Freedom, social support, and motivation

A recent TechCrunch article by Nir Eyal suggests that many apps fail to change behavior because they feel too much like work. We want to lose weight, but the obligation to log every meal seems to rob us of autonomy much like homework does. It is something that we have to do, not something that we inherently want to do.

According to Eyal:

'Dr. Jesse Schell, of Carnegie Mellon’s Entertainment Technology Center, studies the psychology behind why people play. ... Schell said the difference comes down to whether the behavior is a “wanna” versus a “hafta.” The difference between things we want to do and things you have to do is, according to Schell, is “the difference between work and play … slavery and freedom … efficiency and pleasure.” 


... Furthermore, Schell believes maintaining a sense of autonomy is critical to enjoying an experience. Schell points to the work of Edward Deci and Richard Ryan, whose Self-Determination Theory identifies a belief in one’s own freedom to choose as a key requirement for sustained motivation.


...When faced with “haftas,” our brains register them as punishments so we take shortcuts, cheat, skip-out, or in the case of many apps or websites, uninstall them or click away in order to escape the discomfort of feeling controlled.'



After an unsuccessful attempt to log meals and exercise via MyFitnessPal, Eyal discovered that he was able to sustain his engagement via the Fitocracy app. The difference? Social support. As he interacted with the Fitocracy app, other users would chime in with encouragement -- or even to ask questions.


Fitocracy's primary focus is community, which is the lever that enables health and fitness change. A recent academic study that involved Fitocracy showed how "network effects, social influence, recognition, and reciprocal benefits" can predict engagement.


From Weight Loss to Chronic Disease Management

Social influence can help transform work into play. Can it work with the management of chronic disease? We think so. After all, your need for social support doesn't stop when you become sick. In many cases, the need becomes stronger. The challenge is engaging those unmotivated people who do not yet feel sick and have deferred consequences for not changing behavior. 


source: Clayton Christensen, The Innovator's Prescription


How Providers Can Help

This is where healthcare providers come in. Many of us have been told the importance of diet, exercise, and medication adherence by our physicians. But for most of us, the coaching and support abruptly ends when we walk out of the doctor's office. The most enlightened health systems realize that patients need support between encounters in order to stay well. This support can easily feel like homework if it is not thoughtfully delivered. First, it should be conveniently accessible via the patient's mobile device and not via a printed brochure or portal website. Second, it should address the issues that patients are actually grappling with -- in language that ordinary people use. Finally, it should contain the social support and game mechanics that keep people engaged. By the way, that's what we do.