Data science and tiny habits can help patients build a healthier lifestyle
How to change your lifestyle with data science
Have you ever tried to change your habits to get healthy? Maybe your dentist told you that you must floss your teeth or maybe your doctor told you to eat less fatty food to lower your cholesterol or maybe your mother told you to stop biting your nails? Inspired and ready to change, you commit to a healthier lifestyle. You’re determined that this time, you will persevere. But after a few weeks your motivation dwindles, and you are back to your old bad habits.
Don’t worry, you are not alone. Many people have difficulty with sticking with new habits. To help people make big changes with little steps, Stanford behavioral scientist BJ Fogg developed a method he calls ‘Tiny Habits’.
Tiny Habits
Tiny habits are small daily tasks that contribute to a healthy lifestyle. They are easy to do and to incorporate into your daily routine. That makes it more likely that you stay committed to the task and do it regularly. In other words, it becomes your new habit.
“Now if we look at health outcomes, what do we want to do? Well things like lose weight, manage stress and so on. But if you design for the outcomes, you’re designing at the wrong place. You need to design for the behaviors that lead to the outcome.”
— BJ Fogg
Let’s look at how you establish a tiny habit. Say you’re a couch potato and want to start exercising. You don’t start by running a marathon. Running a marathon is hard. It’s easier to start out small, like taking a ten-minute walk every day. You make a small change to your schedule, it doesn’t require a lot of motivation, and it’s healthier than exercising only once a week.
Now, you need a little more than motivation alone to help you make that ten-minute walk a habit. You need a trigger. You find a trigger by looking at your existing habits and finding the action that should come before your new walking habit. For example: “’I’ll take a ten-minute walk after I eat lunch.” Having lunch is already part of your daily routine. This existing habit can be a trigger for your new ten-minute walk habit. You might forget your after lunch ten-minute walk a few times, but after a while it becomes a second nature. You don’t need to think about it anymore because it became a habit, just like eating lunch.
Once you’ve established one new tiny habit, you can add more healthy habits to your daily routine. The tiny habits pile up and over the long run, will lead to a healthy lifestyle. Easy, right? But how do you know which new tiny habit is right for you? And how do you make that choice if you’re starting with health challenges?
This question is especially pressing if you want to change your lifestyle in order to cope with a chronic condition. The exercise you chose depends on your condition. Some exercise might not help, some might even be counterproductive. So how do you make those choices?
Three needs for a new tiny habit:1. There must be some level of motivation2. You must have the ability to do it3. You need a triggerThe rule: Design your new habit as a tiny step towards the desired new behaviour and do it after existing habits.Format: after I [existing habit], I do [new habit]Example: After I had lunch, I will go for a walk.
Introducing dr. Bart: Your guide to choosing and building tiny habits to improve your lifestyle
Osteoarthritis is the most common form of joint disease in the world. It causes irreversible damage to joints and patients suffer from pain, stiffness, and loss of flexibility. Staying active is one of the ways to treat osteoarthritis, but that requires a lifestyle change that’s hard for patients to make.
Physicians struggle with getting their osteoarthritis patients to adopt a healthier lifestyle. They can advise patients on exercises or give dietary advice, but lifestyle changes are difficult. They require a lot of time and coaching that aren’t always available.
Dr. Bart is a personal lifestyle coach app that patients can use on their own mobile phone. Developed specifically for knee and hip osteoarthritis patients, dr. Bart helps them select the tiny habit that fits their needs and condition. First, it asks for the patient’s personal profile and history. Then, it uses a smart algorithm to find the tiny habit that matches the individual and the health outcomes they want to achieve. Over time, this algorithm learns which tiny habits fit which types of users by looking at the success rate of the tiny habits with regard to the user characteristics. We recently published the theoretical framework and development process in BMC Musculoskeletal Disorders.
Dr. Bart helps the people with knee and hip osteoarthritis improve their lifestyles. As a result, they experience reduced joint pain and increased mobility which can potentially postpone a joint replacement.
Developed by Orikami and Symax, along with partners the Sint Maartenskliniek in Ubbergen, The Netherlands and St. Elisabeth Hospital in Meerbusch-Lank, Germany, this app combines the health care partners’ clinical and osteoarthritis expertise with our data science and digital development skills. Dr. Bart recommends healthy habits suited for people living with osteoarthritis that physicians redesigned for the tiny habit format. This digital innovation gives patients personalized coaching providing them with the opportunity to live a healthier lifestyle.
Osteoarthritis is not joint wear and tear!Most osteoarthritis patients are above 55, and it’s often described as joint wear. This is not true! However, this popular misconception means that people with osteoarthritis tend to move less, hoping to prevent further wear. Unfortunately, moving less might make things worse as muscle loss around the joint can lead to more pain.
How do patients use dr. Bart?
When we were building dr. Bart, we had to dissect the tiny habit process and turn it into units we could use. We renamed the tiny habit a goal and then proceeded to work with a task, trigger, and difficulty. So, if you’re going to work on creating your ten-minute walk habit, the walk is the task, lunch is the trigger, and ten-minutes is the difficulty.
When a user opens the app for the first time, they answer questions similar those physicians ask during a first intake. These questions relate to their physical condition, the types of tasks they prefer, and some general information like gender and age. The app uses these answers to create a user profile and create a customized list of recommended goals. These goals are related to four themes, that are core elements in the non-surgical treatment of osteoarthritis. Behind the scenes, dr. Bart compares the user’s profile with the profiles of all other users and selects tasks which users with similar profiles are doing.
The user can choose up to three goals to work on simultaneously. Per goal they choose a trigger that suits their preferences from a predefined list. These predefined triggers differ per goal, but examples are: ‘In the morning’, ‘during lunch’, ‘before I get out of bed’. Every day, the user can tick off goals they completed that day on a checklist. Based on how often a user completes a goal, they earn a reward in the form of an in-app medal.
There has been quite some debate about how much time it takes to form a new habit. Research conducted in 2010 showed¹ ² shows that it takes on average 66 days, however with a range between 18 and 254 days (!). How long it takes varies widely on the chosen habit, the person and environmental factors. For dr. Bart it is somewhat arbitrarily chosen that a patient can start new habits once they have completed a goal at least 21 times. They receive a gold medal and are ready to start working on a new tiny habit. Dr. Bart helps users add more and more tiny habits into their daily routine, slowly but surely making their lifestyle healthier.
The smart algorithm behind dr. Bart
Dr. Bart suggests the goals that are related to the goals that a particular patient and similar patients have previously chosen. It does this using a data-driven algorithm. This algorithm improves over time as it learns more about each user’s goal preferences. It suggests the right tiny habits looking at the user’s history and looking at the history of similar users. This self-learning algorithm works the same way that the app Netflix recommends a new series to you. It collects information on the series that people like you have watched and then suggests that you might like them too. The more you use the dr. Bart app, the better dr. Bart learns which kind of goals work for you.
Dr. Bart adds an extra dimension by also tracking the theme and subtheme each goal belongs to. The four themes are nutrition, physical exercise, vitality and education. So not only does the algorithm look at your specific goal history and that of other users, it also checks which theme and subtheme each goal belongs to. This is similar to the way Netflix keeps track of both the specific series and genre you and others are choosing.
Testing and validation: does it work?
Dr. Bart is a mobile lifestyle coach that was built to support knee and hip osteoarthritis patients choose the right tiny habits to make their lifestyles healthier and improve their quality of life. But does it work?
Our partners at the Sint Maartenskliniek and the St. Elisabeth Hospital are testing and validating dr. Bart and its effect on health care utilization and clinical outcomes. Two large groups of patients with knee and hip osteoarthritis participate in the study. One group of patients, the intervention group, use dr. Bart while the other group will not; the control group. The study lasts for half a year, after which patient outcomes such as use of care, self-reported pain, and mobility are compared between the control and intervention group. While this study is still in progress early results already show that people keep using dr. Bart. Twenty weeks into the study, about 20% of the users are still using the app and completing their goals.
The future of dr. Bart
While dr. Bart is starting out as an app for knee and hip osteoarthritis patients, a healthy lifestyle can make a dramatic difference for many people. People with diabetes, renal patients, and even people who are about to have surgery can benefit from making small changes to improve their health. If the current study proves that dr. Bart helps improving the quality of life people with knee and hip osteoarthritis, we will try to apply the same mechanism in other fields as well. In the future, we can apply the tiny habit method to more patient groups and suggest goals that are tailored to their needs. One idea: incorporating it into our self-monitoring application for multiple sclerosis patients…
Special thank you to Frank de Graaf for co-authoring this article, and to Tim Pelle, PhD candidate at the Sint Maartenskliniek, and Geert Klein Breteler, CEO of Symax, for their valuable input on this article.
[1] Lally, P., van Jaarsveld, C. H. M., Potts, H. W. W., & Wardle, J. (2010). How are habits formed: Modelling habit formation in the real world. European Journal of Social Psychology, 40(6), 998–1009. https://doi.org/10.1002/ejsp.674
[2] Gardner, Benjamin & Lally, Phillippa & Wardle, Jane. (2012). Making health habitual: The psychology of ‘habit-formation’ and general practice. The British journal of general practice: the journal of the Royal College of General Practitioners. 62. 664–6. 10.3399/bjgp12X659466.
