Digital behaviour change – what have we learned?

The conference showcased the important work that UCL CBC have been doing to provide a solid basis for the evolution of behaviour change technology. The COM-B model, behaviour change wheel and behaviour change techniques (BCT) taxonomy were all prominent.

The presentations included real-world success stories using digital solutions for healthcare issues. These included: the Samaritans’ campaign Small Talk Save Lives (a campaign to help the public reach out to people who might need it); a remote monitoring and telehealth programme to help patients manage hypertension in Cleveland, Ohio, to big campaigns rolled out by Johnson and Johnson (with the benefit of instantaneous user feedback loops) just to name a few.

During the conference we noticed several overlapping themes:

How to go about designing your behaviour change intervention? Work backwards.

Start with the behaviour you are targeting. Pick apart the determinants of that behaviour and identify which you can influence. Develop your intervention strategy accordingly. The COM-B model identifies nine different intervention classes: for example, are you intending to persuade or to educate? Within each class, select specific BCTs. These are the ‘active ingredient’. UCL’s free BCT taxonomy lists 93 of them and they even provide the list in mobile app form.

The behaviour change wheel by Michie et al., BioMed Central Ltd (CC BY 2.0).

The right team

In order to build a successful digital intervention, you need to start with the right project team. It’s easy to jump straight to an app developer but for any hope of success a cross-functional team must work together. Your team might include a software engineer, data scientist, behaviour change specialist and an expert in the field whether that be mental health to weight loss. Only by having each specialist area will you be able to build a digital solution which might work. Next the team needs to have a shared language so establishing goals is important.

50% of patients who suffer from chronic diseases adhere to treatment recommendations

Off the shelf?

Getting to the final stages of your intervention is becoming easier. Off the shelf technology solutions are being used to evaluate interventions now. At the University of Toronto researchers devised an Analytics Platform to Evaluate Effective Engagement (APEEE) to assess the effectiveness of a smartphone-based pain self-management app called iCanCope. They used Elastic Stack to help build the APEEE system. Elastic Stack is an off the shelf system which collects, transforms, searches and analyses the results and then visualises the outcomes. Additionally, existing platforms like Facebook and Twitter can provide real-time feedback for your developments, keeping costs low and reaching a bigger audience (if that’s what you need). Both platforms have been successfully used in health programmes.

A different kind of connectivity

One underling point in almost every session was to remember we are dealing with people and people react better with a connection. A strong connection could be brought about by many different techniques which span from online coaching, face-to-face meetings to an app adjustment (which appears to be bespoke).

Changing human behaviour is difficult but hearing about success stories in healthcare was inspiring. As the World Health Organization highlighted in their report Adherence To Long-Term Therapies: Evidence For Action only 50% of patients who suffer from chronic diseases adhere to treatment recommendations. So, discovering new ways to increase patient adherence is good news.