Health 2.0: Building behavior change - what do you need to know?

In the intersection of online communities and health, Health 2.0 focused a session on behavior change. With so many of our chronic diseases due to lifestyle choices, online communities and tools hold the promise to help people make small, hard, and sustained incremental steps. The session reviewed some recent approaches, and the key to their success.

Zamzee is a movement and online tracking system that uses a system of rewards to help fight childhood obesity. Zamzee works, too - kids who use it moved an additional 3/4 of a mile per day. They found that success depended on several factors. One was to make the tool specific to their audience. Kids really liked that tracking movement and getting rewards did not depend on parents, or others. Kids reported that they liked the fact that they could wear it and track results on their own. In addition, Zamzee found that financial incentives worked, but the effect didn't really increase as the amount increased from $5 to $20. They also found that random bonuses in the form of points-rewards had a positive effect on behavior and retention too. 

In a completely different sphere, IDEO talked about "what sex sounds like." IDEO's job was to take on the challenge of reducing the number of unplanned pregnancies in women between the ages of 18-29. Or, in other words, to conquer the human race's most profound biologic urge. Difficult, much? What they found in engaging women is that tone is a huge issue in messages that we give in urging behavior change. Our current, existing messages often have an inappropriate tone, and pack their tool full of jargon. But sex isn't science. IDEO realized that we keep attacking sex with logic and science, and it just doesn't work. They decided to change their approach: Sex is primal, passionate, and even, sometimes, funny. So they made a crucial decision to match the tone to the subject they were addressing. They also decided to make their information useful - including by texting people with engaging messages that changed every day. They found that women who got and liked these messages were even saving them and forwarding them to their friends. Their website, Bedsider, was designed to use everyday, human language. To get the right tone of voice, you need to test the message ("too sexy = slutty, and too funny = not enough authority, so you really have to test"). Agenda of their funders was to reduce unwanted pregnancies, but their audience wanted more fun. So their approach was designed to connect these in the middle.

In another approach, Qpid.me is a free beta-tool that launched October 7. Their product is a text-message service to give users and their partners authoritative STD testing results. They "help people make better decisions before they have sex." It's a modern, flirtatious I'll show you mine, if you'll show me yours. HIV, chlamydia, gonorrhea and syphilis results are sent out to people a user authorizes to receive it. The result comes with a disclaimer, stating that this person could have had sex since his/her last test, and could be infected, so you should use a condom. Qpid.me can verify anyone's results anywhere in the country, and they're HIPPA-compliant. They are also seeing behavior change in their early beta-testers. Their motto is "Spread the love. Nothing else."

Taking a different approach to behavior change, Elizalife.org looked at why people are unable to stay on track. From information their users gave them, they decided that the reason is because "life is really messy." There's a lot of literature showing that this is true - people are juggling many, many stressors. Caregiving, debt, divorce, job stress. The list goes on and on. And perhaps these factors are having more of an impact on our lives than we're wiling to admit. Elizalife found that making health a priority is more and more difficult the more of these stressors a person has. They began to look at what they called "the ostrich effect" to quantify how many stressors have an impact on health choices. The impact was huge, and they do impact health - and therefore should be a part of any behavior change/health approach. There is a hierarchy of any person's ability to process things as stressors increase. "It's hard to talk about managing your hemoglobin A1C if you're going through a divorce." Their tip to developers? if you're building behavior-change tools and infrastructure, expand what you do to address these issues and measures - if, that is, you're building for success.

So how do you get questions about "unmentionables" like behaviors, sex, stressors and body-weight into the mainstream of health tools? The panel discussed this topic with some key tips. One was that success means "not letting technology get in the way of the human side." Tools also "should represent the human dimension." And, "no one should minimize the impact of joy and hope and authenticity." Other take home messages? "What works with your loved ones works with your clients." And "use technology to expand the human element." The overview and demos were both inspiring and useful when it comes to reporting on, and evaluating interventions to address the behavior-related health challenges of our times.