by Stina Jonsson
How psychology, storytelling, and design could create more effective healthcare, and save lives
Antibiotics, which have protected us for more than half a century from life-threatening bacterial infections, are in trouble. Or rather, we are.
Bacteria impervious to antibiotics are estimated to cost the National Health Service (NHS) £1bn, and kill 5,000 people in the UK every year. The UK’s chief medical officer Sally Davies has ranked them a ‘catastrophic global threat’ alongside terrorism and climate change.
Smart people are working on this problem from a medical and pharmaceutical angle. But bacteria’s antibiotic resistance is largely a result of people’s behaviour.
First, people take antibiotics for colds, the flu and other viral infections, although these drugs only work on bacterial conditions. Second, people stop taking antibiotics when they feel better, but before finishing the course. Improper use means more bacteria are exposed to antibiotics for the wrong reason, or in weak doses, and those that survive pass on their resistance as they multiply.
So, besides spending billions on research to find new classes of these drugs, might there be a cheaper, more lo-fi approach to solving this potential medical nightmare? One designed to tap into how our minds work, rather than attacking bacteria?
Once upon a time…
One summer day a few years back in IDEO’s Boston studio, I was part of a team designing a device used in brain and spine surgery. We strayed into a completely unrelated discussion about overmedication in the elderly. An idea popped into my head about a pill as a little character, which I doodled onto a Post-it®.
The little pill character stuck in my mind, and grew: it came with me from the Boston studio when I packed to go home. Over the next year, between projects, I worked with some of my London colleagues to mock up special pills, packaging and a digital story for iPad about a gang of bacteria-battling robots that would teach parents and children how to take antibiotics properly, and help nip non-adherence in the bud.
The Antibotics were born.
A memorable story
Each of the Antibotic robots have names, physical characteristics, and personality traits. They are the protagonists, and their story the conduit of knowledge about taking antibiotics properly.
I think they’re the most important part of the Antibotics concept, and one that’s neglected in modern medicine.
I’m an interaction designer, but my background is in psychology and behavioural science. Studying that, I learned that storytelling is a potent communication tool, for a number of reasons.
Stories that stick
Research shows that the human brain is better at retaining and recalling information and concepts when they are presented in a story format.
Information structured through a narrative makes for very powerful mnemonic devices because stories provide order and structure allowing new information to slot into existing schemas and cognitive maps we already have about the world. Take the Guardian’s example, where the weirdly compelling story of Nigel and his 300lb pet squid encodes a recipe from their food critic Nigel Slater. (Try it for yourself.)
The story format provides familiarity and predictability, setting us up to take in new information and vicariously deal with emotional stress and conflict through the story’s protagonists.
Another reason stories are memory boosters is that they come with images. Sometimes these images are literal — pictures in a book — but stories always have the ability to conjure up images in your mind. And our brains are really good at remembering images.
Psychologist Lionel Standing conducted an experiment where he showed test subjects 1,000 images over the course of a few days, and later tested the participants’ ability to recall them. He showed two pictures side-by-side and asked participants to identify which they had previously seen. Participants were right 88% of the time.
The idea of Memory Palaces take full advantage of this and was used as far back as ancient Greece. The method of loci, as it is also called (from Latin loci meaning places), is a memory enhancement technique by which you make a journey through a place you know well, like a building or town. Along that journey there are specific locations that you always visit in the same order. You can then use the memory palace to “store” information. When you want to recall the information you “walk though the place” to recall. Many memory contest champions use this technique to recall large amounts of information.
The power (and value) of stories was evoked in Significant Objects, an anthropological experiment devised by Rob Walker and Joshua Glenn, where cheap objects were auctioned on eBay with fictional stories written by authors to increase the perceived value.
The relationship between storytelling in video games and behaviour change was investigated by Baranowski T. et a, who conducted a meta study of 25 research projects where video games were used in healthcare. The games “merged the immersive, attention-maintaining properties of stories and fantasy, the engaging properties of interactivity, and behaviour-change technology (e.g. tailored messages, goal setting).
The researchers concluded that stories in video games allow for modelling, vicarious identifying experiences, and learning a story’s “moral”, among other change possibilities. So by using storytelling and game mechanisms themed around the relevant disease or condition such as asthma or obesity, the researchers were able to change behaviour to improve diets or increase exercise.
The healing power of stories
But stories are by no means just an aide memoire. Scientists have even demonstrated that stories affect brain chemistry. Zak et al, 2007, reported that showing participants a short, emotional story increased levels of oxytocin, which promotes connection and care and encourages people to feel empathy.
Storytelling has also been used in healthcare. Research by Houston TK. et al. showed how storytelling interventions produced substantial and significant improvements in blood pressure. One group of patients in the study received a video containing stories with positive health behaviour change messages, a control group received an attention control video that covered health topics not related to hypertension. After a few months the blood pressure of the two groups were measured again and showed that for patients with uncontrolled hypertension, blood pressure had reduced.
Human after all
Although our Antibotics concept was aimed at antibiotics adherence, I see storytelling in medicine having a much wider potential and impact if it was adapted for, say, chronic illnesses like diabetes or cardiovascular diseases.
There the challenge lies in communicating the importance of taking medicine, but also supporting the patient to keep taking the medicine — perhaps for the rest of their lives — even if they can’t see the direct and immediate benefits. In one study of coronary heart disease, only 50% of respondents were using prescribed medications two years after being discharged from hospital.
Storytelling is just one approach though. There’s a huge library of research into what we pay attention to, how we learn and remember, and the influence of emotion. Psychology’s rich insights about how our minds work are invaluable principles and cues for designers.
Instead of incrementally improving things — say, making drug literature clearer — shouldn’t we take a step back, and use these insights to design products, services, and experiences based on how people understand the world, and what prompts their behaviour?