5 things I have learned designing Behavioral Change Products for Healthcare in the IoT and AI Era


I started to work within Healthcare in 2008 and I think that the healthcare scenario is a privilege observatory of innovation.

Just consider how Healthcare has been changing during the last five years by the disruptive impact of robotics, IoT, biotechnology, and other innovations. Even the way to innovate in healthcare is changing. Most of the time the protagonists of the innovation are not big Pharmaceuticals but companies like Google who is working on a cure for cancer or 23&Me who is going to ‘invent’ drugs based on user data.

The Healthcare has been changing in terms of tools, places, points of reference, actors and mainly the relation between healthcare and people.

Being a Designer in a scenario which is continuously shifting, is a really exciting and challenging experience, because you are frequently asked to re-think methods and research tools as a consequence of the fast changing environment.

One of the most interesting fields I was working on is the Behavioral changing product design in healthcare.

The aim of this typology of products is simple: to turn bad behaviours into good ones in order to guarantee a better life to the patients.

It sounds simple but it isn’t because of the variety of disciplines and stakeholder involved in the design process.

I would like to share with you what I have learned.

1 Win-win design strategy is mandatory

The win-win design strategy is not just a choice but it’s the only thing that actually works.

As designer it’s important to understand much more than only what the client´s are asking for. Sometimes you have also to discover what they want to do, if they would have the courage to ask for it. From the other side as designer it is really relevant to understand what users actually need.

Once discovered both universes -the client and the user needs-, the target is to find the common ground in order to deliver a solution that is good for the client and good for people.

Mostly the clients ask for a not inclusive game in which the only goal is, to play the game and battling with other users, rather than changing behaviors.

In that case the challenge is to dialogue with the client in order to let them understand the purpose of the product. Sometimes it might be hard to explain the reason why Farmville-like game mechanics are not in line with a ‘Design for all’ philosophy. In other cases you might be asked to explain the reason why game coins doesn’t work as motivational lever in each playful environment and supporting each other might work better than a competition among the users.

It’s a long way but it’s absolutely necessary.

Dialogue and stakeholder management are the keys of success in this phase. Understanding, listening, feeding the client by providing tools in order to let them understand your point of view, are some of the key elements that you are asked to put in practice at world class level.

2 Dialogue is your weapon

Yes, it is.

Dialogue is one of the earliest forms of interaction and it is one of the most powerful tools that human beings are allowed to use to communicate and to understand other viewpoints without pitting themselves against different perspectives.

Nothing new, there is a vast literatures regarding this topic. I just wanted to invite Designer to reinvigorate their dialogue tools before starting to design a behavioral change product, because dialogue is the key.

It is the primary tool to understand people, to dialogue with stakeholder and to dialogue within the project team and/or with external partners.

From another perspective the Dialogue between the artefact/s and the user is a crucial aspect in designing any product, specially a product which is promised to change the users’ behaviors. It’s not just a matter of devices, UI or similar aspects. It´s a matter of doing the right things, in the right amount, in the right moment, in the right context and grabbing the right feedbacks. Understanding the user and having the possibility to adapt the dialogue according to the user behavior is the key. Designing a Dialogue means designing a process which is continuously re-shaping itself according to the user interaction. Something similar happens among human beings: knowing each other is a way to adapt tone of voice, grabbing information, understanding the needs and having fun.

In the end the Dialogue needs to be ‘sensitive’ enough to change according to the progression of the user relation with the product. In that direction I’ve had a significant experience by using a powerful Artificial Intelligence engine which is able to add ‘sensitiveness’ to the dialogue between users and products. Designing a sensitive dialogue impacts of course also the user engagement by giving a huge contribution in facilitating the product adoption.

In the end the Dialogue is the “dark side of the force” for each designer: “May the force be with you”.

3 Be sensitive my friend

I define Product Sensitiveness the property that makes able to listen and learn about user behaviors, in order to provide a tailor made experience, even anticipating the user needs.

One of the biggest problems of behavioral change products is the adoption. The majority of the users do not fall in love with the product because it is not personal enough and because of the stressful process of data entry.

As result, the product is not able to provide an entire cycle of coaching, so the final users are not able to recognise any benefit.

In my experience the solution for this issue is enhancing the relation between users and the product. The product should be able to listen and perceive what the user wants, than it should provide the less intrusive experience possible. For instance, most of the time to ask the user a certain data, is not strictly necessary or it might be simply caught in other ways. In other cases the ask for data entry might be really well accepted from the user at a certain time, under certain circumstances.

A good AI engine is able to listen to the user, re-arrange the dialogue according to the user interaction and anticipate in some circumstances what the user needs. It will be able to examine a huge amount of data and take decisions or recognise unexpected findings and then re-shape the dialogue with the user.

In the end It’s a ‘soul’ for your product what you need, which is capable to enhance dramatically the possibility to build a relation with users.

IBM Watson for instance is collaborating in different contexts providing its powerful capability to help people to take the right decision or to find new findings in huge amounts of data.

4 Be water my friend — liquid experiences

More pervasive means less intrusive this is my mantra.

Let’s start from the physical perception of the product: the shape.

Ideally the perfect shape for a behavioral change product in healthcare would be a ‘liquid’ form. Yes, I really mean ‘liquid’ form.

The Healthcare domain is a privileged place in which a designer can really provide a liquid experience because of the huge amount of different smart objects already existing and constantly growing. They represent a big matrix of ‘smart dots’ which a designer can connect properly in order to provide a pervasive, but not intrusive, experience to merge the digital nature of the artefact with the physical space.

That’s a perfect scenario to create a liquid experience. Isn’t it?

Some time ago, Leandro Agrò -Digital Product Director at Design Group- said “Smart object are natural born storytellers” and this is dramatically true. The connected objects are able to tell us users’ stories. These stories can be used to understand users and to reduce significantly the stress of data entry from user perspective.

That’s why smart objects are the ideal solution to deliver a pervasive but not intrusive experience, which has a relevant contribution to reduce the user friction in adopting the product.

Don’t be shy to design borderless experiences by including every-day smart-objects that matches your user journey. In worst case it might be a point of discussion with the client about the product vision.

5 Gamification is not always ‘Serious’

Objects tell stories, and now what?

At this stage the designer is asked to engage the user by telling a good story through the collected data. In other words the designer has to shape the dialogue between users and the product. This is a crucial part of the entire process.

What is the correct way use the collected data to change users’ behavior?

Frequently it happens that gamification is indicated as the solution. In my experience this is not always the best choice mainly in a field where we have a learning process (to turn bad behaviors into good ones) that needs to be easy, appealing, accessible, enjoyable for all. It might be more appropriate to talk about Applied games.

There are several approaches to Applied (or Serious) games. What I have learned about this topic is:

  • ‘students’ who are challenged enjoy learning and learn more
  • each task must be completable
  • an immediate feedback is necessary
  • deep, effortless involvement is strongly required
  • sense of control over actions
  • motivation is not just a medal on the chest
  • to provide multiple paths to encourage creativity favouring the different users’ attitudes
  • learning from user failure.

It might be useful to talk more about the motivation aspect because I have recognised that the majority of misconceptions happen around this issue.

First of all in designing a behavioral change product you have to consider that the user needs to be motivated not only in achieving the single task but also to preserve the results in order to turn the reached goals into habits.

Second, Design for all. In Designing the motivational framework it´s really important to consider the fact that competition might not be very welcome to all users. Some of them might not be able to be competitive because of physical reasons for instance. In that scenario a supportive logic -or other mechanics- might be a good replacement.

Third, motivation is not just to add a medal on the chest or earning game points. In that case we are talking about Extrinsic motivation, which is the desire to do something because of external rewards. In a context where users are asked to change their behaviors, an extrinsic motivational level doesn’t appear the most effective. Moreover there is the risk to invite the user to trick the system in order to collect more external rewards. In general the risk is to move the focus on the way to earn external rewards rather than on the way to turn bad behaviors into good ones.

This is the reason why the Intrinsic motivation is usually preferred in those contexts. It is based on the desire to do something because it is enjoyable. For instance the users might be asked to face progresses and learnings as consequences of their actions.


Conclusion

As conclusion I would say that I can consider this experience as one of the most relevant milestones in my career as designer so far. I can confirm one more time the importance to design for people and their relationship with objects. Actually people are not really interested in IoT or wearable technology, they are interested in things that solve real problems. If your product solves a problem, it will be adopted.

As designer we have a fantastic opportunity to play around each every-day object to let it be part of the solution.

If I would use just few words to tag this experience I should say #dialogue which is one of the primary forms of interaction and #relations which needs to be properly designed between people and digital/physical artefacts in order to provide the best product experience.

In the end we are all human beings led by emotions and there is no interaction/relation without emotion.