Will Wellness Wearables Change Behaviors?

There's no doubt that data and technology play significant roles in health promotion. Without data, how do we know what type of health conditions are most prevalent in a population? Without data, how do we know that interventions are making a difference?

Although data has played a role in health promotion for some time, recent advances in technology and the partnering of technology and data have provided a significant shift in the industry. While some of the new capabilities are intriguing, we need to maintain perspective on their limitations. There is the potential that too many organizations will put too much emphasis on these technologies and make assumptions that they will be more effective in improving the health of their populations than they are actually capable of.    

An excellent example of the merging of technology, data, and the high hopes of behavior change are wearable fitness devices. Pedometers are nothing new, but the recent advancements and compatibility of wearables such as FitBits, Jawbones, Nike Fuelbands, new devices from Microsoft and Apple and a host of other devices with apps and computers has led to a booming industry. That's fun for fitness geeks like me, but how much impact will they have across the general population? Yes, they may have a place in health promotion, but that place is relatively limited. They are great devices for people at advanced stages of fitness behavior, but they are not a tool that is likely to induce significant long standing behavior change from the majority of the population.

To justify those statements, let's briefly revisit some foundations of behavioral science, and four  characteristics of behavioral education which we know are significant in driving sustainable behavior change:

People at Varying Stages of Readiness Need Varying Types of Information:
Many readers will be aware of the basic stages of behavior (or the basic idea of a behavioral continuum) where some people are ready and eager to improve health behaviors, while others are far less aware or interested. Tracking devices, self-directed learning, and optional "log in" type activities for health promotion, by their very nature, only appeal to those that are at relatively advanced stages of readiness. That is, people that are already making health changes, or those that are actively preparing to make health changes. Giving someone a wearable device to track or score their success is great for people who are already active, or to provide some extra motivation to those on the precipice of implementing a new fitness behavior, but it will be quite unappealing to anyone who is at the early stages of contemplation and  not yet interested in actually participating in health or fitness activities. Those individuals need more education on the personal, tangible values of becoming active rather than a measurement device and an external incentive. And here's the kicker - the majority of the work population fits the latter group.

Technology and Data Lacks Empathy:
A few years ago, Mark Earls released a book called "Herd: How to change mass behaviour by harnessing our true nature." It's an interesting read, but the key point is that we are a social species. It's part of our evolution. We are inherently driven to fit in and are motivated to comply with social norms. We have an evolutionary need for social interaction and empathy. What this means is that simply giving people information rarely changes their behavior. If giving people information changed behavior there would be no smokers. The information on its harms is  abundant, and yet almost 1 in 5 people continue to smoke. The point here is that data and technology are impersonal. Setting people numerical goals and giving them a device to track it is not inherently motivating. While it may be effective in the short term, the effect on changing long term behavior is minimal. What is more effective is to provide people with emotional support and connection. Hearing about people's needs and goals, and then relating those inherent values to improved behaviors are far more effective at driving sustainable change. People need that human connection rather than basic numerical feedback - and some of the emerging research in this area is suggestive that social interactions via technology based platforms are far less effective at making people feel connected than human to human contact.

Challenges End. Novelties Fade.
For fitness enthusiasts these technologies can be great. They provide a means for people to measure something that is meaningful within their lives. They provide a platform to compete with like-minded friends and to quantify personal progress. The problem is, only a small percentage of the average population fits this demographic. For many, fitness and exercise is a chore. While wearable devices might be a novelty at first, the attrition rate for use is significant, with some research suggesting at least a third of owners abandon their devices within four to six months. It's also important to note that the ones most likely to abandon the device are the ones who need the most help, that is, people at earlier stages of readiness. Similarly, the data available on the sustainability of challenges is also bleak. People can modify their behavior for short periods if they are given an incentive or goal, but the very nature of a challenge implies an end point where people can revert to what they find more comfortable. Constantly issuing new challenges again can work in the short term, but eventually the novelty wears off and "challenge fatigue" kicks in. Constantly re-marketing the next challenge and getting people to reengage is hard work for HR or wellness teams.   

Data and Logic are not Great Motivators:
This was mentioned above in the paragraph about empathy - but it's very powerful and worthy of mentioning again. We know simply telling people what to do and giving them basic data or logical explanations is not very effective at changing behavior. Research from Jeni Cross at Colorado State University, along with others, shows that messaging based on data or logic and delivered through non-interactive methods of communication is only about 20% effective in getting people to think about their own behavior. Compare this to a 60% effectiveness rate (three-fold increase) when people are given more tangible and personalized messages and are involved in more interaction with the people delivering the information.

Yes, the low cost scalability of technology for large employee populations is appealing. But if it's not ultimately going to help you reach your population wellness and cultural goals, is it a smart investment? While new technologies and the fad on wearable fitness devices and challenges look poised to continue to grow in the short term, it would be prudent to question their sustainability or effectiveness at changing behaviors in the people that need the most help. If you are using these devices to keep active people motivated, or to perhaps get those thinking about being active more involved - they may be successful. If you are hoping that web platforms, wearable devices, or health challenges will engage and sustainably change the health behaviors of your broader work population I think you need to be much more cautious.    

Published on by Andrew Stephenson.