Healthcare is increasingly adopting design as a core principle: in the devices we use, the thoughtful layout of healthcare facilities and the human-centred orchestration of services. Design is inherently about understanding user context, making it an important ingredient in any health application. But with the growing focus on prevention, design is yet to realize its potential when it comes to incentivising healthy behaviour.
The intention-behaviour gap is well documented. Despite our best intentions, many of us don’t follow through with healthy actions, whether that’s eating and drinking better, moving more or taking other steps to improve our wellbeing. Public providers and private companies alike have developed a range of tools to incentivise us to bridge the gap. However, the way incentives are designed – both in their reward structure, along with how they are integrated into our lives – can make or break their effectiveness.
Financial incentives are popular for tracking and rewarding the exercise component of wellbeing. London-based Sweatcoin partners with the NHS to reward users who meet their step count, and hundreds of similar schemes are in play across the world. Yet financial incentives don’t guarantee long-term behaviour change and don’t scale well to all health goals. Disincentives (such as bans and taxes) have their own constraints. Enter: nudge theory.
Nudge theory is a behavioral economic concept popularized by US academics Richard Thaler and Cass Sunstein in their 2008 book Nudge: Improving Decisions About Health, Wealth and Happiness. Thaler and Sunstein define a nudge as:
“…any aspect of the choice architecture that alters people’s behavior in a predictable way without forbidding any options or significantly changing their economic incentives.”
Nudges are already used widely in our daily lives: think calorie counts on menus, buildings with fewer lifts, salad as the default side option, or a bit of (healthy) social pressure through gamification. Consumer technology has expanded these possibilities even further, with ‘technology-mediated nudges’ on the rise, delivered by health apps and wearables.
Nudge theory remains controversial, and its definition is still evolving. However, there is mounting evidence of its ability to move the needle on certain health issues, such as this systematic review of nudges in diabetes management. Future generations of health nudges will be even ‘smarter’, using artificial intelligence to understand the unique motivations of each patient in the form of precision nudging.
For health incentives to be successful, they need to integrate seamlessly with users’ lives and resonate with their needs. Designers are experts in this field, and are equipped with specialist tools to understand a whole person and their context. Below, we examine examples from consumer health technology, physical environment and healthcare delivery where design has been instrumental in incentivising healthy behaviour.
Despite the differing delivery modes, the success of these health incentives relies on the same underlying factors: understanding the whole person and their context, while targeting highly specific behaviours or actions to achieve health outcomes. Qindle is excited to be doing just that: we’re currently working with a start-up to develop a product that nudges its users to hydrate, through clever industrial design. It’s high time we used design to its fullest potential, to support healthy people and planet.