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  1. Living Health
14 December 2015

Designed for life: creating technology that encourages behavioural change

By taking into account psychological drivers, the health-care industry can create products and services that will help individuals improve the way they manage their health and well-being.

By Becky Slack

Losing weight is difficult. We all know that unless we keep fit and eat healthy food we are putting our health at risk. Yet despite this, obesity levels continue to rise. Junk food tastes good and exercising requires effort; as such, positive actions get put off until “tomorrow”.

It’s a similar story when it comes to smoking and alcohol consumption. People even fail to take important medicines that will help prevent devastating diseases. All too often, immediate gratification takes precedence over the long-term benefits.

With less than half of all Brits actively managing their health, it is clear that much more needs to be done to encourage people to take responsibility for their well-being. Indeed, this is recognised within the National Health Service, which has a goal of introducing prevention programmes at scale across the country, as stated in the NHS Five Year Forward View.

Behavioural economics has a role to play within this strategy. Rather than forcing people to act in certain ways, it uses a gentle “nudge” to encourage them to act in ways that are better. For instance, as Benjamin Voyer points out in his 2015 paper “Nudging” Behaviours in Healthcare: Insights from Behavioural Economics, which was published in the British Journal of Healthcare Management, the number of no-shows for doctors’ appointments can be reduced by as much as 30 per cent simply by the surgery using posters to communicate the proportion of patients who arrive on time.

Technology can also help steer people in the right direction in terms of their health. We know, for example, that people who use apps and other equipment to track their health often change their behaviour for the better.

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“The good news on the horizon is that three-quarters of Britons say they track and manage their health through a variety of methods, and among these 79 per cent say tracking their health has led to a change of habit – most notably reducing their sugar intake (34 per cent), reducing their fat intake (28 per cent) and increasing their exercise (27 per cent),” reads Philips’s Picture of Health report, published in October.

However, for technology to influence behavioural change effectively, it needs to be designed well. By this, one doesn’t just mean it needs to look slick (although, as the popularity of Apple products shows, looking slick can be a big help in encouraging take-up). Health-care technology also has to meet the needs of both the end user and the health-care professional; and it has to be personalised to the individual, but also useful for a mass audience.

These may seem to be competing priorities but at their heart is a clear understanding of the target audience, says Sean Hughes, vice-president and chief design officer in charge of health care at Philips Design.

“The main thing is that we don’t just sit in an office and design for someone somewhere else. We have to have a clear picture of the end user first,” he says.

Does this mean the end user should be actively involved in designing the product or service? There are mixed views as to the effectiveness of this approach. Fail to give appropriate attention to the needs of the customer, and the product design can end in disaster, wasting a great deal of time, money and energy.

However, as much research has documented, people are not always conscious of the reasons for their actions, so they won’t necessarily recognise the external and internal factors that would influence design considerations – such as the “hyperbolic discounting” described at the start of this article, in which people choose immediate rewards over distant ones.

“Hyperbolic discounting is related to uncertainty avoidance, that is, the fact that individuals do not like uncertainty and try to reduce it whenever possible,” Voyer writes, adding that “most individuals experience difficulties . . . projecting in the future, and therefore undervalue future rewards, as these are deemed less concrete”.

So, although user involvement can play a role in design, many companies use ethnographic research instead to help them understand their target audiences. This involves observing people in their home or workplace, rather than in the artificial environment of a lab or focus group. The aim is to gather rich insight into how people live, what they do, how they use things, and what they need in their everyday or professional lives.

For instance, when Philips was designing its new diabetes app, which forms part of its HealthSuite digital platform, it took into account the fact that parents of children with type 1 diabetes worried about their son or daughter participating in friends’ birthday parties and sleepovers, in case they became ill. By creating an app that allows insulin-level readings to be streamed direct to parents, Philips was able to help remove some of these concerns.

Equally, the motivation behind Philips’s new Minicare Home monitoring service for cancer patients (due to be released on the UK market next year) was to empower those having chemotherapy actively to be involved in testing their own white blood cells while at home. Chemotherapy can destroy healthy as well as cancerous cells; consequently, patients can easily pick up infections. This can cause additional stress for patients, who are already under a great deal of emotional pressure. By sending this data to a remote-care team regularly, doctors can pick up adverse results quickly, allowing the medical professions to respond rapidly and helping to reduce patients’ fears.

User interface design – otherwise known as UI – also has an important role to play. This focuses on anticipating what users might need to do and ensuring that the technology is easy to access, understand and use.

An example of this might be ensuring that words are printed using a font and type large enough for the partially sighted to read, or buttons that arthritic fingers can press, or it might be as simple as using an interface similar to the ones used on some of the world’s most popular websites, such as Facebook and the BBC. Using familiar UI patterns can help users feel more comfortable and therefore more willing to keep using the technology.

Use of colour and simple messaging is another tool in the designer’s toolbox. For example, Anne Thorndike, Jason Riis, Lilian Sonnenberg and Douglas Levy, in the course of their 2014 research for their paper Traffic-Light Labels and Choice Architecture (published in the American Journal of Preventive Medicine), found that when hospital menus used traffic-light labels it decreased -consumption of unhealthy “red-light” meals such as burgers by 20 per cent, while increasing the choice of healthy -“green-light” options by 46 per cent.

Meanwhile, offering two-way interaction can also help encourage behavioural change. For example, providing real-time feedback in exchange for the data inputted by the user can help improve behaviour. Examples of this may be exercise apps that congratulate someone for having been for a run, or a diet app that unlocks a new reward for someone having maintained a healthy calorie intake throughout the week.

Equally, feedback can provide reassurance. For instance, chronic obstructive pulmonary disease (COPD) patients wearing the Philips respiratory sensor can now monitor their oxygen levels and use the results to make decisions about whether or not the situation is serious enough for them to be admitted to hospital, whereas previously they may have called an ambulance at the first sign of breathlessness.

However, as we know, one size does not fit all. So how can designers ensure they meet the needs of everyone, rather than just the few?

Software allows things to be more customised than in the past, Hughes explains. Customisation for the end user is relatively easy because you can configure apps and software in a slightly different way and give the consumer some choice. Imagine you’re creating a health dashboard: some people might want to see every graph and every data point, while others might only want to have one or two. The fact that it’s digital will allow them to configure it.”

He gives the example of Philips’s eCare Companion and eCare Co-ordinator to illustrate his point. A part of the health-care technology provider’s suite of telehealth programmes, both of these facilities are designed to help reduce hospital readmissions and lower costs by focusing on effective chronic care management within the home.

The eCare Companion serves as the patient portal. The person is provided with a tablet and a number of appropriate tracking tools, such as weighing scales, a blood pressure metre and medicine dispenser. They can log in to their personalised application using the tablet, enter the requested measurements, answer questions about their health and find reminders about pre-assigned health tasks, such as taking medication.

The eCare Co-ordinator, meanwhile, is the health-care professional offering, which gives clinicians access to the patient’s health data. This real-time information allows them to prioritise patients, adjust care plans or intervene as required.

“It is one ecosystem that is designed around the needs of that patient – they may have failing eyesight, arthritis problems or another chronic condition, and we design the entire user experience around that,” Hughes says. “On the other side, you have the medical experts who are looking for very specific things, so they have dashboards and displays that show them what they want.”

He adds: “It’s a bit like the dashboard in your car. The speedometer is very important so it is made bigger than, say, the fuel gauge, which is less important so appears smaller. We’ve designed these dashboards so that when the co-ordinators look at the patients they can very easily see who is trending in the wrong way and can intervene.”

The digital revolution has opened up a multitude of opportunities for individuals and the health-care sector alike. While the motivations may differ between these two distinct interest groups – for the individual it’s about an easier life, while for the professional it’s about improved service delivery at a lower cost – the end goal is the same: healthier, happier people. With the right design, technology can enable that.

This article is part of a thought-provoking series on living health, brought to you by the New Statesman in association with Philips, which looks at how technology, innovation and big data are helping to improve your health and our health-care system.

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