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Behavioral Theories that Inform Healthcare App Development
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Behavioral Theories that Inform Healthcare App Development

Creating behavioral change is complex — human beings are complicated animals, often motivated by a variety of factors and conditions. Since the 1900s, when John B Watson first began describing human behavior as a science worthy of study in laboratory conditions,  scientists have been trying to crack the code of behavior change. Decades of research later, we have developed a robust understanding of what works and what doesn’t. But validated research is only the first step. To enact behavior change, that research must be put into action.

Translating the science of behavior change into engaging healthcare apps for patients and clinicians alike is what Vessel Partners specializes in. Motivating users to form new habits, change old ones, and make healthier choices is difficult. And in our case, each app — and the needs of its users — is unique, requiring us to draw on many models and theories to keep users engaged, making progress, and accomplishing their goals.

The scientific community’s understanding of how and why people behave the way they do has also changed over time. Early on, experts relied on cognitive models that explored how behavior was influenced by beliefs and perceptions. Over time, however, the scientific community’s understanding has changed — thanks in large part to the work of Daniel Kahneman. “He is one of the main people responsible for the revelation that humans are not rational beings; rather, he proposes that we are susceptible to a host of heuristics and biases, mental tricks that cloud our daily judgements and decision-making abilities,” as The Decision Lab puts it.

However, understanding both the cognitive and the behavioral side of human motivation is integral to our work, so let’s explore.

Cognitive models

Cognitive models, while older and perhaps more outdated, still have something to teach us. These models often describe why people think they do what they do — even if they are wrong.

Social Cognitive Theory

Social cognitive theory examines how personal factors, environmental factors, and human behavior influence each other. This theory states that self-efficacy, goals, and outcome expectations affect the likelihood that a person will change a health-related behavior.

What does that mean in plain English? Essentially, a person’s capability, level of knowledge, and skill — combined with reinforcements and expectations about anticipated outcomes — all inform a person’s ability to change. To learn more, explore “The BUS Framework: A comprehensive tool in creating an mHealth App utilizing Behavior Change Theories, User-Centered Design, and Social Marketing.”

Health Belief Model

The Health Belief Model focuses on an individual's perceptions of the threat posed by a health problem, the benefits of avoiding the threat, and factors that influence an individual's decision to avoid the threat. It was developed in the 1950s by social scientists at the U.S. Public Health Service in order to understand the failure of people to adopt disease prevention strategies or screening tests for the early detection of disease (research that feels more relevant than ever in the COVID-19 era).

According to this theory, people are motivated by two main factors under the Health Belief Model: the desire to avoid illness, or to get well if already ill; the belief that a specific health action will prevent, or cure, illness. Ultimately, an individual's course of action often depends on the person's perceptions of the benefits and barriers related to a behavior. Dig a little deeper, and you will find even more complex components motivating behavior:

  1. Perceived susceptibility — There is wide variation in a person's feelings of personal vulnerability to an illness or disease.
  2. Perceived severity — There is wide variation in a person's feelings of severity, and often a person considers the medical consequences and social consequences when evaluating the severity.
  3. Perceived benefits — The perceived benefits of treatment can fluctuate from person to person — and this impacts the course of action a person takes in preventing or treating an illness or disease.
  4. Perceived barriers — People perceive different barriers, or impediments, which often leads to a cost/benefit analysis. People weigh the effectiveness of an action against the perception that it may be expensive, dangerous), unpleasant, time-consuming, or inconvenient.
  5. Cue to action — This is the stimulus needed to trigger the decision-making process to accept a recommended health action. These cues can be internal (e.g. symptoms) or external (e.g. advice from others).
  6. Self-efficacy — This refers to the level of a person's confidence in his or her ability to successfully perform a behavior. Self-efficacy is a construct in many behavioral theories as it directly relates to whether a person performs the desired behavior.

Learn more here.

COM-B

Short for “Capability, motivation, opportunity → behavior,” COM-B posits that behavior is influenced by these three components:

  • Capability — an individual's psychological and physical capacity (including having the necessary information or skills) to engage in an activity.
  • Motivation — all the mental processes (including habits, emotional responses, and analytics decision-making) that compel and direct behavior.
  • Opportunity — the outside factors and influences on an individual that may prompt a behavior or make it possible.

Each of these components can influence the others. For example, not only can an opportunity influence motivation but certain behaviors can also impact capability, motivation, or opportunity. Learn more here.

“The confidence that individuals have in their beliefs depends mostly on the quality of the story they can tell about what they see, even if they see little.”
Daniel Kahneman
Thinking, Fast and Slow

Behavioral models

Behavioral models often inform how Vessel Partners approaches actually changing behavior through healthcare apps. These models describe the forces that act subconsciously on users to create actual behavior.

Social Norms Theory

While studying student alcohol use on college campuses in 1986, Perkins and Berkowitz developed the Social Norms Theory. The theory is often used in addressing youth behaviors, where peer influences are often an outsized factor. It also explores the relationship between perceived norms and actual norms — where there is often a wide gap and room for misperception.

In a nutshell, the Social Norms Theory says, “Overestimations of problem behavior in our peers will cause us to increase our own problem behaviors; underestimations of problem behavior in our peers will discourage us from engaging in the problematic behavior.” By presenting more accurate information about peer behavior, you can influence youth behavior on everything from drinking to seat belt use.

Let’s return to one of the great public health crises of our time — COVID-19 — for an example of how Social Norms Theory is put into action today. If you are on social media, you have likely seen the “I Got My COVID-19 Vaccine” stickers on people’s Facebook Profiles. By letting people see what the people in their communities are doing, it helps create a new normal.” We use this same mechanism in apps through social features that allow users to see how much their friends are exercising or how quickly others are progressing in their treatment.

Operant Conditioning

Whether or not you have ever heard the words “operant conditioning,” you’re likely familiar with its implementation. Parents and teachers use it to encourage good behavior in children, through a rewards-based system. If you have ever put a gold star on a chart or handed out a cookie in return for good behavior, you are using operant conditioning. If you have a dog, you’ve likely used it to teach the dog to sit on command or come when called.

We also know that operant conditioning is constantly at work. Whether someone is being rewarded by the response in their opioid receptors after eating cheese or after actually using opiates, the reward is essentially the same and shapes the way we behave.

As we have covered in other articles, the habit loop is integral to creating real-world change. But the key to making the cue - action - reward cycle work — and ultimately form a habit — is operant conditioning. Through the use of positive reinforcement (or negative reinforcement when applicable), we reward users for taking the actions we want them to, acting on their subconscious to shape future behaviors.

Designing for behavior change in the real world

We take these simple, but clinically-proven, tools for behavior modification and put them to work in a variety of ways. By designing for innate behaviors and acting on the subconscious, we can drive new behaviors and actions. To learn more about how we apply evidence-based techniques and technology-driven solutions to address society’s most complex health challenges, explore our case studies.

 

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