Gamified Technology Brings New Life to Disease Management

CEO Tryggvi Thorgeirsson, MD, MPH, and CMO Saemundur “Sam” Oddsson, MD, Cofounders of SidekickHealth
JULY 21, 2017

Doctors have all had the lifestyle change talk, probably thousands of times.

We’re treating a patient with a lifestyle disease – obesity, hypertension, prediabetes. We assess the patient, evaluate treatment options and recommend a plan of care. Typically, this guidance amounts to better diet, more physical activity and less stress.

It’s a completely rational course of action. It’s the right approach to living healthier. But it just doesn’t take hold.

We distinctly recall instances of the lifestyle change talk with patients. Once, a middle-aged man recovering from a heart attack came in for an appointment. He seemed to understand the gravity of the situation, received evidence-based guidance delivered in a traditional way, and then was seen outside the clinic lighting a cigarette. On another occasion, a 60-year old woman was admitted to the hospital with high blood pressure. Because the traditional lifestyle change talk wasn’t working for her, the best treatment plan was to prescribe her an antihypertension drug… when she was already taking two.

We were trying to put out fires we would have liked to prevent, and we knew there had to be a better way. After years of research with leading universities and institutions and many real-world examples, we think we’ve found it.

The Dual Rise of Diseases and Devices
Chronic lifestyle-related diseases account for about 70 percent of deaths and up to 80 percent of health care costs worldwide. In 2014, diabetes affected 422 million people, and the trend continues on an upward trajectory. About one in three adults in the U.S. and the UK has prediabetes, increasing risk of heart attack, stroke, and type 2 diabetes. These diseases pose an escalating threat to global health and wellbeing.

At the same time, mobile devices have seen explosive growth and use. Not only are they widely distributed, but people carry them constantly, spending several hours per day using smartphone apps. As such, mobile devices can potentially increase provider-patient interaction during lifestyle interventions, as well as offer an avenue for primary prevention.

At a time where we need to flip the trend of lifestyle diseases, we have a ubiquitous, adaptive vehicle to tailor behavioral interventions to patients. But we still need to make those interventions more effective.

A new approach: Finding the triggers for lifestyle choices
To slow the lifestyle disease epidemic, we have to re-think how we think. The approach we’re taught in medical school – the takeaway from “the talk” – isn’t wrong. It’s all in the delivery.

The field of behavioral economics combines lessons from psychology and economics to investigate how individuals actually behave, as opposed to how they would behave if they were perfectly rational, with unlimited willpower, and solely acting out of self-interest. It considers how people are influenced by their emotions, identity, environment and the framing of the information.

Many lessons from behavioral economics apply to public health because they help us understand why people make choices, and in turn, how to guide them towards better ones. In three years of research, we teamed with experts from Harvard, MIT, and more than two dozen professionals on both sides of the Atlantic to determine how these applications could be put into practice.

Effective Engagement to Change Behaviors
We hypothesized that a mobile health-engagement platform could significantly enhance a structured lifestyle change program. We integrated principles of behavioral economics, gaming technology, artificial intelligence, evidence-based guidelines and personal coaching. We combined our clinical expertise with a team of experienced game developers and launched SidekickHealth to prevent and manage lifestyle disease.
Seven concepts from behavioral economics serve as pillars for the platform.

1. “Fast thinking” controls most lifestyle choices    

Behavioral research suggests two separate cognitive systems control our choices. Psychologist Daniel Kahneman describes them as fast thinking – which is intuitive, impulsive and emotionally charged – and slow thinking – which is rational, deliberate and reflective.

By targeting fast thinking, advertisers have been winning our hearts, minds and stomachs for years. The cartoon characters synonymous with breakfast cereals are examples of the food industry’s adept appeal. Public health organizations, on the other hand, typically target slow thinking. Just turn the cereal box over for a black and white label densely packed with nutrition information. There’s a lot of squinting at tiny print required for a rational, healthy choice.

To use fast thinking for good, we designed a gamified platform with colorful graphics, characters, competitions and instant gratification through rewards. The result is a highly engaging experience that enables patients of different health literacy levels, languages and ages to get and stay involved in the management of their health.

2.People use mental shortcuts, which can cause unhealthy behaviors

Studies indicate that lifestyle decisions, like how much to eat, are frequently biased toward an initial “anchor” value. For example, the quantities consumed at a meal are subconsciously cued by the size of plates and glasses. Referred to as “mindless eating,” this anchoring can increase how much people serve and consume.
With our platform, we deliver appetite awareness training to encourage users to eat in response to internal hunger cues – a method that has shown promise for the treatment of obesity.

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