Wearable devices are an increasingly common tool to facilitate and support the kind of behavior changes healthcare staff require from patients either living with chronic conditions or recovering from acute conditions. Despite the technology being increasingly user-friendly however, activity levels continue to vary.
A recent study, led by researchers at Penn Medicine, highlights how wearable devices can support behavior change, but financial incentives are often required to grease the wheels of change. It found particular success when money was offered upfront and taken away if exercise goals were not met. The success was attributed to the loss aversion it triggers in users.
“Regular exercise and cardiac rehab has shown to have significant benefit in those with heart disease but participation in such programs is extremely low for various reasons including patient motivation and access to exercise facilities. There is interest in developing creative remote strategies to engage patients in exercise programs but there is little research for guidance,” the researchers say. “In this clinical trial, we tested a scalable approach combining wearables and principles from behavioral economics to show significantly increased activity levels even after incentives were stopped.”
Motivating change
The researchers recruited over a 100 patients to use the Misfit Shine wearable device over a 24-week period to try and gauge the impact both personalized feedback and financial incentives during the early part of the study had on eventual behavior change. In the intervention group, volunteers were given the wearable device, a personalized exercise plan, and $14 at the start of each week for 16 weeks. Every day they failed to meet their target, $2 was taken away. Between the 9th and 16th week the exercise goal for each volunteer increased, with the financial incentives then stopping after the 16th week, but the exercise goals continued to rise. By contrast, the control group simply used the wearable device and were tracked during the 24 week period.
There was a two week start period to help establish a baseline of activity for each volunteer, with the intervention group then receiving weekly targets to increase their step count each day.
“While many are hopeful that wearable devices can motivate high-risk patients, we found that wearables alone did not increase physical activity levels,” the team say. “However, framing rewards as a loss – a technique from behavioral economics – led to a meaningful difference in behavior. During the 6-month trial, the average patient in the intervention arm had step counts that totaled about 100 miles more than the average patient in control.”
The team believe that their work should prompt further studies to evaluate how sustainable such incentives are over a longer timeframe, and to also compare various forms of incentive, in terms of their magnitude, duration and frequency. It’s certainly an interesting start point however, and will be of interest to any healthcare organization, or indeed employer wellness department that is looking to change behavior.
