Invent: Health

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Human beings always seem to end up doing things we know are bad for us. But why? Where do these motivations lie? Does science and technology have the solution?

To find out, join us on Invent: Health, a podcast brought to you by technology and product development company TTP.

Show Notes

Doing what’s good for you should seem like second nature, so why is it that we as humans so often don’t do things which we know will be effective when it comes to our own health and wellbeing? From difficulties in quitting smoking to the 25% of prescriptions in the UK that are left unfilled, medical non-adherence has profound effects on the health of a population, and it’s also one of the trickiest realms for health practitioners to deal with. How do you literally change someone’s behaviour if they already know they’re doing themselves harm?

Find out on this week's episode of Invent: Health from TTP.

This Week's Guests
Paul Upham is the Head of Smart Devices at Roche / Genentech and has over 20 years of experience in medical technology and digital health in R&D as well as global marketing and product management roles, including leading the development of the world's first prescription digital therapy for type 2 diabetes, Bluestar, from WellDoc.
https://www.linkedin.com/in/paulupham/

Dan Lock is a consultant in psychology and human factors at TTP. A psychologist by background, Dan leads on understanding the users of our products, exploring their motivations and figuring out those design features that translate into long-term adherence to medication.
https://www.linkedin.com/in/danlock/

Dr. Olga Perski is an interdisciplinary scientist working at the intersection of behavioural science and digital health. She is a health psychologist by training and completed her PhD at University College London in 2018, with a thesis on the definition, measurement and promotion of user engagement with digital behaviour change interventions. She is a post-doc in the UCL Tobacco and Alcohol Research Group and a UCL Centre for Behaviour Change Associate. Her work is focused on the development and evaluation of digital interventions for smoking cessation and alcohol reduction.
https://www.olgaperski.com/

The Technology Partnership is where scientists & engineers develop new products & technologies that bring innovation & value to clients.
Find out more about our work here: https://ttp.com/invent


What is Invent: Health?

Invent Health, is a podcast about the future of health and technology. Each week, we're joined by the top scientists, engineers, and academics working at the vanguard of this vital industry, to give you a behind-the-scenes look at the world of health tech.

Matt: [00:00:00] Have you ever done something you know you shouldn't have? That extra glass of wine? That second takeaway of the week? That reach-back to your youth for a cheeky cigarette? Human beings always seem to end up doing things that we know are bad for us. We'll even stop taking prescribed medications at the slightest sign of an adverse side effect, or simple inconvenience to our usual routine? We're a strange, self-destructive bunch. But why? Where do these motivations lie, and how would you go about changing things so innate to human nature? Does science and technology have the solution? To find out, join me, Matt Millington, as we plug into Invent Health, a podcast brought to you by a technology and product development company, TTP. Today we ask, medical adherence, why don't we do what's good for us?[00:01:00]

Welcome to Invent Health, a podcast about the future of health and technology. Each week, I'll be joined by the top scientists, engineers and academics working at the vanguard of this vital industry to give you a behind-the-scenes look at the world of health tech. Plus, some of our experts at TTP will be on hand to help us explore how the tech gets made, and its unbelievable real-world impact. In today's episode, we're getting inside our psyches to discover the behavioral science behind one of life's most nonsensical question. Why do we not do what's good for us?

From smoking to not finishing that course of antibiotics. Take me, for example, I have asthma. Yet I hardly ever take my inhaler, happier to risk the potential problems than carry a small, easy-to-use device around with me. It doesn't make sense, especially when I work in health tech and should know better. At TTP, and in particular [00:02:00] the health tech group, understanding how people behave and what makes them more or less likely to take their medication or engage with their therapy is absolutely critical to the design and development process. Why commit time and money solving a problem if the intended user is not likely to use the solution?

First, let's hear from Dan [Lock 00:02:18], who along with being my friend and health tech team mate at TTP, he's also a psychologist in human factors expert, exploring patient motivations and figuring out the design features that translate into long-term adherence to medication. So, put down that thing you're supposed to be doing and listen to this instead. So, human beings don't do what they're supposed to be doing. We sometimes do what's good for us, and we sometimes don't do what's good for us. This is a fairly open question, but why is that important for our healthcare?

Dan Lock: So, what, what we find is that the level of adherence to, um, medication that you typically see, ranges from around 45% to 85%. [00:03:00] Generally, we think that are... from about 80% is like a minimum for effectiveness as a rule of thumb. And so, what we see there is that that can lead to some outcomes in terms of m- the medication not being effective, not helping the people in the way it's designed to. For example, I know that in COPD, there is some studies that show that, you know, non-adherence is associated with two-and-a-half times higher mortality at three years.

Wow.

Yeah, I think when people are, um, are, are not adherent to their medication, there's obviously the immediate effect on, on their own health. But there's also, you know, the, the knock on effects on society as well, in terms of things like hospital admissions, you know, you think about it. It... There's a huge amount of cost to society as a result of non adherence, which can be quite a simple thing,

So, so the,

Matt: the outcomes are increased death. And also I, I read recently, it cost the NHS around £800 million pounds per year of people either not taking their medication at all or wasted medication. So it's a fairly kind of systemic problem [00:04:00] when it comes to healthcare, right?

Dan Lock: Yeah. And it's kind of comes down to instant gratification versus deferred gratification. Are we doing something that we know is going to be grateful for having done, uh, distantly in the future, or is it something that is gonna benefit us right now? And when you have competing priorities, then you often find the thing that is more immediate, is the one that will [inaudible 00:04:21] out, but those that take longer to, to kick in, or to show a benefit, or maybe they don't show any benefit, but they just slow down the rate of decline. Those are the ones where you have the biggest problems.

I have

Matt: asthma, and I'm pretty poor at taking my asthma inhaler. As a result, at a certain time of year, I used to often get a chest infection, so I get prescribed with some antibiotics. I also have a slightly weak tummy. So halfway through my antibiotics, my symptoms will have gone, so I just don't bother taking them, because it makes my stomach feel a little bit uncomfortable. That sort of story has massive impact on society, [00:05:00] doesn't

Dan Lock: that?

Well. Yeah, I mean, I know with, um, what's one of the main problems with antibiotics is if people don't complete the course, then it enables antibiotic resistant strains to emerge, um, over time, and then, they lose their effects. And then nobody can use them anymore. Uh, it's, it's a real problem.

Matt: Yeah, no, it was... it's, your right as motivation. For me, in, in my long list of priorities, it wasn't high up... e- enough up in my list to warrant me being adherent. But in, in doing so, I- I'm creating massive problems for the world, which, you know, it's not, [laughs], it's not very obvious, uh, when I'm just innocently not taking

Dan Lock: my inhaler.

I think potentially you are. Again, is the, the proximity of the consequence. You know, everyone wants the goal. And it's easy to do things that feel like you're moving towards it, [inaudible 00:05:44] no real cost to you. I, I think this is internal consistency. It's a big thing, and self-identity, and what... how people see themselves is a really

Matt: big thing.

So there are, there are much more complicated motivators going on here, beyond just logic, "If I take this drug, I won't die of this [00:06:00] disease"?

Dan Lock: I think that's a huge thing, because there are multiple different things going on, at any one time, when someone's making a decision. There's, there's the practical logical argument, which is, you know, "This is gonna be good for you." And that's all we really need to know. But there are other things going on, at the same time, there's issues about, you know, how people see themselves and their, their identity, and what that says about them. And sometimes that can be more important to people than other matters.

Yeah.

So it's one of the reasons why people will, you know, spend a lot of money on something that doesn't really make any sense. Like, they'll buy a very expensive champagne for £200, because it says something about them.

Mm-hmm [affirmative].

But give them a blind taste test with £10 pounds Aldi Champagne, and can they tell the difference really? Or do they enjoy it that much more? Almost, certainly not. And it- it- it's not just about the, um, the pleasure of actually drinking the wine. It's the self-identity piece that's really playing in that scenario. And that could be [inaudible 00:06:57] something it's also going on with things like smoking [00:07:00] where, yes, you know, logic is bad for you. But it's also... it's more important to you to have that image of the rebel, or cowboy, or all the things that used to play on in the cigarette adverts.

So it's

Matt: not as, not as simple as, "I need to take this asthma inhaler, because it will make me feel better." It's rooted in ideas of my own identity, which, [laughs], which is far more complex than just, "I'm, I'm a bit of a scatterbrain"?

Dan Lock: Absolutely, I think, I don't think forgetting is the main reason for non-adherence.

Matt: So already, it's clear that medical non-adherence goes way, way beyond the realms of merely forgetting things. You might think you just forgot to take those antibiotics, but it can be as deep seated as your concept of self. The idea of diligently taking and completing that course of antibiotics may actually have been at odds with your sense of self, and therefore, subconsciously, you're more likely to be non-adherent. As Dan explained, understanding how we behave, make choices, and define ourselves [00:08:00] is critical to how we design for health services.

The performance of health services and institutions around the world are at the mercy of our own behavioral idiosyncrasies. Needless to say, it is a valuable and complex issue to solve. I wanted to find out some more about the why behind all this, about the academic research which is going into understanding medical non-adherence. So I got in touch with Dr. Olga Perski, whose research is into exactly this. Olga is an Interdisciplinary Scientist working at the Intersection of Behavioral Science and Digital Health. She's currently working on a postdoc at UCL in the Tobacco and Alcohol Research Group. And she's also an Associate at the UCL Center for Behavioral Change. Can you tell me a bit more about what

Olga Perski: you do?

I work as a researcher. Um, a postdoctoral researcher at University College London. So I've kind of got one foot, um, in the Center for Behavior Change. And then I also work in the UCL Tobacco [00:09:00] and Alcohol Research Group, in particular interest in using digital technologies.

Yeah.

So websites, apps, wearables, um, to deliver interventions-

Mm-hmm [affirmative].

... to support [inaudible 00:09:10] alcohol reduction.

So,

Matt: you know, it's naughty to smoke. I know that. I used to smoke. I gave up many years ago, but it required some fairly serious commitment and a little bit of hypnosis, actually, in the end. Why do we do these things when we know, inherently, that this is not necessarily very good for you? Why do we do it?

Olga Perski: Yeah, so, I, uh... so I think that there's a number of factors that kind of just actually make it very, very challenging. So first of all, I think it is important to emphasize our biology. We're obviously programmed to, you know, want to eat sweets, and fatty foods, and things like this. So it's kind of actually quite natural that when things are present in our environments, then we will crave those things and want those things.

Mm-hmm [affirmative].

Most of our, you know, cities and societies are set up. So kind of the [00:10:00] environmental, you know, influences in our behavior actually make it incredibly hard to, to do things that are good for us.

Matt: And there, there are social drivers a well... a- as well, like, the, you know, the term, "I'm a social smoker, or I'm a social drinker," implies that there's something else

Olga Perski: going on.

Absolutely. So yeah, different sorts of cues and social cues are obviously important. But then, if we think a little bit more closely at sort of what goes on under the hood, you know, we can consider things like, uh, motivation. You know, social environment that we're in, obviously feeds into the beliefs, beliefs that we have about what's good, and what's healthy. Um, so if we're surrounded by lots of people who smoke or drink a lot of alcohol, then that will feed into to our kind of moment to moment motivation towards those behaviors as well.

Matt: Yeah. So there's, there's the evolutionary driver of, i- i- if this stuff's around, we're pre-programed to want it, to engage with it. There's also the social [00:11:00] driver, what about the environmental factors that make us do

Olga Perski: this?

Wh- when it comes to environmental influences on, on behavior. A lots of research showing that, you know, we're heavily impacted by th- the things surrounding us in our day-to-day lives. So, for example, if we live in close proximity to, uh, to green spaces, and parks, then it's more conducive to, um, physical activity, for example, in cities where they're less dependence on cars, for example, that's also m- more conducive to, uh, to physical activity. And then, also it tends to be socio-economically patterned as well. So obviously, in neighborhoods where less affluent people are able to afford, uh, accommodation, that... those areas might also be geographical regions that companies might target with shops, or, um, that kind of cue different behaviors like gambling, or alcohol consumption, or unhealthy foods. So [00:12:00] it's a real, real complex factor of things that im- impact behavior.

Matt: Complex indeed. It already sounds like a web of different feelings of motivations driving this issue. So it seems we have a multi-dimensional balancing act happening, good, or bad behavior, or adherence to non-adherent behavior. It's not simply about making the right choice or forgetting to do the right thing. We're motivated to behave in a certain way, driven by our inherent idea of who we are, and our quest to become who we want to be. Maslow refers to this concept as self-actualization, the pinnacle of his famous Hierarchy of Needs model. But our motivations change when they come into contact with surrounding social, and environmental factors. We need to understand the interplay of these forces if we want to create more patient adherent therapies. So we're, we're operating at multiple different levels here, aren't we? There's the [00:13:00] human emotional motivation, how do you go about understanding somebody's motivation to use an asthma inhaler, or an EpiPen, or, uh, whatever it is?

To

Dan Lock: understand them, motivation, I think it's, it's been studied for a long time. People have been trying to understand behavior, obviously, for millennia. But I guess, in terms of psychology, the first person to really look at behavior was, uh, Skinner. Who was one of the biggest sort of names in, in psychology after Freud.

Mm.

And in the '30s, he published a book about behaviorism, that was very much taking the human as a black box that he didn't really care about too much. He was more interested in looking at the inputs and looking at the outputs. And it was his focus was all on conditioning, and reinforcement, and external factors. So, like Pavlov's dog, you ring a bell. The dog salivates, 'cause it associates it with dinner time.

Mm-hmm [affirmative].

He sees behavior in a similar way to that, in the sense that, if you punish someone for doing [00:14:00] something they won't... they're less likely to do it in the future. If we reward something for... someone for doing something, they're more likely to do it in the future. And that's still a view held by a lot of people, and especially in things like education and, and things like that where it can be quite prevalent. There are people out there that are trying to use similar strategies now to create better adherence in terms of punishing, and rewarding people for their poor adherence by, you know, giving them free vouchers if they take their medication. It doesn't really work in the long-term, it doesn't change hearts and minds [inaudible 00:14:29], it's something only works as long as it's, um, in place.

Matt: So the, the motivations are more complex than just logic. I guess, we're getting into the world of, you know, "We don't need to do things, because it's gonna keep us alive." But if we don't do it, it might say something about ourselves that we for whatever reason deem to be of more value than the risk that goes along with not taking the medication, for example?

Dan Lock: I mean, a lot of really interesting wo- work that came out after the war where they were trying to understand why people went along with, with the Nazis for example, why were they [00:15:00] obedient to that authority when they knew that they were doing the wrong thing?

Mm.

And all those kind of Zimbardo in prisons experiments. There's a really famous one where... I think it was Solomon Asch, he did a study where you got a group of five people in a room. The first four people were all kind of in on it. The last person was the real experiment subject. And the study was showing people, you know, a length of tube and asking them to compare with another one and say which one is longer. And then, after a certain amount of time, he would get everyone to say, uh, something, one was longer, when it clearly wasn't. But everyone would say it. And then [inaudible 00:15:34] times the guy who was last in the, in the crowd, he was the actual experimenter, he would go along with what everyone said, even though, he can see with his own eyes that-

Wow.

... that wasn't the case. And in this kind of stuff like that, we realize, you know, this is a lot of stuff. Um, and there's a social element to, to how people behave. It's not just driven by logic, it's about how they see themselves, how they want others to see them.

Matt: I wanted to break down this idea of [00:16:00] motivation even further, and to take it out of the realm of academia and into the commercial world, to find out what methodologies and techniques are being used to create products that patients actually want to use. So I called up Paul Upham. Paul is Head of Smart Devices at Roche Genentech in San Francisco, and has over 20 years of experience in medical technology, and digital health R&D, including leading the development of the world's first prescription digital therapy for type 2 diabetes, BlueStar from welldoc. What are the, what are the drivers, or at least, the blockers to adherence that you, you come across on a regular basis?

Yeah,

Paul Upham: when you, when you look across multiple conditions, some studies have shown that forgetting might be about 20% of the explanation. One way to think about what forgetting is, is that it's unintentional non-adherence, "I forgot." There's a bunch of [00:17:00] intentional, including things like, "I don't believe the drug will help me. I don't trust my doctor," is sometimes intermixed with that. "I'm persistent, but I'm not adherent." And then there's a, there's a couple of other unintentional types that we see and those are often financial or logistics. So when you stack all of those reasons up, and, and you often find a mix of them in every single person that drives you to that average of 50%

Matt: non-adherence.

I mean, that is, that is a startling figure. What piqued my interest slightly was your description of, I forgot, as unintentional, whereas I feel like there are also gray areas within the whole I forgot statement, there's an element of, "I forgot, because I didn't prioritize it enough to bother to remember."

Right. It

Paul Upham: may be that the studies that sort of report forgetting, uh, [00:18:00] really can unpack what forgetting means into things like you described where, "I don't have the appropriate motivation to remember." And I think that is not necessarily the patient's responsibility. I think that is the healthcare system players responsibility. Most people with except a few exceptions, want to be healthy-

Yeah

... want to feel better, and want to live, [

Matt: laughs].

So Paul, can you, can you tell me what kind of techniques, uh, and methodology you're using to be able to get closer to understanding the motivations of, of patients to be able to help them be more adherent?

Paul Upham: An example where a team was at the very early stages have an interest in improving persistence on therapy. So this was, uh, a therapy for a very severe respiratory illness, uh, a deadly [00:19:00] respiratory illness. The therapy had significant gastrointestinal side effects, you know, imagine the worst ones. But the, the drug added five to seven years to your projected lifespan from this condition. So huge benefit, but they had this persistence problem, and, and they didn't understand exactly why that was. And so, they commissioned our behavior design team to help understand this problem and ultimately design a solution for it. We realized we needed to ha- have a conversation and observational session in the patient's homes.

Mm.

And what they were looking for were some of those same traditional endpoints of, uh, of an ethnographic study, but they were also looking to understand, what are the natural behaviors of patients in their home [00:20:00] environments? What are the natural behaviors associated with the management of their condition? And so, we sent the team and, and gathered all sorts of interesting insights. We're interviewing patients, and we detected one behavior that we saw across... I don't know, maybe 70% of the patients whose homes we were in, where they were using a fingertip pulse oximeter. What they were using it for was, if they started to feel out of breath, they would attach the pulse oximeter and measure their blood oxygen level. And then, they would do a breathing exercise, or a meditation in order to try and get... try and calm themselves down. And very frequently, they told us, they would see an improvement in their blood oxygen level.

So it was this [00:21:00] fascinating insight that was completely unexpected. But it was about the only aspect of their health that they could control. And it helped them measurably feel better, even just a little bit, which nothing else about their condition or their treatment did. This became our technique for unders- unlocking, "How do we battled the brain's inability to look at that longer term future value, [laughs], and want immediate rewards, and be much more satisfied with immediate rewards?" And so it was essentially a hack to their own environment that we realized could be quite relevant and useful for many, many other people.

Matt: And th- this is why I still firmly believe that while traditional ethnography, a- or at least firsthand observation gives you deeper insights that you wouldn't be able to get [00:22:00] from monitoring. So being able to find those small things that make us feel like we're actually improving is very motivating.

Mm-hmm [affirmative].

That story from Paul really shows how unexpected reasons for non-adherent behavior can be. Data and remote monitoring is incredibly powerful. But sometimes you need to see people's behavior firsthand in the real world, to get the full picture and come up with the right solution. So now, we understand the impact on society of non-adherence. And most of all, we understand the concept of motivation, but more important than the why for patients at least has to be the solution. What can we do about it? And can technology offer a solution to our human behavioral and consistencies? What can health tech do to change problems which are seemingly in our head? Olga has been working on some cutting-edge technologies, which seek to do just that. Do you think digital technology offers, [00:23:00] uh, an opportunity to tackle addiction health more than, more than previously?

Olga Perski: Yeah. So it's, it's a bit of a complex matter as well, [laughs], uh, like everything. So I think when we're looking at kind of what works for, you know, smoking cessation, or alcohol reduction, I think that, th- we should probably pay attention to where they can play a really important role. So, obviously, when we think about the effectiveness of any intervention, we need to think both about the magnitude of, of that intervention, or its effect, uh, but then also the uptake. Um, and so is there a way that we can design something via technology.

So technology

Matt: is powerful and that it offers scalability, enables us to reach more people, which is why it's interesting. I'm interested in how you actually reach people, uh, using technology. What ways are you gonna use technology to be able to address something like excessive alcohol intake?

Olga Perski: Yeah, so I think de- When designing these interventions, we do need to kind of think carefully [00:24:00] about what ingredients or what components we put into these interventions. And I think we- we're probably seeing a lot of different apps being launched on the market, uh, which may not necessarily have been designed with, um, researchers, or clinicians, or users involved in their design. And when we're thinking about effective techniques, it's often very useful to kind of make sure that we take a systematic approach. So to give you an example, we have some interesting work going on, where we've designed a sort of quick response chatbots. We've conducted, um, some experimental work. In one study, we were able to randomize over 57,000 smokers from different countries, and we were able to look at some indicators of user engagements, and then, also short-term smoking cessation success.

We found some quite interesting results. So user engagement more than doubled in the, in, in the group that, um, received [00:25:00] the chatbots. And then, we also saw that that led to, um, increases in quit success at one month. And I think what- what's coming out of this is that even though people know that it's completely automated, and it's a bot, even though it's got a bit of personality and, uh, a bit of humor, uh, it's not a human being, but people are still feeling like they form some sort of a bond with this virtual character. And that it can help to sort of boost motivation, and interestingly, as well, that people kind of feel like they don't really want to disappoint the bots. They don't want to come back and sort of have to report that they smoke the cigarettes or, you know.

Matt: Yeah. I mean, one, one thing about digital technology and reminders is it's very, very easy to switch off. But I feel like with a chatbot, when you've got that added personality, it's just... it's, it's another reason to engage a little bit more deeply. Have you experimented with customizing tone of voice and things based on the type of, uh, type of user?

Olga Perski: So, that... Yeah, I agree. This is a [00:26:00] ve- It's a very interesting approach for kind of taking something that is typically boring and making it more fun. Another thing that is quite interesting about sort of where things are probably going more and more is to be able to personalize a bit more on, on the basis of the individual's responses. S- so, ul- ultimately, I think now, we're at the phase where we need to think very carefully about, how can we leverage all of this to actually sort of deliver on the promise of health technologies by making them ac- actually useful and usable for people rather than sort of something that's just annoying.

I think it's interesting as well, that a lot of it has probably grown out of behavioral areas where people typically think it's fun to track things, being able to visualize one's performance might then provide even more motivation to sort of beat one's record or sustain a particular pattern of exercise. People have tried to gamify smoking cessation, and probably to a, to a [00:27:00] lesser degree alcohol reduction. And I think that, uh, for, for smoking, for example, it might actually, there might be other ways in which we can gamify the process.

Matt: Those terms, gamify and gamification, always set off my buzzword bingo along. The words which seemed to echo the halls or open-plan loft spaces of digital product design studios the world over. But don't let the buzz spoil the opportunity gamification presents for healthcare. Creating something fun or competitive has many real-world use cases in terms of health and in particular, driving patient engagement. But is it the sugar coating on the digital pill, or is it more powerful than that? I wanted to dig into this a little further. So I, uh, I asked Dan, to break down the concepts for me?

Dan Lock: Gamification is something that's associated with our dopamine response. And the components that make up of, of, m- over mastery kind of driven experience are, you know, your just manageable challenges. [00:28:00] So not too easy, not too difficult that it puts you off, but just manageable within your current level of skill. So it really nice learning curve is really important. And when you find a hobby, or something that has the right learning curve for you, because obviously everyone's learns at different rates, that tends to be the one that you're gonna enjoy, and, and, and kind of progress with. Clear proximal goals is another one. Not every task is, is gamifiable and it tend to be something that would you do again, and again, and again. There's a certain level of skill involved, not too much, not too little. And there's a clear way of measuring it and feeding back that you have done it correctly.

Matt: So this is playing on that mechanism. Using mastery to get people to engage in something over time, which eventually builds that sort of inherent

Dan Lock: behavior?

Yeah. I think, I think so. And it asked some questions about, you know, the design of medication regimes as well. What if we designed it, something from the regime backwards rather than from the drug? With how would we design it? Would it, would it... How different would it look? Would we say, [00:29:00] Actually, now, you're taking a pill every day." It's really, really easy, but it's boring. And is, is there's no skill? You're not mastering anything. So if there was another way to deliver the medication that took a bit more effort, but it was maybe a bit more interesting, would that be better? Maybe it wouldn't, I don't know. Maybe it'd be too much effort, and people would get bored of it eventually.

You know, I've, I've

Matt: seen it used. Gamification very explicitly used on... They've essentially designing video games that have a therapeutic effect. Have you seen any, any good ones like

Dan Lock: that?

I mean, there's a very well known local one to us. Um, the company called Playphysio that's designed a series of games for people with cystic fibrosis. So that is the perfect candidate for gamification, in the sense that it's a very boring task. You have to do 100 breaths or something every day in a very controlled way, at the right rate, not too fast, not too slow. And they'd taken that and they've turned it into a series of video games for children, where every breath, if it's the right level controls, whatever the action is in the video [00:30:00] game. And I think, you know, that has managed to transform some, some family's lives and taken that, you know, experience, which is very stressful for everyone. But this has made it to us an activity that most other kids are jealous of, you know, that they want to do it too. I think that's been really good.

Matt: Gamification, if used correctly, is a great tool for product teams, who needs to elicit regular engagement from their user base. As we've learned the concept of mastery, or investing time in developing a skill actually builds engagement, it also helps flip the context of treating a condition into something that feels more positive. So what's next? Well, we use our understanding of behavioral psychology to make things even more personalized to the individual. Tech that learns who we are, what we like, and tailors itself to our individual needs and even moods. I asked Paul, about the future of health tech personalization. And whether the constant reminders and [00:31:00] notifications that many digital solutions are built around, are here to stay. Can you tell me a little bit about how you, how you feel about technology's role in, in reminding people, whether it works or not?

I think

Paul Upham: it can work. But you'd... You first have to know that... and this is part of the power of digital, um, is the ability to know is the person... somebody who's got a problem with forgetting, is that at the root of their adherence challenges? And then, if the answer to that is yes, then you wanna bring the person to activating some sort of reminder system, and then, have it understand the person's therapy regimen and lifestyle, make it contextual. You know, use the smartphones capabilities. So it's not just a crude, persistent type of thing. "So let's build those first and, and gather some data and see how it's working [00:32:00] for them." Regardless of how somebody feels about Amazon. They are becoming if not already one of the world's largest pharmacies, and have an ability to get things to people's homes [laughs] better than most.

They

Matt: have devices in your home as well, uh, a particularly useful.

Paul Upham: Yeah. Yeah. I think they're... I think, we still are not paying enough attention to what Amazon might disrupt next for any of us in that healthcare ecosystem value chain. It's interesting. I, I am a... I'm an Alexa user, but it's so funny when I look at the history of interactions in their app. You can see what questions, where 80% of the time, it's asking what the weather, uh, weather, weather is right now, or the forecast.

Yeah.

And 20% of the time, it's cooking timers.

Right.

And then, yeah, every once in a while a fart joke.

Yeah, [laughs]. [00:33:00] It's the

Matt: kids that got hold of it.

[laughs], right.

But I, I think that's, you know, there, there is a big problem. Um, that I think that is potentially the solution. How do you cut through the noise? Because, you know, if you have a chronic disease, it's pretty important. But we've already established that we're not fully rational. How do we cut through because it's only gonna become more and more noisy and digital in our lives?

Paul Upham: Yeah. It's a great question and an important one. Actually, the first question for any particular brand, or any particular therapeutic area team is to look in a given market that matters to them and say, "Does anyone own the digital relationship between a doctor and a patient already? An- and if so, who is that? And how could we partner with them, and with the end objective being, 'Let's not, let's start insert ourselves in between the doctor and the patient?'" And then if [00:34:00] you ask that question of a particular patient population in a particular market and you find there's nobody offering anything. Then there's an opportunity to say, "Okay, how could we put together the right ecosystem that could support patients who have this disease?"

Because then what the patient is getting, at the end of that... of a project like that, is something that addresses all those different areas, that addresses sort of core motivations about medication taking, but it, it is part of an ecosystem that addresses the financial barriers. It's part of an ecosystem that addresses the logistical barriers, and it's one that allows the patient to have a better connection with their healthcare team. And, and it's those integrated solutions that are all sort of sharing the data appropriately, you know, with whichever parties in [00:35:00] that ecosystem should have it for the benefit of the patient.

Creating

Matt: more integrated experiences is the holy grail for digital health solutions, and physical for that matter. By putting the patient front and center we're able to personalize solutions, and deliver reminders in ways that don't cause annoyance or present unnecessary burden, but are not so seamless and embedded that they're ignored or forgotten.

Olga Perski: My tickler area that I'm very excited about is the ability to, to better understand individuals, and how they change over time, and their circumstances change over time, and how we can use that information to really tailor the support that we're providing to people.

Matt: And what will that personalization do? It will empower people to be healthy, to want to do what they should, and to eventually actually do what's good for them. So personalization is a powerful tool and [00:36:00] understanding motivations to adhere or not, is paramount. You can't make someone do something, or at least not for a sustained period of time. You have to engage people as individuals on their terms, finding and leveraging their own personal motivations to promote more positive and healthier behaviors.

It's about

Dan Lock: trying to give people back their autonomy and decision making. You know, treating them with respect and making sure that they're fully aware of all the things that are going on in their lives that they, they value.

Matt: That's all we got time for today. Thanks so much for listening, and to all our guests Dan, Olga, and Paul, for demystifying The idea behind our self-destructive tendencies. We'll be back next week, but we'll be looking into mental health to see whether it's the wellness industry or groundbreaking new health technology that will provide the solution to the mental health crisis. We'll see you then. Invent Health is a podcast from TTP. It's hosted by me, Matt Millington. [00:37:00] When I'm not doing podcasts, I'm also a strategic design consultant at TTP. It was written and produced by Harry [Stott 00:37:06]. The executive producers were Abby Williams, and Sam [Zacharino 00:37:09] from TTP, and Ollie George from Adrift Entertainment.