Change health behavior with a gentle nudge

Gentle nudges is a concept termed recently to describe a micro-choice movement that is beginning to carve out a sizable niche in the healthcare start-up space, and is gaining a lot of well deserved national attention. The secret ingredient relates to the power of a gentle nudge; verbal, text or otherwise to accomplish a change in the behavior of the person who receives the nudge. We are just starting to scratch the surface on this remarkably powerful concept. Even the elite scientific community has verified the power of a gentle nudge from a person’s dense social network.

The folks at MIT have recently proven that people with dense social networks are more likely to acquire healthy new behavioral patterns.

Thanks to the early efforts of Contagion, Goinfeld and PremierLogic (@Jensmccabe, @textandshout and @chadosgood respectively), I believe this previously under-ventured space is getting ready to ignite. In addition, the entrepreneurs in this space (me included) may be able to accomplish in short order, what medicine has not been able to accomplish for at least 100+ years. Motivate sustainable, incremental healthy behavioral changes amongst our patients with the use of gentle nudge technologies.

Why the excitement?

Traditional interactions with your physicians have a very small chance of leading to a meaningful, healthy change in your behavior.
Most physicians do not have the time, desire, nor monetary incentive to follow through with you after you have left their office.
It is fairly well proven that the advice you receive from your physician rarely results in meaningful or sustained positive behavioral changes.
The 30 day re-admission rate to institutions is unacceptably high.
There are many patients with hypertension who stop taking their medications because “they feel fine.”
A very large number of patients do not refill chronic medications.
And, from my own personal experience, many post-surgical patients do not follow well described, well articulated, printed, post operative protocols.

More than a few articles on the subject coldly referred to this as self management. Not only is the term cold, it is simply wrong. If people were capable of modifying their behavior on their own there would be no need to write this post and our obesity rate would be 4-5%.

A few months ago the Wall Street Journal wrote about the positive behavioral changes brought about by a simple telephone call or voice message. Great concept, but telephones are so passe. Do you answer all your phone calls now?

What is the appropriate medium from which to nudge someone? This is clearly a case where you need to be sure of your message, and the intended audience whose behavior you wish to modify.

How do gentle nudges pair up with mobile technology? Well, mobile phones have the great benefit of being in the pocket of more than 90% of all Americans. Text messaging, the unsexiest part of mobile, is used by most Americans, with the average person under 55 years of age texting more than calling. Lastly, in many minority communities, the mobile phone has replaced at home Internet access, bridging the digital divide in many urban and rural areas.

That said, how do we use mobile phones to affect healthy behavior change? The simple answer is to do whatever is being proposed for Twitter, Facebook or iPhone and make sure it runs on SMS. Want to know when your friend stepped on a scale and lost 2 pounds? Text it. Or where the nearest farmers market is? Text it. Or heart-healthy recipes to help those with hypertension eat better? Text it.

Looking to more complex behavior changes, it’s helpful to look first at the population one is targeting, then choose the right technology. So, iPhone apps that collect mood data for depression, for example, are great for higher-income groups, but they aren’t great for the 60% of patients who don’t have smart phones. Patient population first; technology solution second.

Lastly, in the past year, there’s been some great data on positive behavior change when patients use texting. Teenagers take their meds more, recently discharged hospital patients are readmitted far less, and public health compliance soars with texting. Often, a simple text is all it takes to nudge someone forward.

This is a very hot topic in a very hot space right now. We have some very smart people working advancing the concept further, and for good reason. We are all patients.

Howard Luks is an orthopedic surgeon who blogs at The Orthopedic Posterous.