I was fortunate enough to attend the South By SouthWest Interactive conference (colloquially ‘Southby’ or SXSW), which benefited from a health ‘track’ that focused on innovation and digital in healthcare.
At the event, I attended a number of panels and I would like to share my notes on some of the panels here. So, I want to talk about a solo piece from
Aza Raskin (@azaaza), founder of the startup Massive Health, who talked about how consideration of feedback loops can help change patient behaviour with regards to lifestyle choices and disease self-management.
Raskin maintains that the secret to changing behaviour is to examine and change these feedback loops associated with health behaviour. For example, a morbidly obese person is likely to be very aware that their condition will have a serious negative impact on their health, and so dieting and exercise to reduce weight/BMI/waist circumference is very important to avoid stroke or myocardial infarction or all the diseases that obesity is a risk factor for. However, we all know that dieting and exercise are very difficult to start and even more difficult to maintain on a long-term basis.
He uses cake as a good example of a feedback loop in action:
A person sees one piece of cake and knows that they shouldn’t eat it, however if they do eat it, there is no immediate consequence (possibly other than guilt or sticky fingers). This demonstrates that people do not consider the cumulative negative effect on health that the cake contributes to, and therefore this cake is part of a long-term feedback loop with consequences way off in the future. The same with cigarettes – smokers know that a cigarette will essentially shorten their life, but those consequences are at the end of the life, not at that moment.
So, it is clear that long feedback loops do not encourage ‘good’ behaviour and, therefore, there is a need to find a way to make it easier for people to adhere to good behaviours for the duration of that feedback loop, either by creating shorter feedback loops (giving often or instant feedback to people on how well they are doing) and/or rewarding people for modifying their behaviour.
To illustrate the idea of rewards for behaviour modification, Raskin described an experiment where young children were presented with a marshmallow. The children were told that they could eat the marshmallow now, however if they waited without eating the marshmallow, they would get a second marshmallow on the researcher’s return (thus the promise of two marshmallows – an exciting prospect for a 4-year-old!). Although the original study was investigating the effect of age on the development of delayed gratification, the point Raskin was making was that the children who waited rather than eating their marshmallow modified their behaviour in order to gain a benefit/reward.
Amusing video of something similar that Raskin showed:
I think this gives food for thought (possibly not marshmallows), as if we can apply this rhetorical theory into the programmes that we produce and find a way to make it work, this could have a great positive impact on patients lives.