How digital health offerings can promote behavioral changes with effective UX design

July 13, 2021

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In this article, we explore the active choices for UX design that contribute to the success of a digital health application and share three key pillars for success!

Many of us at some point have tried to achieve a health and wellness goal. Many of us have also had a setback or have failed said health and wellness goal after a burst of initial excitement to make meaningful changes in our lifestyles. Digital health applications have become part of the suite of resources that people tap into to achieve their health and wellness goals, with marked success recently, especially in the midst of COVD-19 where the focus on virtual care has skyrocketed.

The COVID-19 outbreak has offered a unique opportunity for experimentation and testing on a large scale with users who may have been reluctant to try in the past. An example of this change is how virtual physician visits went from more than one in 250 health care visits prior to February 2020 to more than five percent of all visits today (13 percent at peak during 2020). While virtual health care visits are not necessarily a direct proxy for willingness to use digital health applications, users who found success and convenience in using any digital/virtual tools to manage their health during the pandemic may continue to do so as life moves beyond quarantine.

Effective elements of user experience (UX) strategy often incorporate recent behavioral economics findings. Prospect Theory states that people strongly prefer to use quick, intuitive thinking (labeled System 1) over slow, analytical thinking (labeled as System 2).

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UX design that intentionally appeals to quick, intuitive System 1 thinking is likely to engage and retain users more effectively than elements requiring more mental energy. These elements of UX strategy are evident across digital health applications, especially those that have garnered (and maintained) a large user base and consistent growth. For these successful applications, an essential concept for good UX design is the idea of avoiding “friction”, defined as anything standing in the way of additional app usage (e.g., confusing UX, heavy reliance on manual data entry, etc.).

Some UX elements that promote System 1 thinking may be obvious changes to reduce friction, such as a diet or fitness app reducing the need for manual calorie calculation. Incorporating peer communities and coaching as core UX components for health-related apps similarly adds peer pressure and positive reinforcement to encourage user accountability beyond a rational System 2 analysis of the app’s benefits. Alternatively, a successful element of UX could be as subtle as displaying images and sounds that subconsciously remind users of material they enjoy, framing new content in a way that builds initial familiarity and comfort.

We explore the active choices for UX that contribute to the success of a digital health application, focusing on three pillars of success spanning a wide range of health and wellness areas: Community building, simplified data entry, and familiarity-based marketing and design.

  1. Community building

    A key pillar of success for digital health applications is long-term and sustainable results for the end user. Similar to people going to the gym for their New Years’ resolutions but only lasting for one week before going back to their old habits, there is a distinct difference between an end user downloading and potentially paying for a health application for a short period of time versus an end user being engaged with the application to reap long-term and maintained benefits.

    Long-term commitment to the application will lead to more of a positive impact for both the end user and the digital health company. The end user has better results from usage of the application over a longer period of time, and the company gets to grow and iterate its product further as the topline grows.

    Personalized community building and coaching is a key factor that drives users to achieve long-term and maintained results. Companies investing in accessible health coaches that are intentionally paired with users, and appropriately balancing AI coaches with human coaches, create spaces for communities to come together in a digital fashion (which is especially important in recent times with COVID-19). This focus on community building and coaching is evident through Noom’s and Weight Watchers’ successes as digital health applications in the nutrition and weight loss space.

    Both Noom and Weight Watchers have built an impressive engagement strategy fueled by community building and coaching offerings. Both applications focus on the user and the coach setting goals together based on the individual’s lifestyle and preferences. Coaches are available through direct messaging to act as a source for problem-solving, especially when a health journey becomes difficult, so that each user can reach their end goal. Users may also be nudged when they notice that there hasn’t been a recent sign-in or if there is an overall decrease in activity to hold users accountable and aim to drive activity and engagement on the application.

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    On Noom, once the user has gone through the trial period and has selected a subscription option, users get access to a wide range of support through an on-demand coach (Goal Specialist), a group coach, and a support group with other users. Based on demographics, goals (e.g., defining the “Why”, “Your Big Picture”, etc.), and support and motivation preferences, each user is assigned a Goal Specialist to help them work toward their goals and be a direct point of contact for any questions or concerns. Access to the group coach and support group grows the community aspect of Noom even further and allows the user to find a shared community while working to achieve their health goals. Users can find support through their health journey through coach-led and user-led social connections that Noom facilitates.

    On Weight Watchers (WW), users choose a subscription option between Digital, Digital 360, and Unlimited Workshops + Digital, but regardless of the subscription option selected, users get access to community Connect groups. WW Connect Groups offer support and tips to stay on track with the program, and users are able to join affinity groups and follow other uses to see and engage with their posts. This promotes a sense of belonging, especially with the sub-communities within the overall WW community catered to many different groups and interests that allow the users themselves to drive the content.

    Digital 360 and Unlimited Workshops + Digital offer more coaching and community options as part of the paid subscription packages, with a focus on programming (e.g., classes, podcasts, events for users) and third party partnerships (e.g., Aaptiv for audio exercises, Headspace for meditation). Similar to Noom, WW creates a bond not only between the user and coaches, with users choosing which coaches to follow, but also between users in the social communities.Overall, WW focuses on ensuring that serious users subscribe for a long time, as WW understands how difficult it is to win a user back once they have disengaged.

    Overall, successful digital health applications emphasize community building and access to helpful and knowledgeable coaches and communities, both personal and group-style, to encourage users to stick their goals. Noom markets 84 percent program completion, with 60 percent of users keeping the weight off for one or more years. WW has a high rate of referrals from their current users and promotion programs, and takes pride in constantly improving user retention. Overall, WW and Noom are helping users reach their health goals, and users can accomplish these goals with a supportive community virtually by their side.

  2. Simplified data entry

    Another key pillar of successful digital health app design is helping users maintain new healthy behaviors without feeling discouraged or burnt-out, which may lead to lack of engagement/app usage. The concept of “nudge theory”, popularized by Thaler & Sunstein in their book on choices, highlights how behavior can be influenced by positive reinforcement and indirect suggestions. Nudge theory is an important focus area for health apps, and helps motivate users to replace unhealthy behaviors with healthy ones. However, long-term habit adherence also requires removing obstacles to keeping the new behavior going.

    Many healthy habits require tracking of key metrics, some of which cannot be read by a meter and must be manually captured, such as calories consumed for diet apps. Reducing manual data entry and mental exertion prevents burnout and improves retention. Some app designers think about this as “reducing friction” to use so that users continue to track behaviors and stay on track. Calorie trackers, such as MyFitnessPal, have taken many steps to make data entry as simple and painless as possible. Designers understand that if friction is not reduced, over time even the most compliant users will find it hard to keep up with their tracking habit. Innovative designs such as barcode scanning, calorie estimators for full meals, and partnerships with other apps limit the amount of time users need to spend on daily tracking, leading to more consistent daily tracking over time.

    Apps can also reduce risk of burnout by simplifying complicated disease management and consolidating health information. For diabetes patients, especially those with additional health conditions, simply tracking all aspects of their care can be overwhelming.

    Livongo is one diabetes app designed to connect to a blood glucose monitor device, a blood pressure monitor, and a digital scale to ultimately offer additional information and services for users. Livongo not only keeps track of blood glucose readings and other health metrics, but makes recommendations (nudges) and helps patients by laying out steps that users can take to reduce the burden of managing their disease. This encourages users to rely more on the app and increases engagement. Livongo also offers personalized coaching which tracks demographics and use patterns to identify and reach out to those users at risk of being overwhelmed and burning out. The coaching serves as a human element to help patients feel that they are not alone in managing treatment.

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    Additionally, well-designed apps with sleek dashboards and summary screens can help users keep track of data for themselves, as well as share with caretakers, family members, and physicians. This is especially helpful for users who might otherwise be tracking metrics on pen and paper, which can be lost or forgotten at appointments, while data can be shared easily even remotely. This level of assistance elevates an app from being a novelty to a critical and reliable tool for managing long-term disease.

  3. Familiarity-based marketing and design

    Meditation, journaling, mindfulness, and sleep assistance apps, broadly categorized as “mental health/wellness” apps, have had explosive success in terms of market penetration worldwide, with apps like Calm and Headspace having an estimated 900k and 400k total downloads respectively in just March of 2021. However, this rapid growth in the popularity of mental health wellness apps may appear puzzling considering how products like these have historically been considered more niche and for a wellness-oriented consumer archetype only.

    To understand how apps like Calm and Headspace have bridged the divide between yoga-loving health enthusiasts and the broader mass market consumer base, it is best to identify which UX design elements ultimately allowed these apps to 1) destigmatize mental health/wellness content to expand the potential user base and then 2) retain and train users to build routines that provide meaningful benefits and keep them coming back to the app.

    In terms of destigmatizing mental health/wellness content that many users may not have been comfortable with initially, one highly effective UX strategy incorporated by meditation and sleep apps was to add familiar “packaging” to make unfamiliar content more approachable. For example, Calm offers sleep stories, where a narrator reads a short story to users in an attempt to make them fall asleep. To make this content more approachable, Calm partnered with celebrities, musicians, and actors to narrate sleep stories, so users would be familiar with the voices in the stories even if the concept of listening to a bed time story as an adult was unfamiliar and initially caused hesitancy.

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    After users have been brought into meditation/wellness apps, assisting them with actually building healthy routines related to mediation and sleep is vital for minimizing churn and providing a meaningful benefit for users. Effective UX strategy has supported routine building with small but noticeable features like white noise that automatically plays upon opening the app (to subconsciously establish that it is time for users to relax and end the day) and guided meditation training playlists to educate and provide structure for users that may initially be apprehensive. By developing their UX strategy to continually ensure that apprehensive users (or potential users) are reassured by familiar voices, familiar sounds (e.g., white noise, nature sounds, etc.) and familiar meditation exercises, meditation apps have brought existing meditation techniques to a much broader audience.

Conclusion

Overall, the continued success and user growth on digital health apps is supported by the intentional UX choices that support a user’s success and encourage continued usage:

Key digital health pillars for success: 

  • PILLAR 1 - Community building: Coaching and community building supports user retention and long-term, maintained results as users are held accountable and find greater meaning in their health journey with the support of coaches and fellow users
  • PILLAR 2 - Simplified data entry: Simplifying data entry and reducing friction are important focus areas for app design in order to prevent users from getting discouraged (i.e., burning out) or losing interest in long-term usage
  • PILLAR 3 - Familiarity-based marketing and design: Build approachable products with thoughtful features/interfaces to connect unfamiliar areas of health and wellness with existing content users are familiar with

As the digital health industry grows even further across a variety of different subsectors like weight management, mental health, etc., these pillars of success and strategies to achieve this success are important for the broadening industry to take into account when making decisions around their product offering. Educating and engaging users within these platforms is what fuels a digital health brand and leads to the broader population being aware of the offerings and how it can best benefit their health. These companies and this industry have to be experimental in their offerings and understand what fits best for their wide range of users, and keeping these success factors in mind can help upcoming digital health companies make a splash in a competitive (and booming) industry.