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Want to understand more about how a behavioral scientist works to support long-term health changes? or how you can design a digital health product that lasts? You can learn more here. 

Why People Stop Using Health Apps - And What You Can Do About It

When was the last time you were engaged in something challenging, absorbing and fun? Was it hard to continue with that activity? Probably not. That’s what we call intrinsic motivation. It is defined as doing an activity because of the joy and satisfaction it gives you. Whenever you experience feelings of enjoyment, mastery, personal accomplishment, and excitement, you are intrinsically motivated to go on. That’s precisely the feeling an app user needs to continue on their health journey.  

But too many people focus on their extrinsic motivation. They do an activity for instrumental reasons or to obtain some outcome separable from that activity. That could be the time on a race ( not how running provides you with mental clarity) or the weight on a scale (you love how much energy you get from eating well). Extrinsic motivation looks enticing at first because it usually provides a number we can fix our goal to. 


The problem: It also provides little enjoyment. Habits based only on extrinsic motivation are much harder to keep up. The likelihood of positive long-term outcomes for health and happiness (including a higher quality of life and less anxiety ) is much higher if you focus on your intrinsic motivation. 

For app creators, that means not imposing a goal on people, e.g., lose weight, gain muscle, do x time in a race. If you want people to stick with the change, you need them to harness their intrinsic motivation. Those most effective at making a behaviour change and maintaining it over time will have their inner why. Values (our BIG whys) are the anchors in our lives. We can use values and goals as launch points to drive behaviour change. An app should help its users to incorporate their Why when they use the app. That means we have to make health apps as intrinsically motivating as possible. How can we do that? 

By enhancing a user’s basic human needs.

There are three basic psychological needs:

· Autonomy ( a sense of choice and ownership over one’s own behaviour)

· Competence ( feeling capable of the desired behaviour)

· Relatedness (i.e., feeling connected to and valued by significant others)

Throughout the design process, you should always ask one question:

Can we use this new feature to somehow support one or more of these needs?

If so, how? Here are ways to do that: 

How To Support Autonomy

For digital programme design decisions, we want to ask:

· Are we supporting users to make meaningful choices?

· Are those choices easy to make?

· Are we supporting novelty and fun with our programme?

Make Choices Easier

Part of supporting autonomy is about making healthier choices easier to do. In behavioural science, that is called “friction”. We want to increase friction for unhelpful behaviours and decrease it for those that lead you to your goal. Companies are well aware of this option: Netflix reduces friction to binge-watching by preloading the next episode. On the opposite end, putting fruit or vegetables on the counter makes it more likely you will eat them.

Proximity is another important factor. We engage with what is near us and ignore what is far away. Research shows that those that keep sweets on their desk weighed at least two stone more than those that didn’t. 

Too much choice can also make it harder to make the right decision. For app developers, that means reducing the number of choices they give users. Choosing only three options or one prominent one can be more salient.

Language also plays a prominent role. Avoid the use of needs- thwarting language - phrases like, e.g.,” e.g. ‘must’, ‘should’, ‘need you to’ diminish autonomy and with it intrinsic motivation. 

Always provide an ‘emergency exit’. We should never force users down a path – an option to “try this later” “come back later” gives them more autonomy. 

Social norms are equally powerful- stating that the app “recommended this as it’s what 99% of forum members said helped them most” makes users feel part of a tribe. 

Educating users as to the Why behind the choice makes it more meaningful. A sentence like “The research shows x options is one of the best ways to support you in creating lasting changes” assures users they are spending time on the right program.

How To Support Competence

Here, we need to ask ourselves:

· Will this make the user feel successful?

· How do we make users feel accomplished early on?

· Will this make them feel like they are progressing?

· How can I make this easier for people to do?

Competence can be supported in many ways: By providing feedback to guide their ongoing success. It needs to be framed as a story of the user’s journey. In visual design, this is known as the yellow brick road. It is the users’ visual path to understand their goal and where they are in the broader context of their journey. Since they can only absorb a certain amount of information simultaneously, that needs to be a phased approach. Designers label each element and determine the level of importance it has for the user (here is where your personalised data comes in handy). Such a yellow brick road helps the user to see the effect each of their choices makes. The key to building healthy habits lies in the process, the day-to-day, the climb, not the peak, which is outcome-focused. By breaking goals down into micro milestones, you give people a roadmap to follow. That also means the apps’ feedback needs to be growth-focused, rewarding, upbeat and fun. Feedback is drip-fed to promote confidence and competence - it’s the fuel that keeps the journey lit. You can give input at multiple levels:

  • Immediate (e.g., affirmative sounds, rewards, badges, or acknowledge a choice positively (“Great! Good choice!”)
  • Cumulative (e.g., minutes engaged, streaks )
    That kind of personalisation allows users to feel like they are playing to their strengths. 

If users are in a positive state of mind, it taps into the “broaden and build” theory of positive emotions. People’s emotional state affects how much they can learn and take risks. And promoting positive emotions enhances user engagement.

Thinking purposeful thoughts also stimulates the ventral medial prefrontal cortex, the part of the brain that relates to identity. 

When we try to help people make changes in their lives without purposeful thinking, they often react defensively. The amygdala usually starts panicking, and you’re stuck with fear and aggression- negative emotions that stop us from learning. 

Purposeful thinking is a great exercise to begin reducing defensiveness to change, becoming more open, and nudging users along in their readiness for change.

How To Support Relatedness

Here, we need to ask ourselves:

  • How can we make users feel part of something bigger than themselves?
  • How can we support them to trust and feel connected to others?
  • How can we make them feel valued, respected and cared for as a member of the tribe

Research shows that accountability is key to sustaining habit change. Peer or family accountability provides a type of instrumental support that helps to change habits. Others can become role models for people. They can provide emotional support, talk or coach people when hitting a roadblock, and help celebrate reaching a milestone. Studies show that even the idea of the presence of another person may cause us to engage more. Relatedness is often missed and yet is crucial in helping users stick with their habits. Users can do this with someone outside of the app programme in their own home environment- or as part of their app use. 

  Two things that are of importance when it comes to supporting are:

  • Inside the app: Be careful about whether and how to connect people together. Social media is not an automatic solution to support relatedness. Make sure that any social connection is serving a bigger purpose than just social. And consider how you’ll monitor any social functionality to prevent bad experiences from happening. Reduce perceptions of friction internally in the programme through user testimonials.  
  • Outside the app: Having people outside of the programme championing it is also crucial. That means asking them to share it- and making it easy to do so. Little quotes that can be shared on social media fulfil the same purpose. Offer people a “buddy” within the app, ideally with a friend who can join. 

Do you want to implement these tips into your health app? Contact me here to see how that could look! 

Published on 27th Jul 2021 at 12:00 by Heather McKee

"Heather has so generously contributed to so many areas of our work this year, her thoughtful feedback and insights have allowed us to evolve our work and product in profound and impactful ways. I speak on behalf of all of us when I say we can’t imagine having done it without her unique, informed perspective and diverse voice. She has made an incredible amount of impact on our work in a small amount of time and we are so grateful for her."

Sara Rice, lululemon HQ

"When you work with Dr Heather McKee you know you are in the presence of a true professional. You cannot ignore the passion she has for her field of behaviour change, especially around healthy living. She is committed to making sure that you -- client, patient or project partner -- understand the key facts, appreciate the context and embrace the decisions you made together."

Edna Kissman, CEO The Wonder of Me

"Heather’s academic and applied understanding of behavioural psychology has been invaluable in helping us mould our proposition to the corporate wellbeing market over the last 12 months. Heather was a perfect fit with our culture; enthusiastic, diligent and highly skilled in everything that she does. We look forward to working with Heather on future projects"

Richard Westman, CEO KAIDO

"Heather's practical knowledge and expertise around behaviour change have been an enormous value-add for the Welltodo audience. By incorporating her tools and insights into our course curriculum, we were able to add a whole new layer of credibility. Heather is professional, reliable and an absolute pleasure to work with!"

Lauren Armes, CEO Welltodo

"Heather is a ninja when it comes to behaviour change, and a delight to work with. She has been invaluable to BetterSpace in working out how to nudge people into more mentally health lifestyles."

BetterSpace

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Copyright ©2021 Dr. Heather McKee

Dr. Heather McKee is registered in Ireland Reg. No. 687397 with the registered address at 314 Mother Teresa House, Loreto Abby, Rathfarnham, D14 NR20, Co. Dublin, Ireland

This work is in no way meant to replace any medical advice. Dr. McKee is Non-HCPC-registered. Photography by Dylan Madden.

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