will unconsciously use when interacting with a product allows you to guide users to their goals and improve the success of the desired action. Behavioral design can improve adoption, adherence, engagement and more.
Health relates to a multitude of daily decisions made by patients and providers. By understanding the motivations behind those decisions, we can support and influence more informed decisions and healthy outcomes. Using behavioral design in health technologies and tools, can not only simplify the interface but help guide better choices and improve outcomes.
At access.mobile, we use behavioral science to better engage patients and increase impact. Through our mobile engagement platform, we leverage insights from behavioral economics and cognitive science to influence healthy behaviors. Our behavioral science and product teams work with other experts to ensure behavioral science and behavioral design are embedded throughout our solution.
We sat down with Gabriel Camargo, CEO of Ingenious, access.mobile’s behavioral design partner to understand the application of behavioral design particularly in health. Camargo founded Ingenious in 2010 to help design products that lead people to action. Working across sectors of healthcare, education, entertainment and transport, Camargo has helped make Ingenious a leader in behavioral design across the U.S., Europe and Latin America.
1. What makes behavioral science difficult to understand?
Camargo: Behavioral science is difficult to understand because it is abstract. People have trouble seeing how it impacts their business issues and daily life. All problems, business and beyond, are fundamentally tied to the simple behavior of someone not doing what they are supposed to or intended to do. When you begin to look at problems from that lens of action or inaction, you have a different way to solve problems. With behavioral science you have a whole new dimension to understand and fix issues; it is like going from a 2D to a 3D reality.
People hear of behavioral science and think it is a buzz word or a new innovation, but they don’t see it as being essential and critical to their issues. I try to translate it into real world cases and contextualize it, ideally around strategic problems that are relevant to each person or business.
2. What are the benefits of behavioral design?
Camargo: Many business problems are about people doing or not doing something, getting from point A to point B. When people don’t act as you expect, then there are business challenges. If you can unlock how to make people behave or stop behaving in certain ways then you solve their issue. You can solve external client issues like improving sales conversion or retention or you can solve internal issues like making systems more efficient.
3. What types of products or activities can gain the most value from a behavioral approach?
Camargo: Behavioral science is easier when your goal is aligned with your users’ goal. That is to say, behavioral approaches work best when stakeholders are aligned from the company to the employee to the user or buyer. Fixing an issue then supports the various parties together and fulfills joint objectives. The real challenge is when there are misalignments in the system.
Also, it is hard to motivate a behavior that people do not want to do. Without any internal or intrinsic motivation, you need a great deal of extrinsic motivation. Helping people do things they want to do but are not able to do is easier as you can use intrinsic motivators.
4. At ingenious, what is your process to apply behavioral design?
Camargo: We have a structured methodology. To analyze a problem, we identify and disassemble key behaviors. Each behavior can be quite sophisticated. For example, not buying a product can be composed of many behaviors from going to a location, finding an item, paying and more. Smaller behaviors create the larger one. We map the behaviors and apply behavioral theory which provides a basic algorithm for when behaviors are happening. We work with the variables and values to see how they influence behaviors.
To organize our creative process, we use design thinking and we have behavioral design tools. For example, we have developed a deck of approximately 40 cards that we call “behavioral insights” and each is a reminder of a cognitive bias. When we are in the middle of our creative process, we use the deck and take out cards at random to discuss if we are using the bias and its applicability to the project. These tactics help to ensure that we think through the issue in a comprehensive way.
5. How do learnings and behaviors from one project translate to the next?
Camargo: Experience makes work more precise and efficient; it saves a lot of time and cost. Based on experience you can eliminate ideas that you have tested in similar scenarios that didn’t work. As designers we imagine, dream and work out of the box, but we have a scientific lens to keep us objective and our experience helps ground the work.
Our experience has also taught us to hone in on the problem, not the overarching issue or sophisticated behavior but the real issue. I believe Einstein’s statement, “If I had an hour to solve a problem, I'd spend 55 minutes thinking about the problem and 5 minutes thinking about solutions.”
6. How do behaviors in health differ from behaviors in other sectors?
Camargo: From a behavioral standpoint, health is super challenging yet super rewarding. The behavioral issues in health are complex. There is the health knowledge aspect but then there is the more complicated aspect of acting on your health knowledge. Often having the information, for instance on smoking, exercise, and healthy eating, is not enough to change behavior. Health requires our A-game.
Being healthy and staying alive is the most powerful intrinsic motivator. In our work we can use it to our advantage by digging deep and triggering that intrinsic motivator to overpower the other motivators to improve health. In health any improvement is a big win and quite rewarding.
7. What personal characteristics influence behavior more than others?
Camargo: One of the most critical biases we have is called “social proof.” This shortcut in our brain allows us to gain information from our surroundings and apply it - one does not need to validate an action because she has seen another person do it and knows the result. Social proof works on many levels and creates epistemic truths, truths based on beliefs of those I know and trust, that we take for granite.
Socioeconomic class plays a very large role in culture and tends to drive peer groups more than other demographic factors. People have a tendency to surround themselves with those in the same socioeconomic class. Thus, people’s trusted peers who help define their epistemic truths come from a similar socioeconomic class; people perspective and biases are thus largely formed by this environment of socioeconomic groups.
It is helpful to think about decisions as a scale with a balance of different factors that you place onto the plates of the scale. Factors that are more strongly tied with social networks tend to be more strongly tied to behaviors as compared to others. For instance, beyond socioeconomic class, age is a big factor as your social network of peers are often from a similar age bracket. We tend to surround ourselves with people who are similar to us, facing the same challenges and sharing our perspective.
8. What are the biggest challenges in applying behavioral design?
Camargo: Behavioral design as a discipline has deep scientific roots, but as with much of psychology, for each law or cognitive bias, about 80% of people behave a certain way. That means there are 20% who do not behave as the cognitive bias would anticipate. So you have 80% of people impacted by any cognitive bias, and similarly, each individual impacted by about 80% of cognitive biases. This means that trials or pilots with a smaller sample are dependent on the cognitive bias of that sample population which may or may not reflect the broader population or market of interest.
The other key challenge is communications. The way ideas are communicated greatly impacts the lever you are testing and plays a large role in the success of the project. Language can be arbitrary, but it is so critical. At Ingenious, language is often out of our control and is rather decided by the communications department for the company we are working with and greatly impacts the success of the project.
9. What is most exciting about your behavioral design and the work that you do?
Camargo: The most exciting thing is about behavioral design is seeing incredible behavior changes from our work, particularly when it helps people to be better. It is great to see a health or education project go very well and impact lives. For instance, we recently created an educational engine for teaching content; the content that goes into our system increases children’s ability to learn that content by four times when compared to traditional mediums. Behavioral design can fundamentally change important behaviors that improve lives and we are happy to be part of that change.