The following is an open letter I wrote to the Digital Health industry. In it I outline some of the mistakes the industry is making by focusing too much on designing technical products, and not enough on what encourages humans to change their behaviour. It was published on a number of websites including: http://www.smartphonehc.com and www.healthstartup.eu.
Dear Mobile Health Industry, Quantified-Self Movement, and Champions of Big Data,
As you are no doubt aware, there has been a recent proliferation of mobile apps, wearable devices, and patient services which allow us to measure and track our daily health behaviors. In a world where so many problems are caused by unhealthy behaviors, the popularity of such products has come to be seen as the future of personal health: the panacea to our chronically unhealthy and overweight society.
We now have access to seamless, reasonably affordable technology that can track how many steps we take, the quality and duration of our sleep, how many calories we burn, and even our blood pressure and mood levels. Never before have we been able to gain such detailed levels of real-time data concerning our health-habits.
This industry operates under the belief that the more aware we are of the details of our daily behaviors, the better position we are in to make the changes necessary to improve our health and lifestyle.
On this view, information is the key to change. The more data we have about how much we move, eat and sleep, the more we can control and alter these numbers to become healthier and happier individuals.
However, while these devices do mark a new and interesting direction for personal health, they fall way short of offering true value to the user as they currently stand. A key piece of the puzzle is missing.
Why? I’ll tell you: because the leap from gathering and documenting the details of your daily behaviors to interpreting this data in a way that encourages action, is far larger than it first appears.
Hence, blind faith in these devices as the ultimate solution to the problems of behavioral health is both misplaced and myopic.
Right now, the majority of these products (Jawbone Up, FitBit, Nike FuelBand, etc.) collect large amounts of data from users and offer feedback in the form of detailed graphs and charts that show their daily activity: how many steps taken, hours slept, and sometimes estimate how many calories are taken in.
So, once you buy-in, your health becomes a numbers game: improve your numbers, and you’ll improve your health.
Sounds simple, right?
Yet, there is an essential step missing from this equation. Nowhere do these devices tell you how to improve your numbers, or what numbers are most worth improving.
You are left with a screen full of detailed metrics with peaks and troughs, but no straight-forward, clear advice on what are the best ways to improve these magical numbers.
Thus, all the responsibility falls on the individual to laboriously sift through the data. They must analyze, interpret and contextualize an array of numbers in order to extract the answer to a simple, yet essential, question: what should I do next?
Most people are neither willing nor able to commit to this kind of work and we are left with a situation where the only people who are actually using these devices, and benefiting from them, are young males who are self-confessed data geeks, or those who are already highly motivated to improve their health (athletes and fitness fanatics).
The majority of people – the ones who are actually unhealthy and at-risk - are left feeling overwhelmed and unmotivated by long lists of numbers and detailed graphs.
These devices and applications assume that all people are perfectly rational actors; almost robot-like, waiting to crunch numbers and, as a result, enhance their performance.
Yet, well-established research from the fields of Behavioral Psychology and Behavioral Economics clearly shows that people are not so calculating and in fact often behave in ways that are seemingly irrational. Any device or application wishing to encourage behavior-change must take account of the complex and nuanced nature of human behavior.
It is time for this industry to break out of the product-development bubble they have created, and to finally acknowledge what it is that people need.
With this in mind, the future of health-technology lies not only in taking in big data, but also interpreting it for the user and feeding it back to them through meaningful insights into what actions they can and should be taking.
Simple, clear, actionable advice about specific behaviors, as opposed to abstracted metrics and lofty goals is the key to encouraging change.
I have been using the Jawbone Up for the past few weeks. At the start, I thought it was pretty cool. It is well-designed, and a great conversation piece. Also, it did make me think about my physical activity. I would try to beat my previous day’s steps and so on.
However, after about two weeks I began falling behind; I wasn’t sleeping well, and I was struggling to get through my runs. This kind of slump is inevitable.
I turned to my device for some help.
But it offered no explanation or hint at why I was having a slump. It could have been a number of factors: not eating well, stress, bad sleeping habits or maybe I was over-doing it. All I needed was some advice on what to do next.
But none was coming.
Without this actionable, understandable recommendation, the data itself is of little value to the majority of people who don’t want to do homework every night on their charts and graphs.
Keep the data in the background and reveal the insight. This is what will truly disrupt the digital health marketplace.
I challenge the industry to rethink their approach. They must pull their heads out from a narrow focus on designing sleek, tracking-only products for the already-healthy, and take a look at what could really help those that actually need to make changes to their health-habits. We are humans, after all.
If you don’t do it, some other company just might.
Dr. Robert Grant and GetHealth team.