Health apps: easy to build, hard to do right

Everyone seems to be using health apps these days: from simple medication reminders to habit formation apps that help us to change our behavior and be healthy. But while at the first sight such apps meet a certain need and address a specific problem, at the same time they seem to lack any understanding of how people behave. I'll talk about how people remember medications and how reminder apps neglect that behaviour; how habits form and how habit formation apps ignore that process; and what we could do to design better health apps in the future.

Presented at Cambridge Usability meetup in June 2015

Transcript

1. Health apps:
 Easy to build, hard to get right! Katarzyna Stawarz | UCL Interaction Centre | @falkowata!
2. Medication reminder apps! Habit formation apps!
3. Medication reminder apps! Habit formation apps! People forget! People don’t do things regularly!
4. Remembering medications!
5. Hello, prospective memory!
6. Women taking oral contraception ! ! ! N=971! Online survey! UK! Parents whose children took antibiotics ! ! N=88! Online survey! UK! Older adults with chronic conditions! ! ! N=87! Face to face! Mexico! Understanding remembering strategies!
7. Remembering strategies" Study I" Women" Study II" Parents" Study III" Older adults" Part of a daily routine" 61%" 27%" 5%" Simply remember" 52%" 61%" 57%" Alarm clock! 19%! 17%! 8%! Reminder app! 5%! 8%! 0%! Pill organizer! 1%! 0%! 1%! Printed / written schedule! 0%! 18%! 5%! Other! 8%! 8%! 25%! What do you use to help you remember?!
8. Remembering strategies" Study I" Women" Study II" Parents" Study III" Older adults" Part of a daily routine" 61%" 27%" 5%" Simply remember" 52%" 61%" 57%" Alarm clock! 19%! 17%! 8%! Reminder app! 5%! 8%! 0%! Pill organizer! 1%! 0%! 1%! Printed / written schedule! 0%! 18%! 5%! Other! 8%! 8%! 25%! What do you use to help you remember?!
9. Remembering strategies" Study I" Women" Study II" Parents" Study III" Older adults" Part of a daily routine" 61%" 27%" 5%" Simply remember" 52%" 61%" 57%" Alarm clock! 19%! 17%! 8%! Reminder app! 5%! 8%! 0%! Pill organizer! 1%! 0%! 1%! Printed / written schedule! 0%! 18%! 5%! Other! 8%! 8%! 25%! What do you use to help you remember?!
10. Medication reminder apps!
11. Medication reminder apps! •  App search! – “medication reminder”! – “pill reminder”! – “contraception reminder”! – “birth control reminder”! ! •  229 apps met inclusion criteria!
12. Func%onality  
13. Func%onality  
14. Simple medication reminder apps" (27%)" Advanced medication reminder apps" (37%)" Medication management apps" (36%)" Basic reminder options! Focus on reminders, but provide extra options supporting memory! Focus on both reminders and general health management! Reminders, flexible schedule, customizable alert types and sounds, snooze, etc.! Time zone support, medication photos, user notes, overdosing protection, etc.! User allergies, emergency contacts, doctor’s appointments, period tracking, etc.!
15. Supporting remembering! 1. Daily routines matter! 2. Location of medications matter! ! 3. Support exiting behaviour! ! 4. Don’t just focus on reminders!
16. Habits! Automatic responses to contextual cues! ! Frequent repetition ≠ habit! ! Form as the behaviour is consistently repeated in a presence of stable contextual cues !
17. Action plans:! !“When I do X, I will do Y”! When I get up, I will do 10 push-ups Implementation intentions!
18. Implicit motivation! BUT habits form even without positive reinforcement! Yay, I’ve done it! I’m so proud! Positive reinforcement! Aarts et al., 1997; Lally et al., 2010; Lally & Gardner, 2011"
19. Factors supporting habit formation! •  Contextual cues! •  Implementation intentions! –  “When I do X, I will do Y”! •  Positive reinforcement!
20. •  133 participants! •  28 days! •  “What did you have for lunch?”! " Positive reinforcement" " " None! Cue" " SMS reminder! " " Lunch! None! ! Control group! (no cue)! ! Reminder group! Trigger group! SMS confirmation! ! No cue + positive reinforcement group! Reminder + positive reinforcement group! Trigger + positive reinforcement group! Habit formation in the wild!
21. 94 participants finished (72%)! Measurements:" •  Automaticity: “Sending SMS after lunch was something…! •  …I did automatically! •  …I did without having to consciously remember! •  …I did without thinking! •  …I’d start doing without realising I’m doing it”! •  Adherence (% of expected lunch reports that were submitted)! Habit formation in the wild!
22. Results!
23. VS" Automaticity ✔" Adherence ✘" Automaticity ✘ " Adherence ✔"
24. Habit formation apps!
25. •  App search! – “habit”! •  115 Apps! – 54 for Android phones! – 67 for iPhones! – 6 for both (so counted once)! Habit formation apps!
27. Functionality" % Apps" Habit formation elements" Task tracking! 77%! -! Reminders! 44%! -! Graphs & stats! 36%! -! Goal setting! 35%! -! Calendars! 31%! -! Goal progress tracking! 23%! -! Rewards / points! 17%! Positive reinforcement! Notes! 16%! -! Habits library! 15%! -! Pictures! 9%! Cues! Quotes / Statements! 9%! Positive reinforcement! Peer support / feedback! 6%! -! Visual cues on home screen! 3%! Cues! Routine creation! 3%! Implementation intentions, Contextual cues!
28. Supporting habit formation! 1. Support trigger events and contextual cues! 2. Use reminders to reinforce implementation intentions! 3. Avoid features that teach users to rely on technology!
29. Medication reminder apps! Habit formation apps!
30. Medication reminder apps! Habit formation apps! People forget! People don’t do things regularly!
31. Daily routines! Existing routines! People forget! People don’t do things regularly!
33. Katarzyna Stawarz " Anna L Cox "Ann Blandford" k.stawarz@cs.ucl.ac.uk anna.cox@ucl.ac.uk a.blandford@ucl.ac.uk" @falkowata @DrAnnaLCox @annblandford" " Thank you.! http://usabilitypanda.com/research"