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In an effort to encourage patients to check in on their mobile devices, researchers tested different motivational strategies, including sending inspirational quotes, funny memes, and persuasive messages. 

ANN ARBOR – Keeping track of your well-being— whether workouts, sleep schedule, or even servings of vegetables— on a mobile app has become second nature to many. Consistent tracking can reveal important insights into your health.

But benefits from mobile health monitoring depend on one key factor: regular check-ins. In a world full of distractions, it’s easy to forget to log into that health app.

In a new study, researchers from the University of Michigan’s School of Information and Institute for Social Research are narrowing in on the best strategies to encourage consistent mobile health check-ins.

“If we really want to be able to use technology to get people to engage in healthy behaviors, we have to find a way to engage them in the wild, in their natural environment,” Inbal Billie Nahum-Shani, co-director of the Data-Science for Dynamic Decision-Making Center (d3c) at the University of Michigan Institute for Social Research.

The ease and low-cost of health monitoring by phone has been a boon for health practitioners who want more data on their patients’ progress and which interventions are most effective for health concerns. Some health programs provide monetary incentives to encourage patient engagement on apps, but this approach can be costly and produce mixed results.

The research team included mobile technology researcher Predrag “Pedja” Klasnja, an associate professor at University of Michigan’s School of Information, and principal investigators of the SARA (Substance Abuse Research Assistant) project, Maureen Walton from U-M Department of Psychiatry, and Susan Murphy from Harvard.

They tested what strategies increased mobile self-reporting, while using very minimal financial incentives. “We’re trying to take ideas from basic psychology, decision science and marketing, and see if we can apply them in a mobile setting to convince people to engage in healthy behaviors in their daily life,” says Nahum-Shani.

The researchers looked at motivational approaches for a group of adolescents and emerging adults who were monitoring substance-use. The researchers randomized the participants each day to expose them to differing strategies. “It’s a research design called a micro-randomized trial,” says Nahum-Shani. She notes their research won a MIDAS award for scientific transparency and potential for replicability.

The team tried two key strategies to increase mobile engagement: reciprocity and non-monetary reinforcement. For reciprocity, participants received inspirational quotes on their mobile phone before they were scheduled to check in. The quotes were developed by people in the same age group as the study population so they would be age-appropriate and relatable. The idea was “by giving young adults content that they would find appealing and useful, we can increase their obligation to reciprocate by self monitoring,” explains Nahum-Shani.

The second strategy was to provide reinforcement that had nothing to do with money. They sent participants funny memes and gifs, with the idea of entertaining them and creating positive emotions that might carry over to a daily check-in. “We also gave them summaries of the data they provided if they completed the check-in,” says Nahum-Shani, adding that seeing their own data “addresses people’s need to know more about themselves.”

They found that for reciprocity approaches, check-ins during the week were not influenced , while weekend reporting benefited from interventions. “During the weekends, there’s an advantage to delivering the reciprocity strategy: it increases the likelihood of self-monitoring by about 18%, which is a lot given that we are talking about a push notification on a mobile device,” says Nahum-Shani. She notes the findings make sense because weekends can be less-busy, and participants may be on their phone more and hence may be more receptive to a mobile notification.

When using reinforcement, the team saw different results for entertaining content versus giving patients access to their data. For those who missed a check-in during the previous day, receiving entertaining content wasn’t beneficial. “If you did not self-report in the prior day, giving you entertaining content immediately following current day self-reporting resulted in 25% less likelihood of self-reporting in the next day,” says Nahum-Shani. “It was actually harmful rather than helpful.”

She says although the results were counterintuitive, there’s lots of room for improvement on entertaining content. “What’s funny for one person is not funny for others,” she says, adding that memes and gifs have a short shelf life in our electronic age, which can explain their results.

Although humor seemed to fall short as a motivator, seeing tracked data was a draw for participants who missed a check-in in the prior day. For participants who missed reporting on the prior day, receiving their personalized data immediately following current day self-reporting resulted in 36% greater likelihood of self-reporting on the next day.

Tracked data turned out to be of great interest to most participants—the team says participants generally liked the data summaries, but wanted these summaries to be available on-demand, not just as a reward.

Information is key in encouraging mobile self-reporting. “This study really made clear that one of the ways that we can engage people in giving data through mobile devices is by giving the data back to them unconditionally,” says Nahum-Shani.

The researchers note this is a proof-of-concept study and they hope their approach could provide a template for other researchers who are interested in this kind of work.

“An important take-home message is that we need to be careful with how we design reinforcers that use entertaining content for young adults,” says Nahum-Shani, adding that the feedback they received from participants indicates preference for more personalized content. “Moving forward, we need to deliver content in a way that is more personalized and more dynamic.”

“Strategies like reciprocity can make a huge difference,” says Nahum-Shani. “We don’t have to provide a reward that is extensive or expensive. Sometimes small things, like inspirational quotes sent to the person’s mobile device, can make a difference in terms of people’s willingness to engage, as long as you provide them in a way that is non-conditional.”

Contact:
Sarah Derouin, [email protected]