The fall prevention research for this challenge has consistently cited the need to increase physical fitness and overall activity levels among older adults. However, starting and maintaining a fitness regimen is difficult for people of all ages. Developments in the fields of motivation, habit formation, and behavioral change have provided insights into the power of appealing to people's nonconscious and automatic cognitive processes, as well as the efficacy of properly framing and administering behavioral incentives.
For example, a March 2016 article published in the medical journal Annals of Internal Medicine (attached), assessed the ability of multiple financial incentives to increase physical activity among overweight and obese adults. The experimental design included four incentive conditions that were designed to encourage participants to take 7,000 steps per day. The condition that led to the largest proportion of participants meeting their daily goal (45%) was the "loss incentive" group. In this condition, participants were given a $42 monthly upfront payment for their participation, but for every day that they failed to meet their goal $1.40 was deducted from their initial allocation. The conclusion was that "Financial incentives framed as a loss were most effective for achieving physical activity goals."
The effectiveness of immediate, monetary losses in motivating participants to exercise corresponds to two fundamental concepts of behavioral economics: loss aversion and temporal discounting. Loss aversion stipulates that when people make decisions they generally weigh the potential losses more heavily than the gains. In other words, human beings tend to feel a greater amount of "pain" from a loss than they feel "pleasure" from a gain of equal value. On the other hand, temporal discounting shows the increased value that people place on immediate rewards rather than delayed rewards. This principle is akin to the saying "a bird in the hand is worth two in the bush". In general, people prefer monetary incentives when they are delivered immediately, even if the future reward represents a demonstrably larger return that exceeds a rational discount rate. Learning theory also supports the power of proximal rewards and punishments in creating lasting associations and developing behavioral patterns.
Using the results from the previously cited study as well as the mounting evidence from modern decision-making theory, AARP would be wise to carefully consider the framing and delivery of any incentive-based exercise program.
The prototype being explored in this post attempts to incorporate behavioral economic theory into an AARP sponsored fitness technology. In short, AARP will need to develop a mobile fitness app that will track the achievement of measurable fitness goals and provide daily incentives for reaching predetermined activity levels. The app will set fitness goals based on the user's personal profile, sync with the user's mobile fitness tracker or wearable fitness app (e.g. Fitbit), and aggregate necessary data to assess the completion of daily fitness goals. Most importantly, the app will host a "virtual bank account" into which a financial incentive will be deposited at the beginning of the participation period. Each day that the user fails to meet their fitness goals a proportion of the financial incentive will be taken away. Users will receive daily push notifications informing them of their success/failure from the previous day and encouraging them to "bank" their financial reward by meeting their goal that day.
Several other functions could be built into the app. For example, a social media component that allows users to encourage their friends to meet their goals, or organize group walking or workout sessions with other participants in their neighborhood. Similarly, caretakers, family members, and friends could become "coaches" that are able to offer encouragement through platform.
We are early in the prototyping phase, but think that the combination of collecting data through existing technologies and effectively incentivizing exercise based on that information will help to motivate behavioral changes among older adults and create lasting healthy-lifestyle habits.
I was able to talk to someone at the YMCA about our prototype. She was a 65 year old women that has a smartphone and uses the internet (primarily at home on a desktop). She uses a few apps on her phone, mostly to communicate with family or to perform simple tasks (calculator, check the weather, etc.) I've posted a few of their insights below:
1. She likes using her smartphone apps, but still feels like she as a lot to learn and is constantly relearning things that she uses infrequently.
2. Icons on the apps need to be large and easy to read.
3. Similarly, each "page" in the app can't be too cluttered or complicated. Easy navigation is hugely important.
4. The idea of "community" encouraging participation was intriguing, but social networking was a pretty foreign concept to her beyond the name "Facebook". She liked the idea of considering her friends as "teammates" and family members (caretakers) as "coaches" that encourage her to reach her goals, but she didn't want them to be able to access specific information.
5. Earning money toward her local grocery store seemed to be appealing and she liked the idea of having that "money in the bank" to begin with. I didn't go too deeply into the behavioral economics concepts that are driving the rewards system, but she seemed to grasp the idea of "losing money for not participating" pretty easily. She did get confused a bit about where the money came from: did she have to put the money in? Could she withdraw it at any time? But, again, once I explained that the sponsor put money into a "piggy bank in the app" that could be redeemed at the end of the month she seemed to understand.
6. She seemed equally responsive to the idea of getting a 30% coupon up-front and having 1% taken off the coupon for every day that she didn't reach her goal. But based on the fact that the "piggy bank" metaphor is what really drove home the concept, I wonder if the "percent off" idea would be harder to communicate. Still, definitely worth considering!
7. Lastly, she did not have much familiarity with the mobile activity tracking app and had never used a wearable activity tracker. She seemed pretty interested though, and liked that AARP app would communicate with wearable technology. She was really curious about Fitbits and had a few friends that had recently purchased one. She said that based on her friends description, she didn't think it was "for her", because she was too futuristic and complicated. But after I described the simplicity of many of the wearable products, she thought it might be worth investing in one (though the price was prohibitive). This reminded me of a paper I had read about wearable tech for people over 50 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4749845/).
We have added some images that are higher resolution prototypes for the app itself. Below are a few thoughts we've had regarding the app.
- The reward structure is built around the concept of loss aversion, but we feel that there are ways to augment the experience by allowing people to "earn back" lost rewards. Our idea is that users could complete auxiliary assignments throughout the month (watch sponsored video content, complete fall-prevention quizzes that are associated with in-app articles, etc.).
- The breadth of rewards sponsors could be large, but the most effective sponsors are probably those companies at which AARP members shop frequently. The gift cards or coupons that are earned monthly will be more effective motivators if they are businesses AARP members visit on a weekly or monthly basis. However, this does not mean that sponsors outside of this definition would not be interested. The sponsorship terms could be similar to the "Groupon" model where companies participate on month-to-month terms.
- The social media theme has also emerged as valuable motivating tool. While AARP should take every effort to keep the app simple for the target user, we believe the app should have a community or social component.
- We feel confident that there is incentive for participation among the many stakeholder in developing this technology. However, if the investment is too large we believe in the application behavioral economics theories to existing programs. The research shows that participation is greater when these tactics are employed and their use is not limited to our prototype.
- The app is a way for sponsors to advertise and offer in-store rewards to AARP members. We feel that the costs associated with sponsor participation are outweighed by the gains in customer loyalty, customer engagement, and corporate social responsibility.
Sanjana tested a couple of these things with her aunt, here's the feedback:
-She uses her phone, some basic apps, and like you mentioned she has to relearn things she hasn't used in a while.
-The idea of friends made sense to her because she's on Facebook.
-The pages should be as simple and uncluttered as possible.
-Avoid symbols like the hamburger menu button - we know to intuitively click on them, that there's more info underneath, but everyone doesn't.
-She's aware that her phone has a fitness tracker built in and so doesn't have a wearable device.
Added two new prototype images (day 30 piggy bank with "print coupon" button and example coupon).
Also, I have pasted links to the exercise rewards programs that we have researched (or have been suggested) as working models for our app. You'll see that these programs almost all use "traditional" rewards structures in which participants "earn" (or gain) rewards as they go. As we've stressed consistently, our model is about framing rewards as losses, which current motivation theory and empirical research suggests is a more effective way to motivate individuals. The one program we found that uses this tactic is stickK (stick.com). To see how stickK uses loss aversion (as well as consistency bias, cognitive dissonance, and social perception theory) to motivate behavioral change please visit http://www.stickk.com/tour/1.