Changing Patient Behavior Through Design - an Interview with Nir Eyal
The Pulse is excited to speak with Nir Eyal, the Wall Street Journal bestselling author of Hooked: How to Build Habit-Forming Products. Having sold two tech companies and invested in over a dozen start-ups, Nir has helped various companies design engaging products for their users through his writing, consulting, and sharing of ideas at the annual Habit Summit.
Changing patient behavior is at the center of the healthcare industry’s movement towards preventative care and consumer-centric design. However, our journey has been fraught with challenges not only because of intricacies of the human psyche but also because of complexity of the healthcare system. Nir unpacks some key concepts from his book, Hooked, that can address some of our industry’s challenges. To design habit-forming products and create behavioral changes, we need to leverage the patients’ inherent motivations and remove barriers to act on those motivations - whether it’s making daily walks a social activity or reducing the burden of taking medication. For Nir, the focus should be on designing good products rather than motivating people to do something they don’t want to. For more advice from Nir, read the full interview below.
Pulse: In your book, Hooked, you mention that companies are building either “a vitamin or a painkiller.” Investors like painkillers because they solve an obvious need,” whereas “vitamins… do not necessarily solve an obvious pain point.” How does this line of thinking apply to healthcare products that focus on prevention (vitamins) instead of addressing a medical need (painkillers)? How can we make our society focus more on preventative health when we crave painkiller solutions?
NE: Part of user-centric design is understanding how the user of a product views his or her interaction with the product. If someone has no motivation to adopt a particular behavior, it is unethical to make someone do so. It’s unethical because that’s no longer motivation, but rather coercion, even if a behavior is ultimately good for that person. Our goal is not to get someone to eat healthier if that person doesn’t want to do it. Moreover, most people are motivated to live healthier and take care of their health because they want to live. There is a small percentage of people who do not want to change their current behaviors, and we shouldn’t coerce them into doing so.
For the 99% of people who do want to change their behaviors, they tend to not change because of a lack of good product design. That’s why behavioral design is so powerful. If at any time a person wants to behave in a certain way but is not, it’s most likely not a problem with the person, but a problem with the product. It is our job as behavioral designers to leverage that motivation and change behavior. We seek to understand what’s in the user’s way - what’s making that action more difficult than it needs to be. Is the behavior we want to see too physically difficult, socially deviant, expensive or time-consuming? This is also where technology can help to remove some of those barriers.
The cardinal rule of behavioral design is that the easier something is to do, the more likely people will do it. Thus, for 99% of the population, we need to leverage their existing motivation and remove barriers to get them to change their behaviors.
Pulse: You also explore the idea, in your book, that we, as users and consumers, like to be consistent with our past behaviors. How can healthcare companies overcome that mental hurdle and get consumers to engage in healthy behaviors that are not consistent with our past behaviors? For example, how to get smokers to stop smoking?
NE: Long-term behavior change is identity change. We need to leverage behavioral intervention in such a way that it easily promotes the behavior we want. This would allow people to see themselves differently over time, as they engage more with a particular behavior. What people typically do however - when it comes to behavioral intervention – is to say, “you are a smoker and now, you are going to become a non-smoker.” Even though that’s clearly the change needing to happen, it’s very difficult to do.
Instead, what we want is to make that behavior change so easy to do that it happens naturally in patients’ day-to-day life, such as walking a little more and remembering to take their medications a few more times a day. Then we need to leverage that nascent, existing behavior that we just created and help patients see it as evidence of an identity change. Thus, this behavior change prompts the user to look at the immediate past and believe in this new identity. It’s so rare to get a spontaneous identity change. The better way is to provide evidence that you are already that kind of person, and the way we can get that evidence is to make these changes easier to accomplish.
A good example is the AA program. AA does not have a good record of recovery for people who don't become sponsors. However, for people who do become sponsors, they are more likely to stay sober for the long-term. That is because being sober is part of the sponsors’ identity, which is helping others stay sober. Thus, we need to look for opportunities to leverage those identity points to achieve long-term behavior change.
Pulse: What advice would you have for existing healthcare players, such as insurers and hospital systems, as they navigate how to engage with patients and families?
NE: Oftentimes, the simple stuff gets overlooked. For example, I worked with a client who made an inhaler for patients suffering from asthma. When the client came to me, the company had already developed a multimillion-dollar app and advanced inhaler technology; however, people weren’t using the product habitually.
Part of the problem was that this inhaler was not meant to be used in a way that inhalers were traditionally used. This inhaler was a preventative medication that needed to be taken twice a day - not when someone’s having an asthma attack. When we looked into it, it turned out that people would put this inhaler where they would have their traditional inhalers - purses or backpacks. These were not locations that would prompt the twice-a-day usage required by this inhaler. Thus, we looked into attaching this inhaler to an existing routine that you already perform twice daily – brushing your teeth. Instead of spending more money to modify the inhaler, we just built a stand for the inhaler to be placed next to your toothbrush. All we needed was a clear, external trigger that told the user when it was time to use the product.
My advice is to start simple with the basic principles of behavioral design before jumping into the high-tech stuff. High-tech is sometimes the answer, but not always.
Pulse: What advice do you have for aspiring healthcare entrepreneurs who are building companies and products focused on changing patient behavior?
NE: Really understand your users. Sometimes when it comes to behavioral interventions, people look for the magic bullet - the one thing that will make everybody change their behaviors. But behavioral change is really a war of attrition. We think of one intervention that works for one population, another for another population, and so on. We pile these interventions on top of each other, and we are able to serve more of the population than without any interventions. There is no one thing that works for everyone because of different motivations, living conditions, and other factors. That’s why we need to understand behavioral design and what make different users tick.