Your Phone is the Future of Healthcare: Interview with a Behavioral Scientist
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For decades, healthcare researchers have been anticipating a “silver tsunami”: the oncoming impact of the aging, supersized Boomer population.
Without significant change in how we deliver healthcare, our systems will be overwhelmed in the coming years. By 2030, Boomers will be making twice as many doctor’s visits, and 60% of this population will be managing at least one chronic condition.1
In fact, our healthcare systems are already starting to feel the strain, according to leading behavioral scientist and expert in health decision-making Dr. Sarah Watters. “Our typical approach to managing chronic conditions isn’t all that effective: We share lots of information with patients at a single time with hopes that people will act on this knowledge and self-manage.” But by and large, they don’t.
Behavioral science can explain why. Knowing isn’t half the battle — our behavior is context dependent. It’s driven by social and environmental factors, not just our good intentions. Health care needs to contextualize its requests for patients, with an accessible, scalable solution. And what’s with you all the time? Your phone.
Mobile technology allows healthcare providers to meet patients where they’re at, whether they’re in need of information, ongoing care, or even a word of encouragement. We sat down with Dr. Sarah Watters, a leading expert in leveraging behavioral science in digital health, to get to know more about the intersection of behavioral science and mobile health care.
Thanks for joining us, Sarah! To get started, can you walk us through how mobile health technology can bridge the gaps between health care and a real-world context?
Definitely! One of the great advantages of mobile is that this computer in your pocket is with you through all kinds of contexts: your house in the morning, on your commute, when you're in the office. It's always with you in these different environments and social settings.
For example, picture a feed on an app that surfaces the next relevant action for you to take care of your health. “Don’t forget to refill your prescription tomorrow” or “Don’t forget to pack a healthy snack today”’ Patients have that information as soon as they open the app. Ideally, the app is accompanied with just-in-time reminders that prompt patients at just the right time, in the right context.
This is something that Dr. Patel talked about in his TDL interview, how new forms of technology can personalize health care. Not only can we align things like gender, ethnicity, race, and age — technology has so much to offer contextually relevant behaviors. We have visibility into where the patient is, the time of day, their routines. We can ultimately support them in every moment, eliminating choice paralysis for them.
Behavioral Science, Democratized
We make 35,000 decisions each day, often in environments that aren’t conducive to making sound choices.
At TDL, we work with organizations in the public and private sectors—from new startups, to governments, to established players like the Gates Foundation—to debias decision-making and create better outcomes for everyone.
Enhancing the Patient Experience with Mobile Phones
What types of support can mobile technology provide to improve the patient experience in health care?
There's two main types of support, the first one being informational — like reducing ambiguity. A lot of people are really unfamiliar with what's going on behind the scenes in health care. Giving patients a direct line into their healthcare services removes some of that friction — booking appointments, waiting for a specialist, calling and getting rerouted and rerouted. It can be a frustrating experience. But mobile eases information-sharing.
On the other side of things, there's emotional support. “Hey, thank you for getting your mammogram or your colonoscopy.” Those little things make a big difference, especially when they're actions that we're not super excited to complete in the first place. If there’s no positive feedback, there's not a strong impetus to want to do them again. Really, every action needs some sort of (positive) reaction to drive ongoing behavior. I am very bullish on this point.
The informational side and the emotional side are equally important. Information is typically how we're driving health care today. But our behaviors are emotionally driven. Along the way, we’ve lost sight that patients are people, too. Patient-centered care means bringing in a bit more of the emotional aspect. We need to create scenarios in context, so people can take actions that are good for their health.
And these types of mobile technologies are more accessible to many people who are managing their chronic conditions, is that right?
Definitely. It's really sexy when you talk about these Oura rings and Fitbits and . . . I mean, the Apple Watch is just a technology beast at this point. These are all over the news; people love talking about trends in digital health. But we're forgetting a big, big chunk of people.
Most people don't have access to these wearables, and they’re often the folks who need the most care and attention. That's where mobile offers a real advantage. We’re all walking around with this mini computer in our pocket. How can we leverage something that's with us all the time — importantly, that’s in context with us — to better deliver health care? Or just help people take the right action at the right time? It’s great we’re becoming more sophisticated and advanced with our technologies in health care, but we need to consider the fact that while we're moving ahead, we can't leave the tail end trailing behind. We need to bring everyone with us.
Using Mobile Tech to Improve Health Outcomes
What causes gaps in health care and how can more immediate feedback loops help to close them?
Gaps in care are things that no one has a great mental model around, at least anyone I know. We know we need to get annual physicals and mammograms and blood tests. And by and large, we don't. There are no social norms for those types of things. When I look at my friend group, I'm not like, ‘Oh, I'm the odd one out because I didn't have a particular procedure.’ It's an intimate subject. So we're left to these piecemeal reminders — often literal pieces of mail from our healthcare providers saying, ‘You're due for this procedure.’ And then that piece of paper sits on your counter for three weeks.
We need to establish feedback loops; again, providing a reaction to every action, so to speak. In order to compel people to do behaviors again, we need positive reinforcement at the end. In health care, someone from their care team might send a simple message saying, ‘Hey, great work closing this gap in care!’, letting them know someone is noticing, and to compel the patient to do the action again.
There's very robust, scientific evidence in neurobiology that we like to repeat things that make us feel good. If we're hanging out with friends and it feels good, we want to keep hanging out with them. So if we complete a gap in care and someone recognizes us, it feels good — the next time the opportunity arises, we don’t want to let them down.
How can changing the context from typical health care to mobile support systems help us tackle our own behavioral biases?
We can leverage a whole bunch of different psychological biases by sharing information gradually over time. The ostrich effect plays a huge role in care gaps. For example, a lot of people have this common appreciation for what they think a colonoscopy involves. And, it's really not all that pleasant! When we don't know a lot about something, or we know it’s not that pleasant, we tend to ignore it. The same thing applies with daily behaviors, like not wanting to measure your blood pressure or blood sugars because you just don’t want to know how you’re tracking. We're sticking our head in the sand; we don't wanna hear anymore about it.
By dripping information through mobile, we can slowly make the patient more familiar with the information. We can ask them if they know what a colonoscopy is and then gradually break it down, leading them to eventually complete the behavior themselves.
But it's not a single ask. It's an orchestrated campaign that ultimately drives them to do this behavior. The mere exposure effect refers to the fact that people feel more positively towards information that they're more familiar with. It's about slowly educating them on what that gap in care is and, and not asking them to close it right out of the gates.
And if you look at the spacing effect, we know that people will actually retain information if you space it out over time. If we can teach someone what a specific care gap is over time, they're more likely to remember that information. They're gonna feel more positively, and potentially even empowered, depending on how the information is framed.
Increasing Efficiencies for Patients and Healthcare Providers
How can these mobile programs increase efficiency for patients?
It's great to inform someone about a gap in care and to nudge them to book an appointment, but the patient may have a whole bunch of other barriers preventing them from taking action. That's where mobile can come in. We can survey people regularly about their potential needs or barriers, from transportation to caregiving responsibilities.
Mobile can help identify these barriers and then surface helpful resources in a just-in-time fashion. Typically quite a few benefits are available to people, at least here in the U.S. on their medical plans. But people don’t know what’s available to them. This is something that happens to me as well. When you log into your insurance portal, it's very friction fueled. When it's really confusing and we have analysis paralysis, we just don't end up looking.
We can be a lot more efficient in driving behavioral completion. We can use mobile as a listening tool — and I don't mean that in a creepy way! Just making sure that your provider is up to date on how you're feeling. It front-runs the fact that the patient won't have to wait two or three months before their next appointment to share this information with their care team. It makes it more likely that challenges are spotted earlier on versus letting issues drag on and potentially escalate.
On the flip side, how can these mobile programs increase efficiency for healthcare providers?
The flip side is equally beneficial. Providers have better insight into what's happening over time. And yes, it's a lot of data. Certainly there's gonna need to be some work done in order to filter out the data and the noise. But if a physician or a nurse has better insight into how someone is doing over time, not only does it increase the likelihood that they're gonna have better health outcomes, but the patient themselves is going to feel more supported.
What happens a lot when you go to the doctor? They really don't know very much about you. You have to recap what you remember from a previous visit. Ultimately they're getting a very narrow slice about you, and basing their treatment off of this very narrow slice. Clinical teams have more information to work with. It’s a less biased view of the person's health; a longitudinal viewpoint so they can better understand the best treatment. That’s what healthcare needs going forward.
Definitely! Thank you for taking the time to share your expertise with us, Sarah. We’ll be looking forward to your continued work in the digital health space!
The Future of Mobile Health Technology
While healthcare practices tend to be out of context with our behavior, mobile technology offers an accessible solution to patients managing chronic pain. Mobile phones are already baked into our everyday lives, able to remind us when to take medication, to pick up a healthy dinner before we get home, book an appointment, or find healthcare benefits we never knew we had.
The future of healthcare is mobile technology — and it’s an issue close to our hearts. TDL teamed up with digital therapeutics company Chronwell to design a mobile healthcare app for patients managing Non-Alcoholic Fatty Liver Disease (NAFLD), a chronic condition affecting more than 85 million Americans. Our work was able to help NAFLD patients more closely stick to their treatment plans, with no additional workload on their healthcare providers.
Healthcare isn’t just a matter of transmitting information. We need to ensure practitioners are equipped to meet patients where they’re at, whether it’s providing next steps or creating positive feedback loops with a note of thanks. Behavioral, human-centered design can increase self-efficacy, knowledge, and confidence in patients — ensuring more and more of us stay on top of our health.
- HealthManagement. (2019). Silver Tsunami Infographic. HealthManagement, Vol. 19, No. 5. Retrieved from: https://healthmanagement.org/c/hospital/issuearticle/silver-tsunami-infographic
About the Author
Sarah Chudleigh is passionate about the accessible distribution of academic research. She has had the opportunity to practice this as an organizer of TEDx conferences, editor-in-chief of her undergraduate academic journal, and lead editor at the LSE Social Policy Blog. Sarah gained a deep appreciation for interdisciplinary research during her liberal arts degree at Quest University Canada, where she specialized in political decision-making. Her current graduate research at the London School of Economics and Political Science examines the impact of national values on motivations to privately sponsor refugees, a continuation of her interest in political analysis, identity, and migration policy. On weekends, you can find Sarah gardening at her local urban farm.