Why Are Wearable Health Technologies Failing?

The goal of most mobile health (mHealth) devices is simple: help users track and change their health behaviors. Many types of devices have been released, but most still fail to achieve this goal. Why?

Supported by endless media hype, the stock of mHealth apps and wearable devices continues to rise. Samsung, which expanded its line of wearables in early June, has joined Fitbit and Apple in the never-ending quest to improve fitness, reverse bad habits, and increase productivity (and sell more gadgets).

There’s a problem, though: more than half of mHealth apps in the iTunes store have been downloaded less than 500 times. And according to one survey, one-third of people who buy wearables stop using them within six months. In response, a new field of science is trying to understand the interface between human behavior and technology. This field, which I call the “Science of Social,” is maturing slowly, but it offers a lot of insight into the future of mHealth technologies.

The Science of Social

The three most important factors in behavior change are easy to summarize:

1. The power of social norms
2. The power of role models
3. The power of social support

Social norms strongly influence what we perceive as “normal” behavior. Do you silence your phone in the movie theater to avoid jeers? Have you ever listened to a genre of music you don’t like or rooted for a sports team that you don’t care about because your friends did? We value social support, so it’s common to adjust our behavior to what we think is expected.

Role models are responsible for popularizing behavior. New social norms spread when influencers adopt them first. For example, music trends in high school typically follow a top-down hierarchy. When I started to play bass guitar in 7th grade, I quickly discovered my favorite band—the Red Hot Chili Peppers—after hanging out with an 11th-grader role model.

Social support is key to sustaining behavior change. Friends and family fulfill key psychological needs, such as the needs to trust, fit in, and feel empowered. Successful offline programs like Weight Watchers and Alcoholics Anonymous include a strong element of community, so it’s not surprising that the top-downloaded apps are starting to include this feature.

These three simple principles determine the success of positive behavior change in the real world. Tech companies are catching onto this fact, but they’ve had trouble bringing all three elements together in one product.

How Tech Is Trying to Keep Users Engaged

One successful adjustment the mHealth market has made is using a reward system. The reward system can be complex, as in Zombies, Run!’s use of badges to unlock the next part of the story, or it can be simple, as in Fitbit’s growing flower that’s pegged to how many steps you take each day.

I’ve spent a lot of time advising companies on how they should incorporate reward systems into their products. The research shows that actionable goals (“I want to lose 15 pounds,” “I want to walk 15,000 steps today”) are key to making mHealth devices appealing to people in general, but especially to younger users. That’s why gamification and other interactive features that have a social element, like the personal coach found in Nike+ and other running apps, have helped increase the hype and sales of wearables. It turns out this age-old behavioral psychology technique—reward the desired behavior, or gamify it—is just as successful with us humans as it is with rats.

But gamification doesn’t always work, and there's still the problem of getting people to stay engaged. So, now what?

Using the Science of Social to Get People to Love Their Apps

At UCLA, we’re trying to improve the appeal of mHealth devices with a holistic model that includes all three elements of the Science of Social. This model, known as HOPE, targets one specific behavior to change.

Private community groups are the key to the HOPE intervention. People can support one another through group discussions, private messages, and “liking” posts and comments, just like Facebook or other social media sites. Interestingly, we’ve found that groups become actual communities after the intervention ends—they keep in touch, meet up with each other, and become part of each other’s lives.

In a nutshell, that’s the key to using the Science of Social to retain users: bridge the gap between online and offline worlds with social psychology. In order to do this, companies need to start being more aware of basic tenets of behavior change science, like the Science Of Social, and design around them. It’s encouraging to see health apps are going in this direction.

Your Future Self: A New Way to Make the Most of Daylight Saving Time

Imagine waking up in the morning, looking in the bathroom mirror, and seeing yourself 20 years in the future.

Yesterday, everyone living in the Northern Hemisphere gained a “bonus” hour of daylight. There’s no shortage of recommendations for what to do with that extra time: exercise, learn a new skill, or volunteer top most lists of productive suggestions. Most of us, though, make poor use of free time—it’s much easier to use that hour to nap or get distracted by digital technologies like social media or email. 

So, what can people to do to make better use of their free time?

One of the problems with using time wisely is an inability to imagine how our present and future selves connect. Dr. Hal Hershfield, a psychologist with the UCLA Anderson School of Management, describes the problem this way: “When people think of themselves in the future, it feels to them like they are seeing a different person entirely—like a stranger on the street.” This disconnect can lead to a host of bad decisions in terms of health behavior (e.g., smoking) or long-term planning related to family or work.

In one study, Dr. Hershfield describes an experiment designed to evaluate how and why people save money for the future. The study proceeds from the premise that people are indeed estranged from their future selves (i.e., that saving money is a choice between saving today and giving money to a stranger in the future). I interviewed Dr. Hershfield for BlackBoxPhd.com about this study as well as his general approach to future-self research (click here).        

The study makes clever use of virtual reality technology. In the first part of the study, participants were shown a visual representation of themselves (a digital “avatar”) that simulated how their body and face would look in the future. You can get a general idea of how this age progression technology works by visiting Merrill Lynch’s Face Retirement page.

Dr. Hershfield and his colleagues randomly assigned participants to one of two groups (current self or future self). Participants were told that they were going to enter a virtual reality environment and that they would answer a series of personal questions. The experimenter then showed participants two images of their avatar before they entered the virtual reality environment: participants in the current-self group saw front and side views of their avatar, and participants in the future-self group saw young and age-morphed versions of their avatar.

In line with the researchers’ predictions, people who interacted with the aged version of their self were more willing to allocate money to a savings account. In fact, they saved more than twice as much money to their retirement account! When the study was adjusted to account for the influence of immediacy (i.e., whether participants were reacting to demands of the researchers) or emotion, people who interacted with their aged self still had an increased tendency to allocate a higher percentage of pay for retirement. As you might expect, the phenomenon of caring more about present versus future economic conditions is common, but Dr. Hershfield’s study is a compelling and unique way to prompt behavior change.

In general, future-self research focuses on high-stakes events such as career success and financial planning. But it’s easy to see how this research can help in the short-term, too. For example, if you wanted to use your extra hour of daylight to jog a few times a week, you can use wearable technologies such as a Fitbit or Nike+ sensor, which provide the same sort of continuous data that Dr. Hershfield collects in his studies. With some tweaks by the manufacturer, the collected data could depict a happy avatar of yourself after attaining a mileage goal, or display a fatigued avatar if you don’t sleep right. In other words, technology that’s available right now can help you visualize the effort needed to reach a near-term goal, like getting in shape for the summer beach season, or the effects of not taking care of yourself.

Although you might be scared to see a realistic image of your future self, an avatar might end up becoming a good friend or even a mentor. He or she will give you honest feedback, respond immediately to criticism and change, and can teach you how to spend your time more wisely. I’ll explore this idea more in future posts.

The Health Habits of College Freshman: A Q&A with Sean Young, PhD

1. You’re conducting a research study to determine whether social media can be used to measure and predict health and academic performance among UCLA students 18 to 20 years old. Has this sort of study been done in the past with freshman students?    

To our knowledge, no study like this has ever been done. We’ve also given students wearable fitness and sleep tracking bands to evaluate their sleep and physical activity. A few researchers have published studies that monitored students with wearable trackers, but they did not include a social media component in the their research. We’re pretty excited about the innovation of this study and love coming up with creative new ideas for research.

2. One of your goals is to assess the relationship between writing about behaviors on social media platforms and activity/sleep patterns. What is the one area you expect the students to focus on the most in their social media posts? I would expect both schoolwork and personal relationships to be popular, but are you looking for the study to inspire other types of discussion?

This is exploratory. We definitely have some hypotheses of what students will be talking about and how it may affect their health and academic performance, but overall we’re looking at this study to give us some insights we can use in the future to build models to predict and improve student health and well-being. I think the topics they discuss is perhaps the less interesting question. As you mentioned, they’ll probably be most likely to talk about their schoolwork, job, friends, and hobbies. The more interesting question is how they’ll communicate about these things, what emotions they’ll express, whether we’ll be able to detect these emotions, and whether we can see and predict how they develop relationships over time purely by looking at their public social media data.

3. Since this study involves posting to social media sites, do you worry about the confidentiality of your participants? Also, you require “active postings” to social media sites. What exactly does that mean?

Because this is a pilot study, we need to gather a lot of data. In order to participate, we make sure students are Twitter users who are actively posting so that we can gather data from them. We’re not worried about confidentiality issues because people can change their Twitter settings. In most cases, people choose to have their Twitter handles public so that others can discover and follow them. That means that following someone on Twitter is like overhearing someone talking on the street. It’s all public information. If people don’t want to share something, they don’t have to, or they can go to a private area to share it. Our studies have found that people are growing increasingly comfortable with this concept.

4. With the release of the Apple Watch and other high-end fitness trackers, wristwatches have seen somewhat of a resurgence. However, some audiences still avoid wearables like the plague. Have any of your participants expressed discomfort or other issues with wearables during your studies?

I think it’s strong to say they’ve avoided wearables like the plague. I think they’ve avoided them like they avoided calculator watches, as I’ve compared them to in a previous post, because it’s still unclear whether they’re cool gadgets or whether they can impact people’s lives. The people who participate in our studies tend to be excited about our research and wearing the devices is a big reason why they want to participate. We’ve gotten a lot of athletes who signed up to participate, and many of them have reported back that the devices are helping them track their workouts. I think the next step or iteration is whether and how devices can help people who aren’t already doing things like exercising every day. In a previous post, I gave some examples of how wearables can become more effective at achieving this goal and leading to version 2.0.

5. How do you see your research helping improve the health habits of the first-year university students? And do you see any beneficial effects continuing later into life for these students?

Freshman students undergo a huge change in their lives when they start school. They move away from home, have to make new friends, are exposed to a lot of new experiences, and have to perform well academically compared to a smart group of peers. It can be a very stressful experience. It can lead to academic issues, mental health problems, or even suicide. Typically, it takes a while for university administrators to learn about students having these issues. Sometimes they don’t find out at all. The studies we’re conducting are aimed at developing tools that analyze data from technologies that students are already using in their daily lives, and use those data to predict and improve student health, well-being, and academic performance. We have the support of the university administration and if this approach shows promise, we hope to implement it more widely to help students better adjust to the transition from high school to college.