• Designing Juicy Feedback Loops

    The term “juicy feedback” comes from game design when a small action produces a surprisingly large reaction. Here are six design ideas relevant to products intended to change people’s behavior.

    1) Forgive Regularly

    Forgiveness empowers change. Catholics are forgiven whenever they confess. Protestants receive absolution weekly with the command to “go forth and sin no more.” Jews have to wait until Yom Kippur.

    Technically, of course, we have the ability to store exercise, diet, or medication adherence data for eternity. But, especially for under-performers, it’s more motivating to periodically get a clean slate. Weight watchers gets this too by refreshing your point allotment each week. You can’t bank extra exercise or food points week to week. It’s a clean slate weekly.

    After some experiments at Vitality, we decided to calculate medication adherence monthly, then start from scratch when each new month turns over. While a three or six month rolling average may be more helpful for a physician, we wanted to keep it simple for customers to explain and understand.

    Vitality monthly adherence report

    2) Offer Multiple Incentives to Strike a Chord

    We don’t understand why, but we seems we are much more likely to act when multiple reasons conspire. A potential date looks especially attractive if she is good looking, brilliant, witty, and rich. George Loewenstein, a behavioral psychologist at CMU, found that offering a combination of a high-probability small rewards, with a low-probability large rewards satisfied both the skeptical and optimistic sides of your brain. You get frequent intermittent reinforcement coupled with the lottery-like chance for big winnings.

    Vitality uses to the same multifaceted approach to great effect. We combine polite reminders, social incentives, the sentinel effect (your doctor sees your data), automatic refills, and in some cases pharmacy coupons.  One of the most popular (and ridiculous slides) that is often shown at medication adherence conferences is a pie chart showing the reasons why people don’t take their medication: forgetfulness, don’t believe they need the medication, cost, side effects, etc. It’s market-research reductionist drivel. It’s like asking people to pick the ONE reason they stay in their marriage. For most of us (I hope) a spouse comes with multiple attractive features. Mine does.

    There is a great debate about which incentives are more effective for which customer segments. Is it better to use social OR financial incentives? Extrinsic OR intrinsic rewards? Should people select their reward program OR be automatically segmented by a motivational profiling algorithm? All are interesting questions, but I believe the most important work is around how to mix and blend rewards to gain the largest multiplier effect. The challenge with blended rewards is to design programs that remain simple enough to explain and remember, while still hitting multiple keys as a chord that will resonate in people’s minds.

    3) Get Off the Web

    As one of the Vitality customers said: “I have to open the GlowCap to get at my medication out anyway.” Our product would have failed if we had asked people to go to a web site or app to log their data. In fact, the FaceBook app we built a few years ago to track daily adherence and share that data with friends did fail. The social sharing instinct may have been right, but the extra step to log this daily behavior (even if it was just one click) provided too much friction.

    Any effective behavioral change program must log data automatically and reflect it throughout the course of their day without a web site, app, or annoying SMS text. See my previous post “Why I’m down on Apps” for more. If you are building daily self tracking tools into some web portal or PHR… go home, you are wasting your time.

    4) Be Subtle

    Most technology needs to go to finishing school. Beeps, buzzes, and startup sounds are usually so exaggerated that we come to resent them after about three days. My TIVO, Samsung TV, Microwave, toaster oven, phone, and Mac all have terribly overstated sound effects. The Panera food-ready buzzer is especially panic-inducing. Like doctors in the ICU, we get alert fatigue and simply turn the sound off (or throw the offending object out).

    At Vitality we aim for subtlety. We try to reach people in the zone between conscious and unconscious, so people remember to take their medications but don’t resent (or even credit) their GlowCap. We start with light, escalate to iconic sounds (cute arpeggios), then after a few hours of prompting send a text message or an automated call.

    My Philips wakeup light masterfully coaxes my out of sleep every morning with a sunrise-like experience. I set the alarm for 6:30, and between 6am and 6:30 it slowly becomes brighter and brighter to awaken me calmly. If I’m not up by 6:30, it plays quiet then louder birds chirping which my wife mistakes for actual robins outside the apartment. It serves the function of being an alarm without being alarming. Other product designers should aim for the same subtly.

    Philips Wakeup light (image not of the author)

    5) Design Your Carrots Carefully

    As any coach or sales manager knows, to get top performance you balance hunger with belief. The team needs to be hungry enough to run after the carrot, combined with a belief that they can succeed. Carrots need to be bright orange, juicy, and tasty enough to run after, yet close enough to appear attainable.

    Here is a concrete example in an activity program that mispositioned their carrots. Fitbit’s premium service made the mistake of putting the carrot behind me. To my surprise, I was already beating the average activity of 40-year-old males in Boston–why change?


    Fitbit Benchmarking

    6) Keep finish lines in view

    Philips direct-life, an activity tracking key fob and web service, does this well. Each activity program is ten-weeks long. It’s short enough period to believe that you can stick with it. After all it’s just a couple of months. But in reality these programs are daisy-changed together. As soon as you complete one, you are offered to change your goal and sign up for another 10 weeks. Consider the demotivating alternative: Are you willing to walk 10,000 steps each day for the next 10 years? A series of bite-sized 10-week sprints is better.


    Direct Life Progress graph against a goal

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