One of my SXSW highlights was a talk on how behaviour can be changed using persuasive design, a rapidly emerging field that raises ethical questions regarding best practice. In his talk, Matt Danna gave great examples of how design can manipulate users. For example trapping them on check out pages (Amazon), making it challenging to opt out (newsletter subscriptions) or tricking them into confirming actions or permissions (Linkedin). Other common uses include using scarcity scare tactics and fake peer persuasion i.e. pick this one it was the ‘most popular choice’.
When used in consumer environments these design manipulations will most likely persuade a user to choose a more expensive product, commit to checking out, unknowingly share information/data or sign-up to a marketing newsletter. Although ethically dubious these design features will mostly frustrate users or in extreme cases backfire and damage a brand. In healthcare persuasive design could have far greater consequences – especially when they manipulate a healthcare professional or patient to change their usual behaviour. On the flipside health is one area where clever persuasive design could help change a patient's behaviour in a positive way; such as improving compliance, empowering patients or motivating them to make beneficial decisions.
In healthcare the most commonly used persuasive design is based on Fogg’s behavioural model (FDM) - which states that motivation, ability and trigger affect behaviour.
Motivation: pleasure, pain, hope, fear, social acceptance, peer pressure and social rejection
Ability: directly affected by training as well as the perceived ease of the target behaviour
Triggers: facilitated, signalled, or sparked depending on the level of ability or motivation the person has with the target behaviour in mind.
In practice, FDM helps designers determine the right kind of trigger to use. For example, if someone ignores their goal (motivation) of doing daily push-ups (within their ability), a mobile application might to remind them to do so (trigger).
One of the challenges we have at Geneix is changing the behaviour of prescribers; we have to find innovative ways to persuade doctors to check for drug or gene interactions at the point of prescription. To build our solutions we have taken the time to understand our users motivations, abilities and triggers. Persuasive design for us is a tool that should only be used to help benefit our users and ultimately improve healthcare. So how do we use this model?
1. First we determine the target behaviour of our audience
We started by asking the question: “If we could wave a magic wand and get our users to do anything, what would that be?” After deciding, we determined how we motivated our users were as well as how difficult the target behaviour is for them now.
2. Then we select the right trigger to apply to the target behaviour
Using the Fogg model, we determine whether our users lie with regards to motivation and ability. Fogg frequently states that the best approach is to make it easier for people to do the things they already want to do. Therefore for every behaviour target users who already have the motivation and ability but have not yet experienced a trigger.
Next, we targeted users who have motivation but not ability. Implement facilitators that simplify the task and create a progression dynamic where these users work towards a final goal. A further option is to target users who do not have the motivation. Spending time and effort on unmotivated users is a poor choice, because motivation is slippery. You may be able to motivate someone to do behaviour once or twice but their motivation may decline quickly if the behaviour is too hard to do. These users are most likely to be motivated later in the product cycle when peer pressure or uptake reaches a tipping point.
3. Finally we brainstorm to select the best strategy(s) and implementation(s)
After determining which triggers a website or app might be used to facilitate behavioural change, we consider Fogg’s seven strategies to influence behaviour: reduction, tunnelling, tailoring, suggestion, self-monitoring, surveillance, and conditioning. At Geneix when we design for our users we closely follow these strategies.
Reduction – simplifies a task that the user is trying to do (our app InterAct simplifies drug to drug and drug to gene interaction checking)
Tunneling – guides the user through a sequence of activities step by step (we use clear UX to create an intuitive user journey)
Tailoring – provides custom information and feedback to the user based on their actions (based on specific data we produce immediate feedback)
Suggestion – gives suggestions to the user at the right moment and in the right context
(based on the data we guide prescribers with clear results and offer suggestions for how they should act upon this information)
Self-monitoring – enables the user to track his own behaviour to change his behaviour to achieve a predetermined outcome (a prescriber may become aware of their own habits and may adjust if these habits do not align with best practice)
Surveillance – observes the user overtly in order to increase target behaviour (our platform allows a hospital or institute to monitor the prescribing habits of their team and gain useful insights)
Conditioning – relies on providing reinforcement to the user in order to increase target behaviour (as prescribers use our tools they will improve their clinical outcomes and be conditioned to always check for interactions before prescribing)
As health continues to become a hot area of digital design it will be interesting to see how established and popular approaches to UX are implemented in this space. By looking to these mainstream models, designers can greatly benefit users by using persuasive design them to change their lifestyle, improve their prescribing habits or adhere to treatment. Unfortunately, just as in non-healthcare settings, it may not be long before we also see less ethical uses of persuasive design in health. What remains to be seen is whether regulation will come into place to monitor this or if due to the higher stakes companies will be held to greater account for manipulating their users. Till then let’s hope most designers keep their users best interests in their hearts and minds.
By Morgaine Matthews