Health Management – Center for Advanced Hindsight

Helping Remote Employees Towards a Healthier Lifestyle Some Insights from MTurkers

admin — Thu, 05 Aug 2021 15:05:36 +0000

By Nina Bartmann, Jonathan Corbin, Ziyi Yan

Remote work is here to stay

In response to the global COVID-19 pandemic, around March 2020, most companies across the U.S. required their office-based employees to work from home. While this shift provided new opportunities such as collaborations across time zones and allowing for flexible work hours, it also meant a drastic change for millions of employees. The boundary between work and life has become blurred and routines disrupted.

Prior to the pandemic, there had been much concern over the lack of physical activity in the workplace. Shoulder stiffness, back pain, headaches — these are all common ailments resulting from prolonged sitting. Whereas the change in environment from office to home might bring the potential for positive changes in health behaviors, recent work suggests that those reporting working from home are in fact sitting more.

While many employees are starting to return to their physical offices, remote work is here to stay. Not only have employees voiced their preference of working from home at least a few times per week, many employers have either granted full choice with regards to work location or adopted a hybrid model. Therefore, it is important to find ways in which we can help this new and growing population of “hybrid-workers” reduce their sedentary behavior patterns and encourage more physical activity.

Surveying experts on remote work

Traditionally, efforts to encourage an active lifestyle among employees have relied on (mostly) in-person occupational health and wellness programs. While those are not only expensive, but also difficult to expand to the home environment of employees, we need to find new ways to effectively reach employees regardless of their work location.

In a very real sense, most office workers are now experiencing a work environment that is very similar to that of the average MTurker.

Yet, in order to generate ways to improve healthy work behaviors at home, we first need to understand employees’ environment and habits while working from home. Instead of surveying employees newly transitioned from the office to their home environment, we are able to draw upon results from a large survey that we distributed among Amazon Mechanical Turk (MTurk) workers who are experienced with working from home — they are individuals who do online tasks (like research studies or consumer surveys) from their personal computers. In a very real sense, most office workers are now experiencing a work environment that is very similar to that of the average MTurker.

Thus, by surveying MTurkers, we gained valuable insights from their work experience that we can extrapolate to office-based employees now faced with a reality of a hybrid work model.

Understanding the work environment

The research was conducted between December 2019 and April 2020, and included over 2,000 MTurk workers between 20 and 77 years of age. The majority of respondents use MTurk for part-time work for approximately 11-20 hours per week, which equals to 2-3 hours per day, assuming a 5-day work week.

When asked about their current working location, over 75% of participants reported that they are currently located at home, confirming that most MTurkers were already working from home pre-pandemic and thus are a valid population to draw inference from.

Just like most other office-based employees, surveyed MTurkers all work on desktop or laptop computers. Almost all of the MTurkers indicated that they at least have some space to move around. This information is particularly important as it points out that employees do not face environmental constraints, but other constraints (most likely psychological constraints) that prevent them from moving sufficiently during the work day.

Sedentary and break behaviors

On average, MTurkers spent approximately 5 and a half hours sitting during their workday. When zooming in on the average time different age groups spent sitting during the day, we found that younger adults tended to sit longer and the time spent sitting generally decreased as age increases.

Based on current activity guidelines, it is recommended to break-up sitting and to stand up and move around once every 30 – 60 minutes. From our study results, around 70% of the respondents self-report to adhere to this guideline.

When asking about the types of breaks MTurkers usually take, most of them had to do with meeting basic physical needs such as using the bathroom, or getting water and/or food. Only about 15% of the participants took breaks to go on a walk. Also, only one in four of the participants were actively aware of the health benefits of taking breaks.

Summary

The MTurk workforce provided us with a lot of insights into their work environment and habits while working from home, which we can use to inform future interventions to improve physical activity levels in all desk-based employees now confronted with the reality of a hybrid work model.

While MTurk workers do have enough space to allow for movement, such as stretching, many do not break up their sitting bouts enough, which is particularly problematic among the younger workforce. When sitting is interrupted, it is mostly for physical needs; only few people use their break time to walk or engage in exercise, and only one-fourth of the participants were aware of the health benefits of taking breaks.

Particularly striking is the fact that slightly more than 25% of participants reported spending time on the Internet when taking a break from their work, while only about 15% reported using that time to go on a walk. Whereas social media is certainly entertaining, there are ways in which we can transform that break into a healthier one: Break-up sitting and stand-up while scrolling through Facebook or imitating the latest dance on TikTok (just make sure you do it in a safe place where you can be distracted!)

Particularly striking is the fact that slightly more than 25% of participants reported spending time on the Internet when taking a break from their work, while only about 15% reported using that time to go on a walk.

By making a connection between behaviors – social media use and standing up – we can piggy-back on existing habits to add a new, healthy behavior. If you get some water, use this time to go on a short walk. Any time you open social media, use that as a reminder to stand-up and stretch. These connections are also referred to as implementation intentions — the act of forming “if-then” plans, stating that if a certain situation occurs (e.g. if I’m taking a phone call), then I will respond in a certain way (e.g. then I will stand-up and walk around). Thus, implementation intentions help us remember to complete an activity by associating it with a typical daily habit.

The other benefit of forming implementation intentions is that they are not environment dependent, meaning that they are ideal for employees working in the physical office some days of the week, and at home on other days.

In addition to implementation intentions, other research we have conducted has shown that novel reminders to break up a work task can be effective in encouraging people to stand-up. Our research has shown that up to 86.8% of message recipients indeed follow the advice to break-up their sitting by taking a short break standing up.

As many of us continue working from home or change to a part-time home/work schedule, it is important to develop habits of getting up and moving around periodically, regardless of where we are. Forming implementation intentions as well as thinking of novel and creative ways to remind colleagues or ourselves to stand up more frequently, are promising avenues to combat a lack of physical activity in the workplace.

The post Helping Remote Employees Towards a Healthier Lifestyle Some Insights from MTurkers appeared first on Center for Advanced Hindsight.

Making a doctor’s appointment should be easy. (It isn’t.)

admin — Tue, 05 Mar 2019 15:43:50 +0000

This post originally appeared on the Pattern Health blog.

By Aline Holzwarth

I recently had a friction-filled experience when I tried to make an appointment for a routine physical exam. It’s been a while since I’ve had my annual exam, as my previous doctor moved away in 2015 and I haven’t gotten it together enough to find a new primary care physician. (I know! Shame on me.) Finally I had a few extra hours this past weekend, and instead of using them to catch up on email I decided to take care of my preventive health needs.

So I launched myself into the research stage. I downloaded an app (very popular, highly rated, I’m sure you’ve heard of it) that provided me with information that could only be completely inaccurate (locating no doctors within 20 miles or so, despite the fact that I live in an area densely packed with medical care).

I turned to google to ask how to find a doctor, which pulled up a nifty “Find a Doctor” page. But with every answer came a new question, and I quickly found myself flooded with a deluge of information to compare but no great way to compare it. I resisted making a spreadsheet and instead opened up browser tabs for the eligible doctors, starting with 39 physicians and ultimately narrowing down to only three. To narrow my search down to three, I had to figure out where the various doctor’s offices are and how close they are to my work and home, whether their hours accommodate a 9-to-5 working schedule with night and weekend availability (none do), whether they take my insurance (surprisingly difficult to confirm), whether the cost is any different to go to a family medicine center near my house (I’m still not entirely sure), what the difference is between internal and family medicine (not much, I think?), and which physician is best for my particular needs.

By the time I had narrowed my options down to three doctors, I was exhausted and ready to quit. So I watched the short videos taken of each physician and chose the one who mentioned her collaborative problem-solving approach with patients. But mostly, she seemed nice. Note: Sometime in the future we should talk about System 1 decision-making.

Ready to get this over with and return to my weekend chores, I moved on to the action stage. Now all I had to do was make an appointment with my chosen physician. New questions arrived: First, of course, How do I make an appointment? Can I do it online immediately, or do I have to call someone? If I have to call someone, can I do it right now (remember, it’s the weekend) or do I have to wait until a weekday during work hours?

After hours spent researching physicians and finding the answers to my questions, I still didn’t have an appointment. I was left with the option to send a message requesting an appointment (no, I was not able to schedule online) or call in later when the office is open (I know myself well enough to not rely on that — after all, it did take me four years to put any effort into finding a new primary care doctor.)

Now here I am, hoping that someone will see my appointment request and reach out to me. It might not be hyperbole to say that if I don’t get a scheduling call or email, I might never go to the doctor again.

All this is to say that small barriers are a BIG deal. One tiny little step can be *the step* that prevents someone from achieving their desired health behavior. Even something as small as mental effort (deciding, what kind of doctor do I want?), or something that needs to be looked up (I have to input my health insurance number? I guess I’ll have to find my card), or too many fields in a form (I have to enter my address AGAIN?) — all these steps are friction, and they each decrease the chance that you’ll find a doctor.

Small barriers are a BIG deal. One tiny little step can be *the step* that prevents someone from achieving their desired health behavior.

These are exactly the kinds of barriers we’re talking about in the Friction and Fuel Framework (which you can read a bit about here, and download below).

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Decrease friction and add fuel for health behavior change

admin — Fri, 01 Mar 2019 15:09:19 +0000

This post originally appeared on the Pattern Health blog.

By Aline Holzwarth

Human behavior is anything but simple, and for that exact reason I believe that oversimplifications can be useful in the first step of designing for behavior change. When it comes down to it, there’s a lot of human behavior that we can explain in terms of two simple forces: Friction and Fuel.

There’s a metaphor that Dan Ariely uses that I think is very nice, and that’s of a rocket ship. It would work just as well with a plane or a car, but let’s face it — you can’t beat a rocket on the cool-meter. For a rocket ship to fly through space, it needs to not only bypass atmospheric friction and avoid debris, but also consume fuel to propel itself up and out of the atmosphere. Too much friction, and it won’t fly. Not enough fuel, and it won’t fly either.

Too much friction, and it won’t fly. Not enough fuel, and it won’t fly either.

Ok, you get the metaphor. How do these two forces, friction and fuel, play out in healthcare?

Friction in Healthcare

In healthcare, frictions are anything that get in the way of performing that positive health behavior, from the feeling of exhaustion that always arrives when it’s time to exercise to that application form you have to fill out to opt in to your health savings account. Technology can go a long way to decrease friction, removing steps like filling out forms by hand and mailing them, or bringing the doctor to you through your smartphone instead of having to make an appointment, take off time from work, and get to the clinic.

If we return to the rocketship example, we can think about gravity as an important type of friction. The gravity of our lives — the thing that is always there and keeping us steady and stable — that’s the status quo. We can move against the status quo, but it takes some effort. Just like gravity, the status quo may be an invisible force, but it’s deceivingly powerful. One way to combat the status quo is to add fuel.

Fuel in Healthcare

Fuel is anything that makes a positive health behavior more appealing, from the gamification of un-fun procedures to delivering incentives (rewards, discounts, and so on) contingent on good behavior (like the WellnessWins rewards program from WeightWatchers). Fuel doesn’t have to come in the form of tangible rewards like baseball hats and travel shoe bags, and in fact the joy of playing a game can be even more motivating than winning a prize. For example, one s tudy (Kumar, Wentzell, Mikkelsen, Pentland & Laffel, 2004) used a guessing game to incentivize diabetic children to better manage their condition (“try and predict your next blood glucose measurement!”).

Personally, there’s nothing that gets me moving like a good old fashioned competition. But if competition’s not your thing, try temptation bundling (Milkman, Minson & Volpp, 2013) where you pair “want” activities (like listening to an addictive audiobook) with “should” activities (like exercise). If you only allow yourself to consume The Hunger Games while on the treadmill, you’ll be much more likely to get to the gym.

These are just a few examples of friction and fuel in healthcare, but we’ve added a lot more to the comprehensive Friction and Fuel Framework, which we’ll share with you if you trudge through a bit of friction and share your email address with us (don’t worry, we promise not to do anything evil with it).

Behavioral science is incredibly complex, but the reality is that it’s possible to use these two simple concepts of friction and fuel to make a big difference in behavior change. You can decrease friction and add fuel to make desired behaviors simple, salient and appealing — and, importantly, more likely to actually happen.

Find the Fuel and Friction Framework here.

References

Kumar, V. S., Wentzell, K. J., Mikkelsen, T., Pentland, A., & Laffel, L. M. (2004). The DAILY (Daily Automated Intensive Log for Youth) trial: a wireless, portable system to improve adherence and glycemic control in youth with diabetes. Diabetes technology & therapeutics, 6(4), 445-453.
Milkman, K. L., Minson, J. A., & Volpp, K. G. (2013). Holding the Hunger Games hostage at the gym: An evaluation of temptation bundling. Management science, 60(2), 283-299.

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Why This New Year’s Will Be Different: How Behavioral Science Can Help You Keep Your Resolution

admin — Thu, 20 Dec 2018 19:46:56 +0000

A version of this post originally appeared on the Envolve Blog.

The holiday season is a beloved time across America when we fill our houses with family, friends and laughter, and fill our bellies with meals, drink and dessert. By January 1, reality sets in along with a few unwanted extra pounds.

The end of the holiday season offers us a chance to make up for our overindulgences in the form of a New Year’s resolution. Among the 44 percent of the U.S. population that make resolutions, “be a better person,” “lose weight” and “exercise more” were the most popular in 2018.

Despite our intentions, almost 30 percent of New Year’s resolvers give up in just two weeks. Six months later, that number shoots up to more than 50 percent.

Behavioral scientists call this problem the intention-behavior gap. And it turns out to be a pretty big gap.

Why Is It So Hard to Keep Our Resolutions?

The New Year is a monumental moment, and we strive to make monumental changes. In doing so, we display an optimism bias — we’re overly optimistic about our chance of success. As a result, we set vague, unachievable goals — a recipe for failure.

Even the smallest roadblocks make it less likely that that we’ll enact our resolutions. This is known as friction costs, which refers to our tendency to be deterred by seemingly small barriers.

Adding to the challenge is a phenomenon known as ego depletion. Ego depletion suggests that our willpower gets tired the more we use it. A single act of self-control now leaves us even more susceptible to temptation later.

With our self-control depleted, we find it almost impossible to resist that delicious chocolate cake. For this, we can thank present bias, the tendency to choose immediate rewards over our long-term goals. Present bias works hand in hand with our (lack of) self-control, and together, they send us down a slippery slope.

You promised to cut back on sweets, but a single bite of chocolate cake can’t hurt, right? The what-the-hell effect describes how a small step off track can cause us to spiral out of control. Because once you have one bite, you might as well have another. And now that you’ve had two, well, what the hell …

This Time Can Be Different

I’ll admit, the situation looks pretty dire. To keep our New Year’s resolutions, we’re up against a formidable team of behavioral biases and fallacies, each conspiring to get us to give up on exercise, eat more junk food, and leave our resolutions behind.

But there’s good news. Behavioral science has discovered the strategies that can make this New Year’s different than the rest.

Step #1: Make it SMART

To accomplish your resolution, you’ll need to overcome the optimism bias. Try making a SMART resolution. Revise your resolution until you can answer yes to the following:

Is your resolution as specific as possible? Can you measure your progress? How achievable is it? Is it relevant to your life goals? Do you have a time limit?

My SMART resolution: To run a half marathon by June.

Step #2: Break It Down and Build It Up

Reducing friction costs requires making it as easy as possible to achieve your resolution. To do this, break your resolution down into smaller “sub-resolutions,” like running for 20 minutes on Saturday.

This sub-resolution may seem small, but that’s the point. Small goals lead to small wins, small wins build momentum, and momentum is crucial for long-term success.

Still, sustaining momentum requires making progress. Once you successfully complete your sub-resolution, try making it a little bit harder next week. Keep adjusting to keep your sub-resolution challenging, but still achievable.

This week’s sub-resolution: To run for 20 minutes on Saturday.

Step #3: Find Your Opportunity

Now that you have a sub-resolution in place, you’ll need to make a plan. “Opportunity plans,” or when-then plans, map out exactly when, where and how you’ll act. By planning in advance, they also lessen your chance of succumbing to ego depletion and present bias.

To make your opportunity plan, use the “when-then” formula to decide when and where you’ll do your sub-resolution.

My opportunity plan: When it is 10 a.m. on Saturday, then I will run for 20 minutes around my neighborhood.

Step #4: Overcome Your Obstacles

A simple plan can also stop the what-the-hell effect in its tracks. “Obstacle plans,” or if-then plans, let us decide how we’ll behave when a challenging obstacle arises.

To make your obstacle plan, identify an internal obstacle to carrying out your opportunity plan. Then, decide on one behavior to overcome that obstacle.

To make your obstacle plan, use the “if-then” formula.

My obstacle plan: If I feel too tired to run, then I will play some music to wake me up and get moving.

The Year Ahead

Achieving your New Year’s resolution won’t be easy. Behavioral biases and fallacies leave us overly optimistic, easily deterred, tired and feeling a lack of control. But with the help of a few simple strategies tested by behavioral science, you can turn your resolution into reality. Here’s to the New Year, and each one that comes after it. Because this time really will be different.

Jonathan Cloughesy is a behavioral scientist in the Better Living and Health Group at the Center for Advanced Hindsight at Duke University. He is a recent graduate of the University of California Santa Barbara, where he studied biopsychology and applied psychology. He is interested in the design and evaluation of scalable interventions that promote health behavior.

The Envolve Center for Health Behavior Change™ is a partnership between the Brown School at Washington University in St. Louis, The Center for Advanced Hindsight at Duke University and Centene Corporation. The Envolve Center advances life-centric health research to improve lives so that communities can thrive.

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Birds of a feather don’t just flock together. They also influence each other’s behavior.

admin — Mon, 19 Nov 2018 17:27:10 +0000

This post originally appeared on the Pattern Health blog.

By Aline Holzwarth

Your beliefs don’t always predict your behavior

While it’s true that your beliefs may spur action when you’re particularly passionate about something (if you believe that Coke is superior to Pepsi, you’ll choose Coke over Pepsi until you die), it may come as a surprise that you’re actually not as influenced by your beliefs as you think (for example, if you believe ice cream is not great for you, but eat it anyway).

Oftentimes, your beliefs are not very strong and don’t translate into behavior. Preferences can be elicited in the moment, influenced by extraneous factors (even the mere presence of a number) that are completely unrelated to the thing at hand. If such arbitrary things can sway your decisions, just imagine the influence that much more relevant factors could have on you.

Social norms guide your behavior

Types of Norms (a cheat sheet)

Personal Norms: your own internal standards of conduct
- I recycle
Social Norms: perceived standards of group behavior
- Descriptive: what most other people like me are doing
  1. My peers recycle
- Injunctive: what most other people like me find desirable
  1. My peers think it’s good to recycle

Other people are one of the strongest influences over your behavior. But how do they influence you? Two ways, basically: What they do, and what they approve of — even merely what we think they do, and what we think they approve of.

As inherently social creatures, humans constantly seek affirmation from their peers. Social norms are the informal, often-unstated rules that govern what is considered normal in a society. Social norms (see our cheat sheet to the right) determine what sorts of behavior you think is acceptable among your peers, and therefore what is acceptable to you.

What others do

We all want to fit in, so we take cues from others to make sure we’re doing the socially acceptable thing.

First, let’s consider the norms surrounding the behavior of other people like you do. (Pro tip: these are called descriptive norms). When others behave in one way, that behavior is more desirable. We all want to fit in, so we take cues from others to make sure we’re doing the socially acceptable thing. Imagine, for example, that all the people you admire are recyclers. You’re probably going to be a recycler too. And if you ever throw a plastic bottle into the trash, you’re going to be pretty discrete about it.

When social norms help, and when they can backfire

Any discussion of social norms would be incomplete without a mention of the father of social norms: Robert Cialdini. One important study from Cialdini and colleagues (Schultz, Cialdini, Goldstein & Griscevicius, 2007) looked at when social norms help, and when they backfire — and how to mitigate the backfire effect. The norms that reflect what others do serve as a reference point to judge your own behavior against; so they are helpful and motivating when you’re doing less well than others, but backfire if you’re better than average (your behavior relaxes instead of continuing on as the superstar you are). If you are below average on saving energy, for example, then knowing this will motivate you to save more. On the other hand, if you are above average on saving energy, this same information will lead you to decrease your saving efforts.

What others believe

To solve this backfire problem, the researchers decided to harness a different kind of social norm to communicate what others find desirable rather than what others are doing. If descriptive norms are what everyone else is doing, injunctive norms are what everyone else believes. The researchers found that when they incorporated a simple smiley face to communicate approval of energy efficiency, the backfire effect went away — an effect that persisted a month after the intervention. So if you were in the study and if your energy use was more efficient than average and you saw a smiley face of approval along with this information, you were now likely to continue saving and maintain your superstar status.

What other people believe is an important predictor of behavior.

Julie O’Brien, Principal of Better Living and Health at the Center for Advanced Hindsight at Duke University and previously a behavioral research manager at Opower (which was acquired by Oracle in 2016 and f ounded on the heels of social norms research) recently published findings from her time at Opower. In the article, authors Jachimowicz, Hauser, O’Brien, Sherman and Galinsky (2018) look at perceptions of others’ beliefs in the context of saving energy. O’Brien says of her work, “Our research shows that beliefs about what other people believe are an important predictor of behavior in response to social norm information. If I believe that my neighbors care about saving energy for the environment, and I see that I’m not performing well compared to my neighbors, then I’m likely to be responsive to the social norm feedback by changing my behavior. But if I don’t believe that my neighbors care about saving energy for the environment and I find out I’m not performing well compared to my neighbors, the social norm information has less of an effect on my behavior. Social norms don’t influence people uniformly.” As with all things in behavioral science, perception matters — two different interpretations of the same information can lead to very different behaviors.

Social norms in Pattern Health

The positive beliefs and behaviors of other patients are highlighted as a motivational tool in Pattern Health to help patients realize just how popular some health behaviors are. We can share the optimistic beliefs of other patients, or fun facts about what other patients are doing when that behavior is both popular and desirable. (We do not, of course, highlight behavior that is unpopular and desirable, as that would send the message that no one does the desirable behavior and therefore you don’t need to, nor do we highlight popular and undesirable behavior as that would send the message that everyone does the undesirable behavior and give permission to join them).

Imagine that as a patient you were informed that the majority of other patients like you regularly walk for exercise (as demonstrated in the Pattern app to the right). This information is likely to make you want to start walking if you aren’t already, or help you feel affirmed if you already are.

This sort of social norm information can be shared in other ways as well, including through social media where patients can find the approval of their peers. These same peers can provide varying levels of support, from simply signaling that healthy behaviors are the norm to providing accountability when patients need an extra dose of encouragement.

The persistence of social norms

Social norm interventions lead to long-term results.

The best thing going for social norms is that (unlike some short-term incentives or nudges), social norm interventions can lead to more long-term results. And it makes sense that social norms lead to longer-term change. To have a sustainable impact, technologies and behavior change interventions need to integrate with the permanent societal structures of our everyday lives. Technologies come and go, but the role of social networks — in person and online — is here to stay. While the form of human relationships may change over time, other people will always be an integral component of our lives. And because of this, we should incorporate these systems in behavior change efforts, particularly when behaviors are as complex as those related to health.

References

Schultz, P. W., Nolan, J. M., Cialdini, R. B., Goldstein, N. J., & Griskevicius, V. (2007). The constructive, destructive, and reconstructive power of social norms. Psychological Science, 18(5), 429-434.
Jachimowicz, J. M., Hauser, O. P., O’Brien, J. D., Sherman, E., & Galinsky, A. D. (2018). The critical role of second-order normative beliefs in predicting energy conservation. Nature Human Behaviour, 2, 757–764.

The post Birds of a feather don’t just flock together. They also influence each other’s behavior. appeared first on Center for Advanced Hindsight.

If social media is bringing you down, you’re probably not doing it right.

admin — Thu, 01 Nov 2018 17:18:27 +0000

This post originally appeared on the Pattern Health blog.

By Aline Holzwarth

Social media is everywhere, and shows no signs of slowing down. There are now more monthly active Facebook users in the world than there are households owning a television set. Any product experiencing this degree of success is bound to experience backlash, and it’s no surprise to see headlines touting the dangers of social media. The New York Times warns us of systemic misinformation; prominent researchers like Leslie John of Harvard outline the state of personal data collection by companies of their consumers, and how we are lured into divulging our secrets to the strangest of strangers — not only by marketers, but even by our own minds. It’s not a rosy picture being painted of the networks that connect our online selves.

Please understand — it’s not my intention to downplay any of the very real concerns about the risks that social media exposes us to, nor the responsibility of industry to step up its game. (Indeed, I share the concerns of the New York Times and Leslie John, and I’ve even written with Dan Ariely about how organizations can weigh the tradeoffs between privacy and transparency to make better decisions for and with their constituents.) However, it is entirely my intention to argue that, still, it is possible to use social media for good. Not only possible, but advisable. I’d like to propose two things: First, that there is a right and wrong way to use social media more generally, and second, that we can harness the power of social media to support our health goals.

How to do social media right

Social media affects you negatively when it displaces human interaction, but positively when it supplements real-world interactions.

You may have heard that social media is leading the planet into a global depression, causing people everywhere to pick up a newfound form of antisociality where they no longer remember how to interact with other human beings. But if social media is bringing you down, you’re probably not doing it right. Fortunately, there is a pretty simple formula for getting it right. Recent research shows that when you use social media to deepen existing offline relationships or make new offline friends, it leads to decreased loneliness (Nowland, Necka & Cacioppo, 2017) and increased sociability (Waytz & Gray, 2018), whereas when you use social media as escapism, in the place of offline relationships, it leads to greater loneliness and decreased sociability. In other words, social media affects you negatively when it displaces human interaction, but positively when it supplements real-world interactions. If you hope to reap the social benefits of social media, make sure that your relationships are primarily grounded in the real world. Not to mention, too much of anything can backfire; use the “stop after 30 minutes” heuristic to limit your time on social media each day.

That’s all good and well, but what if you can use social media in even more useful ways? What if you can use social media for your health?

How to use social media to support your health goals

I used my social network to hold myself accountable and reach my health goal.

As I was preparing, physically and mentally, for a 5-mile race a while back, I decided to share it with others. I posted my plan on Twitter, not to show off (trust me, I barely made it to the finish line), but to hold myself accountable. I knew that by declaring my goal to the wide world of Twitter, I wouldn’t be able to back out of the race. I leveraged my social network to hold myself to my health goal, ensuring that I not only showed up on race day, but also that I continued training for it in the months leading up to it. I thought that if I shared my plan on social media, I’d be more likely to stick to it.

And research confirms this intuition. A meta-analysis of interventions using social networking sites showed that social media interventions were indeed effective at changing health behaviors (Laranjo et al., 2014). Good news! Turns out, social media can be used to promote health behaviors (and not just spread hate and lies).

Social media in Pattern Health

How to use social media to strengthen your relationships and achieve your health goals:

Use it to enhance — not substitute — offline relationships
Limit your usage to 30 minutes a day
Announce your health goals publicly to hold yourself accountable
Share your health activity over time to keep your networks in the loop on your progress

At Pattern Health, we’ve used social media to promote health behaviors among our users, and we’ve done this in a few different ways. The simplest way that we leverage social media for good is by allowing patients to share their commitment to their health plan, or pattern, on Facebook. This is a simple way of declaring that they are dedicated to sticking to their plan.

And we’ve also experimented with other versions of using social media to help people reach their health goals. A one-time commitment (such as sharing one’s commitment to their pattern on Facebook) can be an effective way of declaring a commitment, but the effect of this single commitment may disappear over time. Imagine that you not only share your commitment to your plan as a whole, but you also share your activity over time such that your networks are kept in the loop on your progress. On any given day, your network may learn that you succeeded at reaching your step goal, or you failed to take your medication. And this could just be the motivation you need to make sure you get in your steps or take your meds on time.

We tested this version of daily sharing in a 7-week pilot study where we asked participants to opt in to sharing their activity for a few health behaviors on Facebook each day. And we found that it worked! For example, participants who shared their medication-taking progress on Facebook had much higher adherence to their twice-daily “medication” regimen (which, in this case, was a bitter-tasting multivitamin) than those who did not share on Facebook. As you can see in the graph below, Facebook sharing led to much higher adherence over the course of the study than those who kept their health behaviors to themselves.

As humans, we are inherently social animals. We care what others think about us, and want to make sure our networks think of us positively. This social incentive can get us to behave in all sorts of ways, and social networks can serve as a vehicle to transmit this information. So, you ask, can social media be used for good instead of evil? We certainly think so.

References

Nowland, R., Necka, E., & Cacioppo, J. (2017). Loneliness and social internet use: Pathways to reconnection in a digital world? Perspectives on Psychological Science. 13, 70-87.
Waytz, A. & Gray, K. (2018). Does Online Technology Make Us More or Less Sociable? A Preliminary Review and Call for Research. Perspectives on Psychological Science, 13(4), 473 – 491.
Laranjo, L., Arguel, A., Neves, A. L., Gallagher, A. M., Kaplan, R., Mortimer, N., Mendes, A. & Lau, A. (2014). The influence of social networking sites on health behavior change: a systematic review and meta-analysis. Journal of the American Medical Informatics Association, 22(1), 243-256.

The post If social media is bringing you down, you’re probably not doing it right. appeared first on Center for Advanced Hindsight.

A how-to guide for setting better goals

admin — Tue, 23 Oct 2018 17:15:17 +0000

This post originally appeared on the Pattern Health blog.

By Aline Holzwarth

We often hold vague notions about what we want to do for our health. You might say you want to exercise more, eat healthier, or stick to the doctor’s orders. But it’s not often that we transform those fuzzy desires into concrete action plans. And yet, we would be so much more likely to succeed if we simply set better goals to plan our behavior before those moments of temptation hit.

How to Set Better Goals with Implementation Intentions

We’ve written before about the magical powers of implementation intentions, which is what informs this goal-setting guide. Now it’s time for you to set your own goals using implementation intentions. Just follow these four simple steps and you’ll be well on your way to supercharging your health goals.

Get started now by downloading our Goal-Setting Worksheet here, a resource we made in collaboration with Dan Ariely’s Center for Advanced Hindsight at Duke University.

DOWNLOAD THE GOAL-SETTING WORKSHEET

Or read on to learn more about each step.

1. Choose your Big Goal

Do you want to start flossing? Perhaps you want to have more energy or feel stronger. How about decreasing your stress? Increasing the number of veggies you eat? Creating deeper bonds with your friends? Adhering to a complicated medication regimen?

Once you’ve chosen your Big Goal, make it “SMART” with the following steps.

Specific – make your goal as specific as possible. Then make it even more specific.
Measurable – how will you know when you’ve reached your goal? s
Achievable – it’s good to set challenging goals, but make sure you can succeed. Is your goal possible?
Relevant – how is your goal related to the things that are important to you in life?
Time-bound – when will you reach your goal?

Say your Big Goal is to stay hydrated. Here’s how you can make that goal even better.

Specific: I want to drink 8 glasses of water a day in order to stay hydrated.
Measurable: Each glass has ~8 oz of water in it, and I need to drink 8 of them every day.
Achievable: I have access to drinkable water and glasses
Relevant: I want to do this because I read about the health benefits of drinking water and it is important to me to stay healthy.
Time-bound: I would like to start this immediately, and continue this behavior indefinitely.

DOWNLOAD THE GOAL-SETTING WORKSHEET

2. List your Goal Steps

What do you need to do to reach your goal? If you need to get 8 hours of sleep a night, how will you achieve that? (What time do you need to go to sleep and what time do you need to wake up? When do you need to start your bedtime routine — pajamas, facewash, brushing teeth — to get to sleep on time? How will you finish up all that you need to do in order to start your bedtime routine on time? And hey, we get it, it’s hard to be in bed before 10pm! You often find yourself making dinner too late, then responding to emails far later than you intend, and then you just want to relax and feel better about life with an episode or four of Queer Eye. Ok, we might have some experience with this..)

For the purpose of this example, let’s stick with our “drink 8 glasses of water a day,” big goal and list the corresponding goal steps.

Create a tentative schedule for drinking each glass of water

1. Right when I wake up

2. With breakfast

3-4. At lunch (2 glasses)

5. On the way home from work

6-7. With dinner (2 glasses)

8. Right before bed

Keep track of my water drinking throughout the day so I know when my daily goal has been reached
Fill my water bottle in the morning to bring to work (where I can refill it later)
Bring my water bottle with me to work
Take my water bottle back home
Wash the water bottle and put it somewhere I won’t forget it tomorrow

DOWNLOAD THE GOAL-SETTING WORKSHEET

3. Identify your Obstacles

There are lots of things that could get in the way of your goal steps. Most of these obstacles will be surmountable, but you’ll be more likely to overcome them if you foresee them to make a plan in advance.

Sticking with the water-drinking example, let’s list out some things that could go wrong.
I forget to drink in the morning when I wake up
I don’t want to drink water with breakfast because I am desperate for caffeine and want to drink coffee
I order a non-water drink at lunch or dinner when eating out and am not thirsty for water
I forget my water bottle at home
I run out of time
I’m not in the mood
I’m not excited about drinking water
I’m not thirsty

DOWNLOAD THE GOAL-SETTING WORKSHEET

4. Make an If-Then Plan

What will you do if these obstacles come to fruition? Set an implementation intention in the form of “if [obstacle from Step 3] occurs, then I will [plan to overcome the obstacle]”

For all the obstacles you listed in Step 3, think through what you will do in each situation.

If I forget to drink in the morning when I wake up, then I will have an extra glass with breakfast
If I don’t want to drink water with breakfast because I am desperate for caffeine and want to drink coffee, then I will drink coffee in addition to water
If I order a non-water drink at lunch or dinner when eating out and am not thirsty for water, then I will still drink two glasses of water (in addition to the other drink) rather than replacing my water with that other drink
If I forget my water bottle at home, then I will use a backup glass that I keep at work for drinking water throughout the workday
If I run out of time, then I will make sure to have water with me so I can drink it while partaking in other activities (like walking, being in meetings, while working, commuting)
If I’m not in the mood, then I will ask a friend or coworker to hold me to my goal
If I’m not excited about drinking water, then I will create a water-drinking ritual to make it more enjoyable
If I’m not thirsty, then I will remember why it is important to me to drink water, and do it anyway

P.S. We are very much interested in how you are using behavioral science for your health. If you’ve made your goals based on this guide, send us a tweet @ptrnhealth to let us know what it is

DOWNLOAD THE GOAL-SETTING WORKSHEET

The post A how-to guide for setting better goals appeared first on Center for Advanced Hindsight.

Implementing our Best Intentions

admin — Tue, 16 Oct 2018 20:02:18 +0000

This post originally appeared on the Pattern Health blog.

“If I am parking, then I will park in the spot farthest from my destination.”

“If I wake up tomorrow morning, then I will put on my shoes and go on a 20 minute run.”

“If I am feeling tempted to eat a cookie, then I will put tape over the lid of the cookie jar.”

“If there are fried things on the menu, then I will not order them.”

“If I finish brushing my teeth, then I will take my medications.”

“If I am about to shower, then I will weigh myself on the scale.”

“If there are stairs, then I will take them.”

These are all examples of what behavioral scientists call “implementation intentions” (sorry, it’s a mouthful — scientists don’t always play nice when they invent their terms). I won’t tell you which of these implementation intentions I’ve applied to my own life, but I will tell you that it’s more than one. These kinds of if-then plans are remarkably effective at translating vague desires into concrete action plans that might actually come to fruition. What are implementation intentions, and how do they work?

Implementation Intentions are Specific Plans for Behavior

Implementation intentions are specific plans for behavior. There are hundreds of studies showing just how effective implementation intentions can be (see Gollwitzer & Sheeran, 2006 for a meta-analysis), a surprising finding given how simple they are to create. Just by setting a specific plan for your desired behavior, you’re more likely to follow through. And when I say specific, I mean really specific. The best plans include all the whos, whats, whens, wheres and hows.

Situations Trigger Reactions

If the first part of implementation intentions is adding more specificity around a particular behavior, then the second part is choosing a situational trigger that will cue your planned response.

Let me dissect that a bit. Implementation intentions usually take the form of, “If situation A occurs, then I will do X behavior.” The situation then becomes a trigger for the behavior when it comes up in real life.

Take this one, for example: “If there are stairs, then I will take them.” Seeing a staircase becomes a trigger for walking up them. If you confront a set of stairs (which generally show up where there’s an elevator or escalator around), then you already have a rule established in advance to guide your behavior. This rule makes the decision for you; it determines that you will choose the stairs over any other alternatives. Taking the elevator is simply not an option — you have eliminated it from your choice set.

Implementation Intentions in Pattern Health

At Pattern Health we use implementation intentions to help patients make better plans. In one study, congestive heart failure patients who need to carefully monitor their weight used implementation intentions to remember to step on the scale. They did so by deciding when they would take a measurement that afternoon, choosing their preferred situational trigger for stepping on the scale (see screenshot). They chose between stepping on the scale before or after dinner, or before or after brushing their teeth.

So, for example, if patient chose “after dinner” then their if-then statement was: “If I have finished eating dinner, then I will step on the scale,” and finishing dinner served as their cue to step on the scale.

When these patients set an implementation intention, they were twice as likely to take the afternoon weight measurement. As you can see in the graph, heart failure patients who set an implementation intention stepped on the scale 70% of the time compared to only 36% of the time when they didn’t set an implementation intention.

And all they did was decide when exactly they planned to step on the scale. That’s the beauty of implementation intentions. They are as easy as can be, and remarkably effective. So if you are looking to turn your fuzzy goals into actual results, why not try setting up some implementation intentions?

P.S. We are very much interested in how you are using behavioral science for your health. If you’ve made your own implementation intentions, send us a tweet @ptrnhealth to let us know what it is.

References

Gollwitzer, P. M., & Sheeran, P. (2006). Implementation intentions and goal achievement: A meta-analysis of effects and processes. Advances in Experimental Social Psychology, 38, 69-119.

About the author

Aline Holzwarth is an applied behavioral scientist, primarily focusing on digital health research and scientifically informed product design. She is Head of Behavioral Science at Pattern Health, an evidence-based connected care platform that leverages behavioral science to help patients stick to their care plans. She also co-founded the Behavior Shop, a behavioral science advisory company, and holds an appointment as Principal of the Center for Advanced Hindsight at Duke University, an applied behavioral science lab that helps people be happier, healthier and wealthier, at home and abroad.

The post Implementing our Best Intentions appeared first on Center for Advanced Hindsight.

Using Social Norm Marketing Tactics for Effective Health Communications

admin — Thu, 11 Oct 2018 17:35:46 +0000

This post originally appeared on the Envolve Blog.

In a world filled with misinformation, it’s tempting to design health campaigns that correct false beliefs. Many educational campaigns attempt to do so by first stating and then debunking the common myth. For example, a typical ad campaign might say:

“The flu vaccine causes the flu. FALSE! Thousands of studies have proven that you cannot get the flu from the flu vaccine.”

Unfortunately, research shows that these myth-correcting strategies don’t actually work. In today’s blog post, we’ll explain why you should avoid myth-busting in your health campaigns and use a social norms approach instead.

Myth-busting is not effective and can backfire.

Numerous studies have shown that debunking common myths can actually backfire. For example, after being told that the flu vaccine cannot cause the flu, people who were highly concerned about vaccine side effects actually became less likely to vaccinate.^[1]When individuals are exposed to information that disconfirms strongly-held beliefs, particularly beliefs tied to their identities, they are motivated to cling to their original beliefs due to consistency bias. As a result, they dismiss the new information as irrelevant, thereby further reinforcing their existing belief.

In another study to test myth-busting effectiveness, participants were presented with four true statements paired with supporting evidence, along with four false statements paired with a correction and supporting evidence.^[2] When surveyed a few days later, participants tended to incorrectly remember one of the four false statements as true. The more false statements someone misremembered as true, the more their attitudes shifted to align with the false statements. “Myth-busting” thus not only damaged recall, but also shifted initially neutral attitudes towards false beliefs!

Try social norms instead!

If you’ve stayed in a hotel recently, you may have noticed a card in your room asking you to reuse your towels. Perhaps they tried bribing you with a credit at the coffee shop or guilting you about the environmental impact. We’re susceptible to both caffeine and guilt trips, but there’s an even more effective route: telling people about the behaviors of others. As social creatures, we want to fit in, and one of the best ways to fit in is to do what everyone else is doing. (Sorry, Mom, if everyone is doing it, over the cliff it is!) People rely on group norms to guide their behavior; changing perceptions of norms can nudge people toward new, desirable behaviors.

Researchers^[3] partnered with a hotel to test whether changing the message on the towel card could increase towel reuse. Rooms were randomly assigned to receive a neutral message, simply asking people to reuse their towels to help the environment, or they were asked to join their fellow guests in reusing towels to save the environment. The standard message resulted in about one-third of guests reusing towels, while the message establishing a group norm resulted in about half of guests reusing their towels. Follow-up work in this domain has found smaller but reliable effects,^[4] and an energy efficiency company, Opower, has applied this finding to increase conservation among their users.^[5]

Social norms can also be deployed in a health context. For example, colleges are a hotbed of health social norms campaigns, trying to give students accurate information about the way their peers study, eat, drink and exercise. In our research partnership with Envolve and Centene Corporation, we tested the concept of social norms and their impact on our members as it pertains to flu vaccination-seeking behavior. The new flu vaccination campaigns found that a social norms framing increased the percentage of Centene members who said that they were likely to get a flu shot after viewing the campaign (46 percent) when compared to the percentage who viewed a myth-busting frame (41percent). Based on this research, Centene is implementing its flu vaccine campaign for health plan members in the 2018-2019 flu season using social norms.

Social norm campaigns seem to be most effective when the message is:

Relevant: College students want to know the drinking norms of their peers, not their parents!
Relatively specific: “Hotel guests in this room” may be stronger than “hotel guests” at large.
Doable: Don’t ask people to give up electricity altogether!

With these guidelines in mind, you can build stronger, more effective campaigns no matter the target behavior.

About the Authors

Lindsay Juarez is a senior behavioral scientist in the Center for Advanced Hindsight at Duke University. She has a Ph.D. in social psychology and specializes in goal pursuit and self-control. She works with the Envolve Center’s Behavioral Economics (BE) team, which incorporates BE and social science into health-related behavioral modification programs.

Rachel Kahn is a behavioral researcher on the Better Living and Health Group at the Center for Advanced Hindsight at Duke University. She has a BS in biomedical engineering and a strong background in social psychology. She works with the Envolve Center’s Behavioral Economics (BE) team, which incorporates BE and social science into health-related behavioral modification programs.

About the Envolve Center for Health Behavior Change™

^[1] Nyhan, B., Reifler, J., & Ubel, P. A. (2013). The hazards of correcting myths about health care reform. Medical care, 51(2), 127-132.

^[2] Peter, C., & Koch, T. (2016). When Debunking Scientific Myths Fails (and When It Does Not) The Backfire Effect in the Context of Journalistic Coverage and Immediate Judgments as Prevention Strategy. Science Communication, 38(1), 3-25.

^[3] Goldstein, N. J., Cialdini, R. B., & Griskevicius, V. (2008). A room with a viewpoint: Using social norms to motivate environmental conservation in hotels. Journal of Consumer Research, 35(3), 472-482.

^[4] Scheibehenne, B., Jamil, T., & Wagenmakers, E. J. (2016). Bayesian evidence synthesis can reconcile seemingly inconsistent results: The case of hotel towel reuse. Psychological Science, 27(7), 1043-1046.

^[5] Allcott, H., & Rogers, T. (2014). The short-run and long-run effects of behavioral interventions: Experimental evidence from energy conservation. American Economic Review, 104(10), 3003-37.

The post Using Social Norm Marketing Tactics for Effective Health Communications appeared first on Center for Advanced Hindsight.

The Power of Precommitment

admin — Wed, 10 Oct 2018 19:59:14 +0000

This post originally appeared on the Pattern Health blog.

Did you sign a lease to rent housing, or sign a deed to buy your house? Did you have to sign your marriage certificate to solidify your nuptials? What about the last time you executed a business contract? Or when you took out a loan from the bank? Did you sign your tax return?

You probably answered yes to at least one of these questions, and that shouldn’t be a surprise to you. There are all sorts of things we have to sign in our lives, and this simple act of writing our name on a document — the only time we leverage our cursive skills until the next document we sign — is more than a legal obligation to stick to our promises. In fact, when we sign our names we are also reminding ourselves to follow through on those promises. The signature is hard evidence of the seriousness of our commitment, and it stays in our mind as a symbol representing that dedication.

Signing Seals the Deal

Behavioral science research supports this notion that a signature can make commitments more resolute. In a series of studies looking at honesty in reporting, researchers found that participants were less likely to lie when they signed a commitment to be honest before filling out their report. The act of signing brought thoughts of ethics into their minds, serving as a reminder of their desire to be honorable. (Shu, Mazar, Gino, Ariely & Bazerman, 2012). Despite the fact that people had an incentive to lie on the report (they would pay less if they fudged their numbers), the simple act of signing their names to commit to honesty at the beginning of the report (before they had a chance to be dishonest) prompted participants to engage in more honest behavior than those who signed at the end, after it was too late.

Precommitment Works

Even without the signature, precommitment can dramatically improve behavior. In a study by Professors Ariely and Wertenbroch (2002), the researchers asked some of their students to set deadlines for a series of assignments. They found that the students who precommitted to assignment deadlines were more likely to turn in their assignments on time and to perform better on the assignment.

We Rarely Precommit to Our Health

If you think back to the scenarios where you’ve signed a precommitment (a rental lease, deed for a house, marriage certificate, business contracts, bank loans, tax returns), you might notice that none of these fall into the health domain. Think about the precommitments you’ve made for your health. If you’re like most people, then you haven’t made many at all. This might lead you to believe that people don’t care very much about their health, that it simply isn’t all that important to them.

We Do Care About our Health, We Just Don’t Act Like It

However, people do care about their health. And quite a bit. According to a Gallup survey, 90% of the people that were polled claimed that health was very important or extremely important to them (46% and 40%, respectively) — much more so than the importance they assigned to work, friends and money.

And yet, we don’t commit to our health in the way we do our non-health undertakings. Why not show that same dedication to our health goals?

Pattern Health uses Precommitment to Help Patients Commit to their Care Plans

Patients using Pattern are given the opportunity to precommit to their health. How so? Once they have converged on the best care plan for them through discussions with their physician or care manager (for example, which medications to take, how often to check blood pressure, how much to exercise, and so on), they review their personalized care plan (which we call their “pattern”) and commit to it. They commit by signing their name in the app (just like the example in the image below).

The review-and-commit process has numerous benefits. First, reviewing the elements of their care plan helps patients better understand what they need to do to manage their health. Having everything laid out in one place reduces the inherent complexity of many clinical care plans, transferring the cognitive burden from patients to the app. Because it can feel overwhelming to try to hold all of their health tasks in their minds at once, patients appreciate having the ability to offload this responsibility.

Second, the simple act of signing to commit to the plan should lead to higher adherence, and it’s not merely because it feels like a more formal process (and is more likely to be taken seriously, as we do with our taxes). In addition to the implied formality of a signature, the act of signing has a self-signalling effect, where people’s actions serve as feedback, sending the message that adhering to their care plan is important to them. And then they are more likely to follow suit.

So if you are among the 90% of people who believe their health is very important or extremely important, then perhaps you should start acting like it. And perhaps we should all find more ways to precommit to our health.

P.S. We are very much interested in how you are using behavioral science for your health. If you’ve made your own health precommitment, send us a tweet @ptrnhealth to let us know what it is.

References

Shu, L., Mazar, N., Gino, F., Ariely, D., & Bazerman, M. H. (2012). Signing at the beginning makes ethics salient and decreases dishonest self-reports in comparison to signing at the end. Proceedings of the National Academy of Sciences, 109(38), 15197-15200.
Ariely, D., & Wertenbroch, K. (2002). Procrastination, deadlines, and performance: Self-control by precommitment. Psychological Science, 13(3), 219-224.

About the author

The post The Power of Precommitment appeared first on Center for Advanced Hindsight.