This document summarizes a panel discussion on designing mobile services for health behavior change. The panelists were from Kaiser Permanente, UCSD, Intel Research, and Stanford. They discussed persuasive techniques for mobile technologies, examples of persuasive design in practice, and how tracking, reminders, and rewards can influence health behaviors. Tracking behaviors and providing feedback was seen as important. Reminders work best when they are short, contextualized, and allow user control and social elements. Rewards are more effective than punishments and work best when positive.

1. +
Designing
for
Persuasion
Mobile Services for Health Behavior Change
April 27, 2009
Persuasive 2009, Claremont, CA

2. + Panelists
 Kendra Markle
Kaiser Permanente/AlterActions
 Kevin
Patrick
UCSD/Calit2
 SonnyConsolvo
Intel Research
 KaraChanasyk, Moderator
Stanford Persuasive Technology Lab
White Lotus Design

3. +Agenda
About the Panelists

Persuasive Techniques for Mobile

Examples:

Persuasive Design in Action
Discussion

Q&A


4. + Kendra Markle
Kaiser Permanente/AlterActions.org
I design tools that help people Nutrition
make healthy changes in their behavior
Exercise
Kaiser Permanente's
Stress Management Services Stress Management
Text & email reminders,
Weight
screensavers, audio guided
Management
relaxations, etc
Breathe
Cognitive Behavior
Relaxation Remindersvia Text Message Therapy (CBT)

5. + Kevin Patrick, MD, MS
Professor of Family and Preventive Medicine
University of California, San Diego
Director, Center for Wireless and Population Health
Systems, Calit2
University of California, San Diego
Editor-in-Chief
American Journal of Preventive Medicine
Co-Founder, Santech, Inc
UC San Diego
Center for Wireless &
Population Health Systems

6. + Kevin Patrick, MD, MS
Exploring the use of mobile devices, sensors and related systems to
promote improved health behaviors and outcomes
SMS/MMS approach to reduce weight in obese adults; Pilotcomplete; Larger
mDIET
study pending incl. Spanish language (NIH/NCI)
Mobile-phone based system supportingnear real-time capture of energy intake
e/Balance &
and expenditure; tools for researchers and for consumers (NIH/NCI SBIRs)
my/Balance
Measurement of physical activity time/space paths in context of Gene-
environment exposure biology research (NIH/NIEHS)
PALMS
Social-Mobile approach to reduce weight in young adults
SMS/MMS + Facebook apps (NIH/NHLBI; pending approval)
SMART
Mobile phone + sensors to provide near real-time feedback to users on
environmental health factors plus collective data over time to third party users
CitSense (public health, etc.)
(NSF; under review; W. Griswold, PI)
UC San Diego
Center for Wireless &
Population Health Systems

7. + Sonny Consolvo
Houston
+ =
+ ?
journal pedometer social influence increased
step count?
+ =
+ ?
UbiFit
glanceable display
journal fitness device regular & varied
physical activity?

8. +

9. + Persuasive
Design Goal Setting

Techniques
Reminders

Tracking

Rewards

Social Support

... among others


10. + Tracking Transformed

11. + Reminders Redefined

12. Reminders
Social Support
Rewards
Reminders
Goal Setting
+
Reminders
Social Support
Tracking

13. +
Reminders
Kendra Markle

14. + Text Message Reminders for
Stress Management
Reminder & prompt to
respond
Response & tracking
Reinforcement
Social support

15. +
Reminders are Triggers
Break down new behaviors into small steps
Reminders can teach, guide and reinforce these steps
They’llbe asking
Small steps should be Make them feel
Fun/Interesting Is this worth it to me? Immediate
Not Annoying gratification
Easy/Achievable Can I do this? Like they rule*
Fast
Text messages are only 160 characters long
*Kathy Sierra: 'Creating Passionate Users'

16. + Accommodate Personality Differences
Relaxation Types:
Physical tasks

Visualization tasks

Thought tasks, etc


17. + Reinforcement
 Positive reinforcementincreases
motivation before next reminder
(regardless of success)
 Use surveillancelet them know
you‟re paying attention to what they do
 Reiteratewhat you want them to learn
so they remember it

18. + Use Teams to Exert Social Influence
 Reminders can communicate social dynamics and create
friendly competition
Brian is your rock
 Use intermittent reinforcement star relaxer for
Team Tension
Tamers with full
participation so
Good job Lynn far.
and Marcie! Can
you help Marilyn
relax? New
Congratulations on full
message coming
participation this week, Team
later today.
Harmonious! You are in first
place. New messages each
day this week.

19. + Let Them Initiate Contact Too
 Push remindersdeliver frequent, randomly timed
text messages to them
 Pull
remindersallow them to ask for help when
they need it
Try this: Envision going
down a slow escalator.
Count from 10 to 1 as
Help me you descend deeper
Aurrgh! I‟m Relax now into relaxation. Text
feeling tense
back how effective this
was for you (0-5)

20. + Lessons Learned about Reminders
 Design for contextyour reminders enter their
life in their context
 Make160 characters memorable(Read
„Made to Stick‟)
 Give
them options(how, when, how
many, what type) upon sign up and in real time
 Builda personal connectionby personalizing
feedback to them based on their actions. (Don‟t
say „Great job relaxing this week‟ to everyone
regardless of their actual behavior)

21. + Text Messages Make Great Reminders
Text message reminders:
Reach people where ever they are

In their context

Real time (mostly)

Can interrupt (which can be good and bad)

Exerting influence at decisive moments:
Before scheduled stressful events

When they‟re in traffic

By proximity, when they‟re near their friends or their gym or other triggering

locations
When their friends are relaxing/engaging in the target behavior


22. +
Tracking
Kevin Patrick, MD, MS

23. + Tracking & Self-Monitoring
Volitional

 Event-driven (e.g. after every meal)
 Practiced art (mastery…)
Prompted

 Time of day (routine or tailored)
 Event-driven - requires context/situation awareness
via sensor. e/Balance and my/Balance do this via
GPS
 Learned (pattern recognition)**
**Subject of current and proposed research
UC San Diego
Center for Wireless &
Population Health Systems

24. + mDIET Intervention Components
supporting tracking
Daily Text & Picture Messages

Participant could choose the # of messages to receive & times to receive the messages

(2-5 messages per day)
Daily messages are statements or questions

Printed Materials for recommended weekly reading

Behavioral Skills, Nutrition, and PA topics (e.g. Self-monitoring, Portion Control, Routine Physical

Activity) First half provided in Binder at baseline; Second half provided at mid-point
measurement visit
Monthly Brief Counseling Calls (5-15 minutes)

Progress and counseling calls from their Health Coach addressing strategies,

social support, problem solving, etc.
Goals

Daily 500 calorie deficit (through calorie reduction and an increase in calories burned)

Self-Monitoring

Weekly weigh in (text weight) and daily food & exercise journal

Control group received mailed educational materials monthly on nutrition & physical activity.

25. + Types of mDIET Messages that support Tracking
Type of Text or Picture Message Example
Motivational Sayings Never say never, you can do it! Keep up the good work!)
Nutrition & Physical Activity Tips Try 10 baby carrots and a tablespoon of fat-free dressing for a
100 calorie snack; Want extra steps? Take the stairs today
Nutrition & Physical Activity Reminders Remember to move more today to reach your 12,000 step
goal; Be sure to practice portion control strategies at your next
meal
Short-Term Goal Reminders Think about what you can do in the next 4 hours to be healthy
Behavior Questions Have you practiced portion control strategies today? Have you
reached your 12,000 step goal today?
Weekly Weight Questions What is your weight?
Weekly Weight Graphs Chart of weekly weights
Portion Control Picture Messages Pictures of portion sizes

26. +
MMS & SMS Feedback
Nice progress! You're on your
way to reaching your goal. It will
take time, but you have the
motivation to succeed.

27. + Rule-based Dialogues:
Messages sent based on the user‟s previous
responses
UC San Diego

28. + Tracking & Self-Monitoring
Volitional

 Event-driven (e.g. after every meal)
 Practiced art (mastery…)
Prompted

 Time of day (routine or tailored)
 Event-driven - requires context/situation awareness
via sensor. e/Balance and my/Balance do this via
GPS
 Learned (pattern recognition)
Closely linked to reminders and “attention technologies”
UC San Diego
Center for Wireless &
Population Health Systems

29. + Attention Technologies
Proactive – best to know when it‟s most relevant (e.g., when you‟re

being exposed)
Peripheral – shouldn‟t divert attention during “critical” tasks

Unobtrusive – shouldn‟t cause social problems

 sound will be out in many cases
Rich – don‟t have to get out phone to look at it

Adaptive – changes according to your task, etc.

Redundant – if you‟re busy, miss a notification, or don‟t understand

it
From: William Griswold, PhD, UCSD

30. + Rewards
Sunny Consolvo

31. Rewarding vs. Punishing
+
If your mobile phone rewarded or punished you based on

your physical activities, how would it likely affect your
behavior?

32. Rewards & Punishment in Technologies
+
that Encourage Physical Activity
Fish‘n’Steps(Lin et al.) Houston (Consolvo et al.) UbiFit(Consolvo et al.)

33. +
Participants‟ reactions: Fish„n‟Steps
Happy Fish => Happy Participants

Sad Fish => System avoidance/abandonment

Reactions caused researchers to rethink the use of punishment

as a motivator

34. +
Participants‟ reactions: Houston
 Small rewards felt surprisingly good
“It was kind of cool to have that

[the „*‟]. It was like, oh, a star…gosh
how the little things, you know. The
little things that count, the star.”
“It was like, yes, I rock!...and it was

fun to go back [in last 7 days] and
go, yes, there’s my star for that
day…”

35. Participant‟s reactions: UbiFit
+
 It was a “gentle reminder” to be active
“It’s a nice, gentle reminder that getting off

my duff…every other day is not too much to ask.”
 Barriers came up more frequently than
participants realized
“It was awful…I was like counting the days since I had

been to the gym or since I had done anything because I
had some really sick days where just stretching made
me want to throw up.”

36. +
Reward, don‟t punish
These are often intended to be long-term, discretionary

use technologies
Use positive reinforcement or rewards to encourage

change.
Do not punish the individual for lack of the desired

behavior, but try to keep her engaged in the behavior
and the technology to help her get back on track.

37. + Social Support
Opportunities for leveraging Social Support as
a Persuasive Design technique
Considerations when incorporating Social
Support

38. Is there a
+ Recipe for Persuasion?

39. What are the
+ near future opportunities?

40. What challenges are keeping
+ mHealth from becoming
mainstream?

41. + Q&A

42. + Thank you! Kara Chanasyk

kara@whitelotusdesign.com
Kendra Markle

We‟d be glad to talk kendra@alteractions.org
with you if you have
questions. Kevin Patrick

kpatrick@ucsd.edu
Sunny Consolvo

sunny.consolvo@intel.com
Slides are available at:
www.whitelotusdesign.com/per
suasive09