Refocusing Behavior Through Design.
By Gretchen Anderson & Janna C. Kimel
Issue 4 Summer 2010
A designer and a design researcher investigate how motivational theory can inform design decisions that increase the adoption of healthy behaviors. This article begins with an exploration of trends found in the theories of thought leaders who study motivational behavior. After identifying the motivating significance of freedom, belonging, power and fun, the text goes on to present nine design strategies that harness those motivating factors. The reader is encouraged to incorporate elements such as personal goal setting, network building, feedback loops, competition and more into design solutions.
There is an old joke that asks, “How many psychologists does it take to change a light bulb?” The answer? “One, but it really has to want to change.” As usual, it’s funny because it’s true. Long-term behavior change cannot happen until an individual truly wants to change and they have an internal desire to transform a habit or behavior. And yet, many tools designed to support medicine and healthy living, seem to ignore what we know through an expanding body of research about how to help people help themselves to live better.
With the current emphasis on improving healthcare using technology, it is important that product designers understand how behavior change happens. This article lays out some fundamentals of behavioral theory and then offers design strategies to harness that knowledge and influence behavior and wellbeing.
What motivates an individual to do anything? Why don’t we just lie on the beach all day and hope for the best? Researchers focused on this human condition provide us with a few factors that motivate individuals into action.
Several key thought leaders of motivational theory include: Daniel Goleman, author of Emotional Intelligence,1 Edward L. Deci and Richard M. Ryan who postulated Self-Determination Theory,2 William Glasser, who developed Choice Theory3 and Abraham Maslow who postulated Maslow’s Hierarchy of Needs4. Combining these theories with the benefits of intrinsic and extrinsic motivation, we can provide a framework, which can then be integrated with products and services designed to motivate wellbeing.
Each of these thought leaders offers a list of concepts that describe what motivates a person. When listing the key components of each theory side by side, we begin to see trends which show that human motivation can have up to five basic components, four of which are most relevant to creating a successful product. As evident in Figure 1, multiple experts agree that four factors contribute to motivation: freedom, power, belonging and fun.
For this article, we will assume that the fifth component, the basic need for safety and survival has been met and, therefore, will not be addressed in this design-driven conversation. For the purpose of this conversation it is also assumed that we are discussing motivation from the perspective of the western world.
Three of the four theories postulate that some form of freedom or autonomy is important to an individual. When a person shares in the responsibility of setting goals and outcomes, there is a much higher potential for achieving success. Examples include engaging low-income individuals in the design and construction of their home (Habitat for Humanity), allowing workers to decide which 40 hours they will work or asking a patient to take an active role in defining their health goals.
Feeling powerful or showing mastery of a topic is another motivational force identified by all four of these theories. An individual may be motivated to spend endless hours in the gym to become an Olympic athlete and prove complete mastery of a particular sport. The top student in class may spend hours memorizing and studying to show excellence in intellectual pursuits. Each of these individuals is motivated by the feeling of mastery and excellence.
Mastery of a skill often results in a positive feedback loop that keeps a person motivated to continue. Harnessing this force for healthcare means giving people feedback about their progress and presenting them with discrete tasks to complete or skills to learn. Many people struggle with their food intake and being overweight or even obese. Research has shown that asking people to simply keep track of what they eat leads to losing weight, which in turn inspires people to make healthier choices.
Belonging to and committing to the goals of a group is a third key factor in creating individual motivation. Being responsible to a group creates a situation where an individual knows s/he is being watched and a situation in which an individual does not want to disappoint another. This is the value of meeting with a book club once a month as incentive for finishing the reading or meeting regularly with an exercise partner. Facebook has an interesting application that allows the community to support you in your New Year’s goals. Whether it is losing weight, walking, or quitting smoking, being publicly responsible to those around you helps to commit to new, healthier behaviors.
Additionally, Glasser adds fun as a motivational force. Autonomy, committing to the goals of a group and striving for excellence are all a part of intrinsic motivation, but fun can be a make-or-break factor in certain situations. If all of this striving and motivation feels too intense, adding an element of fun increases enjoyment and, therefore, increases the likelihood a person will engage in a particular activity long enough to qualify as behavior change.
Motivation comes in two forms: intrinsic and extrinsic motivation. Intrinsic motivation is the ability to motivate regardless of any awards, financial prizes or recognition. It is the human desire to do better simply for the sake of being better; it is about the things that interest us and capture our attention.
Marathon runners are the epitome of intrinsically motivated individuals, as are the millions of people who do “Race for the Cure” and other fundraising walks every year. Running a marathon is not a requirement. It is something certain people are just driven to do. A runner at Pumarunning.com says, “I run for clarity, I run for internal peace, I run for an outlet, I run to free my legs, I run to run away from the day, I run so I can look back…”5
Extrinsic motivation is the opposite. It involves financial or material rewards or recognition. A person may work on a task that is less interesting to him/her simply to reap the rewards once the task is completed.
“To enable autonomy, experiences around healthcare need to feel tailored to a person’s specific situation.”
Often, when we approach the design challenge of changing behavior, we think about setting up a reward system to capitalize on that extrinsic motivation. But, as research shows, the things that actually motivate people can be much less tangible.
Design Strategies for Building Motivation
Nine key design strategies have been identified that can be used in the creation of products and experiences to most effectively utilize research surrounding motivating people to change. The strategies are described here with examples that intentionally craft experiences to motivate certain behaviors.
One of the simplest design principles is that of harnessing the power of “inertia.”7 Bank of America’s “Keep the Change” program helps people do something they know is good, but have trouble executing on: saving money. By telling the bank to “round up” each transaction and transfer the difference to a savings account the bank harnesses the inertia of spending toward saving.
Our interactive experiences are becoming more and more personalized. People expect to have control over the type of information that they share and see. Personalization is a great way to draw people into an experience. Netflix has a huge challenge in presenting its diverse customers with a dizzying array of movies to view. By asking users to rate movies and then presenting suggestions to people based on those ratings, Netflix creates a strong bond with customers. By rating more movies, customers reveal more (and presumably better) suggestions for themselves.
Enable Goal Setting
Educators have known for years that children who can structure their own explorations and direct their interests show improved behavior and performance in the classroom.8 The key takeaway for designers is to enable the setting of personal goals which are meaningful and relevant. Designs should support goals that are specific and that relate to skills or actions that users need to learn or change.
Goals are the journey, not the destination. When structuring goal setting in a product or experience, designers should remember that the purpose of goal setting is to motivate the user and help them connect choices with outcomes. Designers should work with subject-matter experts to structure goals that are safe, achievable and that clearly relate to better health outcomes.
In order to gain perspective on our actions and instill new behaviors, people need to connect the dots between what they do and how it affects their goal. In a healthcare context this involves giving rich, interactive visualizations of both actions and outcomes. As mentioned above, relating choices to outcomes helps people learn (and master) healthier behaviors. It is important to provide people with a sense of progress over time, and in relation to goals.
In today’s “anywhere, anytime” computing world, people expect that their experiences will be networked. But for designers, it is important to understand the value a network has in affecting behavioral change.
A network of “friends,” in the context of healthcare, means either actual “friends” of users or relative strangers who face similar challenges. Supporting a simple way for people to share support and information personally is a start. Virtual support groups like babycenter.com are a popular destination for expectant mothers who crave information and want to know that they are not alone with their prenatal concerns.
Game theory also tells us that asymmetrical relationships, where better contribution earns the person a level of status in the larger group, are a key part of networked experiences. This can be seen in action on Yelp! or Amazon, where certain reviewers or sellers who contribute more build their reputation as trusted experts. By giving people ways to gain status according to their participation, designers create rewards for those who are motivated by their standing in the community.
Enable Competition and Comparison
It is somewhat obvious to say that competition is a motivational force. And yet, it can be difficult for designers to incorporate competition into products related to healthcare. If someone really cannot compete with their peers then competition quickly becomes de-motivating. It can also be dangerous with complex health conditions and must be used with caution.
Comparing ourselves to others gives us a sense of where we are and provides a gentle prompt to catch up if behind. The display of this information needs to be carefully considered. Beware of chastising or overly praising people on their progress and losing focus on the ideal behaviors. But for those who gain momentum through the urge to compete, it is a powerful tool to keep in the designer’s toolkit.
What is the biggest surprise about the competitive force? Beware of letting your users “win.” Research9 in the area of energy conservation has shown that people who receive a smiley face rating for their efforts tend to lapse once they see that they are already performing “well.” Instead look at ways to acknowledge progress without implying that a threshold has been crossed or that there is no more room for improvement. Consider a scale that told people that they were simply “thin” rather than their actual weight. Given that weight management is not a one-time achievement, users would have no reason to continue mastering their diet.
Scaffold Success & Manage Failure
Building skills and mastery are a key motivational force, which means that products and experiences need to enable people to “win” from time to time, not simply chase a specific long term goal. Make sure to build into your system the ability to create and revise.Timothy Bickmore of MIT’s Media Lab conducted a study with an artificial intelligence agent named Laura, designed to encourage exercise. A journalist for Wired Magazine10 writes about his experience with the system. At one point he has to “explain” a minor injury to Laura: “She moves in close and shows a look of concern…She asks me if the injury will have an impact on my exercise program. [No.] But later that session, when I tell her I will be able to walk only 4,000 steps the following day, she doesn’t ask me to do 10,000. She knows not to push.”Whether you make use of algorithms or healthcare counselors and staff to maintain and evolve goals for people don’t make the mistake of setting one (or even just a few) huge, monolithic goals. Posit Science’s “Brain Fitness” product line is a more subtle example of this. As people play games designed to improve their visual or auditory processing power, Brain Fitness adjusts to their level. A plateau in performance means harder challenges are presented and as people begin to make mistakes, the application automatically serves up easier challenges. In the Jewel Diver example, (see above) people track hidden gems as they are moved around by fish. The number and movement of the fish changes to make the program more challenging over time.
“The key here is to provide rich visual feedback tied to choices or actions that help people learn the relationships between various factors.”
Designers should also remember to take advantage of information that can be gleaned about the situation in which a device may be used, including (but not limited to): time, location (online and off) and concurrent tasks. This also means choosing your platform accordingly. If location information is important, think about piggy backing on mobile phone GPS information. PC-based experiences are necessary when tasks or information are detailed and important enough to demand the user’s full attention. Additionally, they are best used to help people get into a reflective mode and make connections between behaviors and outcomes.
Consider the example of glucose meters and insulin pumps. Currently, a diabetic sitting down to dinner is asked to test their blood glucose levels before they eat. This is important to avoid catastrophic choices about food and insulin, but it does not contribute to changing lifestyles. A meal is often a social event, not the right time to connect the dots for people about their actions and effects. Rather, that education can take place during a more reflective moment.
Play Against Loss
Daniel Pink’s recent presentation at the TED talks11 states that for highly repeatable, time-based tasks, money works fine as a motivator. But when the aspiration is more open-ended and involves more intellectual creativity or problem-solving (“Why am I not losing weight? Is it the ice cream? Or do I just need to hit the gym?”), innovators need to encourage people differently.
One approach that designers can consider is to make use of a “pay it forward” model for extrinsic rewards. Since science shows that people are more motivated to avoid a loss than by the promise of gaining more, give users a way to set aside an amount of their choosing (say $50) that they “earn back” their money by achieving milestones. Money that they do not earn in a certain period goes to charity.12
Long-term behavior change can only happen if people are properly motivated and engaged. Designers can make use of motivational theory to craft products and experiences that actually transform those who use them, for the better. But it is not enough to simply add features to a product with the intention to create positive change. The techniques presented above need to be applied carefully and actual outcomes must be monitored to ensure that the desired change is occurring. As shown in the examples, products have the power to affect how people behave. Designers have the responsibility to reflect that behavior change in the design of devices that support and promote healthy lifestyles.
STRATEGIES IN ACTION:
Motivating Healthy Behavior Through Design
Enable the user set personal goals
Provide feedback that measures progress
Incorporate small tasks that encourage learning
Establish a community to support public commitments
Make it fun!
About the Authors:
Gretchen seeks out those design challenges that ultimately make a positive impact on people’s daily lives and environment. Her design philosophy is rooted in the belief that a user interface should be as seamless and invisible as possible. Throughout her career, Gretchen has designed a wide variety of products, experiences and users. From medical devices, to casino entertainment, to business productivity tools, her varied clients, technologies, and customers form a solid foundation from which she approaches new problems eagerly and fearlessly.
Gretchen graduated with honors from Harvard University. Prior to joining LUNAR, she worked for several Bay Area design consultancies and clients including: Johnson & Johnson, TurboChef, Microsoft, Intel, and Starbucks. She has also taught design and research methodologies to designers and clients.
Janna C. Kimel has been practicing design and design research with a focus on accessibility, high tech and health since 1991. Logging hundreds of hours of research in the lab and in the field, her focus is on qualitative research in the form of individual interviews, contextual inquiry, focus groups and user testing. Her work focuses on performing well executed research to transform an organization’s understanding of its customers and create compelling experiences. She has consulted with innovative companies such as IDEO, Ziba, and Herbst Lazar Bell and health care companies including EnteroMedics, Providence Health and Oregon Health Sciences University. Janna spent several years working with Intel’s Digital Health Group where she was part of research and development.
Janna was vice-chair of the Oregon Chapter of the Industrial Design Society of America from 2006-2009 and teaches industrial design and design research as adjunct faculty at the Portland Art Institute. She holds a master’s degree in industrial design from Georgia Institute of Technology.
TED Talk: Dan Pink on the Surprising Science of Motivation
Nudge: Improving Decisions About Health, Wealth and Happiness by Thaler and Sunstein
 Goleman, Daniel. Emotional Intelligence: Why it can matter more than IQ. Bantam Books, 1995.
 Ryan, Richard M., Deci, Edward L. (2000). Self- Determination Theory and the Facilitation of Intrinsic Motivation, Social Development and Well-Being. American Psychologist,55(1), 68-78.
 Glasser, William., Choice Theory – A New Psychology of Personal Freedom. Harper Collins Publisher, 1998.
 (2010) http://www.re-mission.net/
 Thaler, Richard H., Sunstein, Cass R. Nudge: Improving Decisions About Health, Wealth and Happiness. Penguin, 2008. This idea and its origins are described in greater detail and would be useful for designers to understand more fully.
 Bronson, Po., Merryman, Ashley. Nurture Shock: New Thinking About Children. Twelve. 2009.
 Schultz, P. Wesley, Jessica M. Nolan, Robert B. Cialdini, Noah J. Goldstein and Vladas Griskevicius. “The Constructive, Destructive and Reconstructive Power of Social Norms.” Psychological Science 18 (2007): 429-34.
 Diamond, D. (December, 2003) The Love machine.
 Pink, D. (July, 2009) Dan Pink on the surprising science of motivation
 see Thaler, Richard H. et al.