The document discusses teaching behavior change through effective behavioral interventions. It advocates using "baby steps" which involve making, empathizing, and testing interventions rapidly through iterations. Examples from a class project illustrate how students developed mHealth behavior change prototypes by starting with many ideas, making simple interventions, and testing assumptions through quick trials to learn what works before further refining interventions. The document concludes by encouraging this agile science approach to more quickly realize the potential of mHealth technologies for behavior change.
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1. Teaching Behavior Change:
The baby steps for making
effective behavioral interventions
Eric Hekler, PhD
School of Nutrition and Health Promotion
Arizona State University
May 16, 2012 Photo from Flickr - San Diego Shooter
2. We want interventions that are:
Evidence-based
Cost-effective
Tailored
Easy to disseminate
Promote maintenance
3. 500,000th App
Accepted on
App Store
2005 2006 2007 2008 2009 2010 2011 2012
Conceive Submit
Conduct the study
of a study Grant
Gather Receive Submit publications
Pilot Data Funding for review
Flickr – Metrix X
7. The Class
Designing Behavior Change Interventions
Grad class evidence-informed interventions
Syllabus
http://bit.ly/ASUhealthdesignclass
See students work
http://www.slideshare.net/DesigningHealth/
8.
9. Class Projects Timeline
wk1 wk4 wk6 wk18
Develop an SMS Use theory to Use previous work, theory,
Focus
health behavior make yourself and UX Design to iterate on a
Intervention. healthier. health intervention.
Who?
Family & Self Targeted User Group
Friends
Baseline –
Methods
Pre/Post Iterate at least 3 times
Comparison Intervention – Test with A vs B experiments
Baseline Study
10. Making
Intervention: “Genuinely smile at one
stranger a day. If you already smile at
people, make it a big toothy grin.”
Procedure: Morning SMS,
Evening Measurement SMS.
Amy Luginbill’s SMS project
11. Empathizing
Trigger
Make guitar easily accessible
Put guitar in plain sight
Simple
Had to play one chord
Positive Reinforcement
Color calendar
Before During Avgerage
Intervention Intervention Increase
Guitar 7% 40% 33% Serena Loeb’s DIY
12. Prototype 4:
Testing De-stress your
car
SMS: “If you are stressed
today, try one of the MOBILE
following options, Deep CAR MAID
Prototype 3:
breathing, Stretching, get SERVICES
up move around.” SMS
Intervention
GREEN CLEAN
Prototype 2:
Facial Wave
S=Stop
M=Move
I= I statement; I can do it! Prototype 1: S.M.I.L.E.
L=Love (positivity)
E=Exhale
Amy Luginbill; Samantha Quagliano; Sepideh Zohreh
13. Summary
Current evaluation methods are too slow
Behavioral theories cannot fully explain
mHealth data
To realize the potential of mHealth technology
Start from a wide array of ideas to learn HOW
mHealth technologies work.
utilize “baby steps” for rapid iteration of making,
empathizing & testing
Photo from Flickr - San Diego Shooter
14. Do as quickly as possible
Pick a reference: theory, user, or previous work
Explore multiple ideas
Make something
Identify assumptions
“What else is true?”
Test assumptions with a “crummy trial”
Repeat
Photo from Flickr - San Diego Shooter
15. Agile Science – beta
Explore time-effective funding channels
Emphasize time-effectiveness of methods
Create, test, & iterate MVPs
Use a variety of dissemination channels
Use business to disseminate
16. Thanks to my fantastic students
Sarah Kiser
Serena Loeb
Amy Luginbill
Nathanael Meckes
Samantha Quagliano
Catherine Roland
Jesse Sandvik
Brooke Schohl
Jesse Venzina
Sepideh Zohreh
Photo from Flickr - San Diego Shooter
17. Thank you for your
attention!
Eric Hekler
Designing Health Lab @ASU
Twitter: @ehekler
ehekler@asu.edu
Syllabus: http://bit.ly/ASUhealthdesignclass
See students work:
http://www.slideshare.net/DesigningHealth/
Photo from Flickr - San Diego Shooter
Hinweis der Redaktion
To quickly summarize a very large field of work, ultimately, we are trying to make interventions that are evidence-based, cost-effective, tailored, easy to disseminate, and promote maintenance. I have lots of experience with this, for example I’ve developed and have been testing in collaboration with Abby King and others here at Stanford some smartphone apps with the hopes of reaching this ideal.
Science has been a very thoughtful and deliberative process.We move slowly to be “certain” we know something.We are moving so slowly, however, that we are making ourselves obsolete.Take for example the pace of science. Here is a typical timeline for a large NIH-funded grant (the gold-standard for health researchers).Compare this to the pace of technology companies moving.We need to do better and currently, our old ways of thinking about behavior change, including our old theories are frankly, not up to snuff to the challenges and opportunities that mHealth technologies allow us.
Based on this, we need to move more into an open discussion in which we explore lots and lots of different ideas if we really want to understand which ones are best.Sadly, science, particularly behavioral science doesn’t really have the sort of “maker” culture that would allow us. As such, a key emphasis.
If we are going to really move forward, we must also take lessons from user experience design with regard to fully emphathizing and feeling the problem of those we are trying to develop a solution for.
Finally, it is very interesting that one of the more popular books in the Startup world is the Lean Startup, which basically argues for the scientific method within startups to ensure true learning. Classic in behavioral science, but as stated before we take too much time, particularly in early stages. BJ has been talking about a “crummy trial” which is a quick trial to learn the basic on if something is going to work.
This brings me to the class I’ve been teaching at Arizona State University called Designing Health Behavior Change Interventions. It’s a grad-level class focused on teaching students how to develop evidence-informed apps. In the class, I attempt to integrate the best of behavioral science, user experience design, and rapid iterative design processes to teach students how to come up with the next generation of intervention ideas.
As discussed earlier, the key areas of focus are learning how to empathize, make, and test ideas. Please note, these were health students and therefore, they focused on “making” experiences, not code.The First baby-step for starting this involves picking a theory, a particular user, or a riffing off of previous work. They give the foundation for making something.
As suggested earlier though, I really wanted to push my students to make things as I felt that was the way for them to learn. In the first stage, I just wanted them to figure out how to take a theory and turn it into an intervention. As such, I assigned Cialidini’s work on persuasion and BJ”s Behavior Model and had them design.They then started basics on empathizing including interviewing, observation, surveying, etc. I also wanted them to “feel” what it was like to try and change a hard behavior and to link theory with an intervention. Hence, the DIY Health assignment. In the DIY Health study, they were assigned to use a within-person ABA study design to examine changes in themselves when they are or are not using an intervention. Soon after they started the DIY study, they then formed groups. The groups chose a target behavior, target group, and attempted to connect everything together. A key part of this was the use of experiments to test and confirm ideas.
Students came up with some great ideas quickly within the SMS interventions. For example, Amy wanted to improve mood, so she explored providing prompts for smiling to others.The students explored a variety of topics such as sleep or reducing candy consumption.1st SMS, Friday January 20th: Happy Friday!! Psychologists have found that even a bad mood can be instantly lifted by forcing yourself to smile! Share the joy today, and smile at a stranger 2nd SMS, Saturday January 21st: It’s Saturday, smile 3rd SMS, Sunday January 22nd: Studies suggest people who smile more live longer! 4th SMS, Monday January 23rd: You are doing great! Keep it up!! Smiling is a great way to not only improve your appearance, but those who smile at others are perceived as more likeable, confident, conscientious, and stable! 5th SMS, Tuesday January 24th: No reminder 6th SMS, Wednesday January 25th: Good morning you gorgeous, smiling, radiant person! Did you know studies show people who smile often actually make more money than those who don’t? Big toothy grins = big paychecks! 7th SMS, Thursday January 26th: Final day of the 7-day smile challenge!! Smile today because you are truly a treasured friend, a kind and wonderful person, and a champion of this project!! Thank you all!! Last follow up text will be sent tonight, and results will be sent to you via email soon. CONGRATS!! :D
The DIY experiments were really interesting as the students had to come up with something they forced them to better understand themselves and also figure out how to fix their own problems. They explored a variety of channels for this often with good success such as Serena’s Guitar intervention. She attempted to riff off of BJ’s baby steps SMS intervention to get herself to play more guitar. She felt that it fit in personal model of what was going wrong.
The group studies were where the most interesting things happened. In particular, this was when the groups really took advantage of “crummy trials” for better understanding when an idea was working.For example, Amy, Sam, and Sepideh’s group was trying to reduce stress. They did a lot of empathizing work and looking into the previous literature to find the importance of breathing and stress management techniques. Sadly though, whenever they tested some of their ideas, which included mantras and other ideas to help simple triggers for relaxing, they all failed.This was particularly fascinating because in their initial brainstorming, they really loved their “S.M.I.L.E.” accronym that they came up with. When they tested it, comparing it to a control, it simply didn’t work.They perceived but ultimately found that they needed to pivot and instead ended up focusing on figuring out ways to de-stress a person’s environment. So they went and started cleaning cars and got great responses.