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!
   

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2. Medication
   reminder apps!
   Habit formation
   apps!
   

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3. Medication
   reminder apps!
   Habit formation
   apps!
   People forget!
   People don’t do
   things regularly!
   

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4. Remembering medications!
   

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5. Hello, prospective memory!
   

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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!
   

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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?!
   

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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?!
   

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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?!
   

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10. Medication reminder apps!
    

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11. Medication reminder apps!
    •  App search!
    – “medication reminder”!
    – “pill reminder”!
    – “contraception reminder”!
    – “birth control reminder”!
    !
    •  229 apps met inclusion criteria!
    

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12. Func%onality  
    

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13. Func%onality  
    

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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.!
    

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15. Supporting remembering!
    1. Daily routines matter!
    2. Location of medications
    matter!
    !
    3. Support exiting behaviour!
    !
    4. Don’t just focus on reminders!
    

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16. Habits!
    Automatic responses to
    contextual cues!
    !
    Frequent repetition ≠ habit!
    !
    Form as the behaviour is
    consistently repeated in a
    presence of stable contextual
    cues !
    

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17. Action plans:!
    !“When I do X, I will do Y”!
    When I get
    up, I will do
    10 push-ups
    Implementation intentions!
    

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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"
    

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19. Factors supporting habit
    formation!
    •  Contextual cues!
    •  Implementation intentions!
    –  “When I do X, I will do Y”!
    •  Positive reinforcement!
    

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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!
    

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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!
    

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22. Results!
    

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23. VS"
    Automaticity ✔"
    Adherence ✘"
    Automaticity ✘ "
    Adherence ✔"
    

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24. Habit formation apps!
    

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25. •  App search!
    – “habit”!
    •  115 Apps!
    – 54 for Android phones!
    – 67 for iPhones!
    – 6 for both (so counted once)!
    Habit formation apps!
    

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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!
    

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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!
    

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29. Medication
    reminder apps!
    Habit formation
    apps!
    

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30. Medication
    reminder apps!
    Habit formation
    apps!
    People forget!
    People don’t do
    things regularly!
    

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31. Daily routines! Existing routines!
    People forget!
    People don’t do
    things regularly!
    

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32. View Slide

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"
    

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