4 Keys to Behavior Change

How to design digital health apps to create changes in behavior

Are you on a diet? Trying to exercise more? Working toward new personal or professional achievements? Or maybe you’re building an app that helps users achieve these goals? If you take a close look at your objectives and desired results, what you're really hoping to achieve is behavior change. But changing ingrained habits is complex, and people often need help — that’s why they turn to coaches, trainers, and, increasingly, apps.

At Vessel Partners, we help clients tackle the challenge of altering user behavior by leveraging our research experience in decision sciences and behavioral psychology. Because our clients are in the behavior change business, so are we. In this article, we will provide insight into how we design based on research in behavioral psychology, behavioral neuroscience, and behavioral economics — and detail our four step process that drives behavior changes within your app and encourages users to adopt new habits.

How to design an app for behavior change

Whether you’re developing an app to create better health outcomes for digital health patients or simply looking to retain and engage app users more successfully, our four keys to driving behavior change can help you design a better app.

1. Start small to encourage change

When you're trying to build a pattern with a new user, the best way to start is with small tasks. It's tempting, especially in digital health contexts, to want to motivate a patient to make sweeping life changes on day one — but that does not work. Everybody — our clients, our users, and the Vessel Partners team — grew up with the myth of the "behavior change moment" where someone realizes she wants to change her life and then makes dramatic changes.

But the truth is, change is accomplished through small steps that add up over time, and the most common reason for failure is trying to bite off too much at once. We design every product to ask for the smallest change possible to drive long-term engagement with the app or other digital health solutions.

2. Use small rewards to motivate users

Vessel teammates have spent years coordinating clinical research studies and there’s one mistake we see over and over again: studies often rely on "large" cash rewards for participants who come in for a visit, rather than smaller and more variable rewards throughout the study.

We correct this frequent, fundamental error by focusing on reward types, timing, and variability to build habits. The science here is clear — humans are more motivated by small, immediate rewards than by big ones that are further down the line. We design products to deliver the most immediate feeling of reward. At a very high level, human neuroscience roughly maps to three types of rewards:

• Task motivation — Dopamine motivates people to take an action by creating the anticipation of receiving a reward. This is most applicable to small tasks or behaviors. These rewards can be created by giving someone a sense of progress or completion, economic rewards, or sensory rewards like pleasing images or sounds. Without this type of reward, behavior change does not happen.

• Accomplishment Motivation — Serotonin is responsible for positive feelings and a good mood after major accomplishments. These rewards can be created by giving someone a feeling of mastery, often by amassing accomplishments they feel are meaningful.

• Social Motivation — Oxytocin motivates people to conform to group norms, provide value to others, seek acceptance, and avoid rejection. It creates rewards through feelings of belonging and security. These rewards are created by helping someone feel they belong to a group or giving them the feeling of having a social status within a group.

Using a creative mix and match approach that employs each of these reward types keeps users motivated.

3. Create automatic habits for lasting change

Do you immediately start scrolling through Facebook when you wake up in the morning or check your email whenever you get a spare moment? Then you understand the power of habit automaticity. We call something a habit when behavior crosses a threshold and the decision to engage in a behavior becomes subconscious — and this is when real change becomes possible.

Whether your goal is data collection, treatment compliance, or creating healthy habits, you need people to stick with it long enough to have an outcome. At the early stages of behavior change, patients often require near constant reinforcement through small rewards. Later you can introduce what scientists call a variable reward system. By introducing a little randomness into the dispensing of rewards it heightens the person’s anticipation — and because immediate rewards, governed by our dopamine system work on anticipation, this increases the potency of the reward. With this research in mind, we design apps that reward newer users every time they open the app and sometimes many times within a single session — which keeps users coming back more often and working toward bigger behavior changes.

Understanding the trigger, action, reward cycle

Employing the trigger, action, reward cycle is key to building automatic habits so let’s take a moment to explore how this cycle works.

• Trigger — Triggers come in two forms: external and internal. Early in your relationship with a patient or app user, triggers are usually external and come in the form of a reminder to open and engage with the app. You can send a push notification, an email, or even a text message to remind a user to open your app. If a user is already in your app and you want them to take a specific action, you can employ in-app messaging. The goal is to eventually form such strong habits that your users develop their own internal triggers and you can phase out your reminders.
• Action — If your triggers work, the user will take a specific action. In a digital health app, it may be taking a weekly survey or reporting their pain levels. The most important thing to remember when designing actions is to break any larger goals into the smallest actions possible.
• Reward — When the user takes the desired action it’s time to reward them for the behavior. It may be as simple as playing a celebratory chime or you may offer them a badge for completing a certain number of tasks in a row.

After users move through this cycle enough times, the habit of regularly opening and using your app should become ingrained, and internal triggers should kick in to keep the user moving toward meaningful change.

4. Prioritize personalization for a more rewarding experience

If one man’s trash is another man’s treasure, then it stands to reason that rewards also need to be based on personal preference. Rewards-based change is rooted in human biology and works for everybody, but there are important nuances that vary between people.

An individual might find a certain action easier or harder, or a type of reward more or less salient based on their culture or past experiences. We have found many of these individual differences can be predicted by their personality traits through research conducted with thousands of study participants. We always personalize rewards based on user personas and profiles to drive quicker, more lasting results.

Want to learn more about the science of behavior change and how we use clinically tested methods to create better digital health outcomes? Explore our case studies:

• TAPR-CPM: Treating opioid addiction and chronic pain with cutting-edge healthcare technology
• PRISM: Improving Patient-Reported Outcomes for remote patient monitoring

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