Why Apps Have Prompted a Paradigm Shift in Promoting Healthy Behaviors

Whether "old habits die hard" or "you can't teach an old dog new tricks," our idioms suggest that it is extremely difficult for people to change their stripes, hit the reset button and turn over a new leaf.

OK, you get the point. Fostering new, healthier habits where behaviors are entrenched is a challenge. It is doubly difficult when the behavioral norm is the "easy" option, and the healthier alternative presents obstacles, and even some pain. (Whether the challenges are real or perceived is immaterial.)

Often, it is only a major disruption that prompts change in habits that influence our health. It might be a near-death experience, such a surviving a heart attack, or it could be a life-altering circumstance, such as becoming a parent. It's not always dramatic, but there is a disruption (or disruptions) that triggers the internal desire to change — a conscious decision to turn over a new leaf.

The same is true of change in general — often prompted by less personal, external disruptions. Technology, for example, frequently acts as a disruptive force. It is responsible for completely reforming so many daily activities: navigation systems and apps have made paper maps obsolete, digital books on Kindle and iBook are phasing out textbooks. Even coupon-cutting has been overtaken by resources like Groupon and LivingSocial. When we react to these disruptions by adapting our behavior to accommodate new — i.e., better, easier and/or faster — methods of completing tasks, it results in sustainable change, at least until the next disruptive force enters the scene.

Whether a function of a personal disruption or a result of disruptive technology in the marketplace, change in behavior ultimately requires a decision to change. Sometimes it feels like an epiphany-inspired moment of choice, and other times it barely registers consciously. Some internal trigger, though, pushes the decision. And the more difficult the change or the perception of difficulty, the more powerful that trigger must be.

Apropos context for apps

Apps have that disruptive potential to promote healthy and sustainable behaviors. Some apropos app context:

•    Apple launched its app store on July 10, 2008, to coincide with the launch of the iPhone 3G.

•    On Jan. 22, 2011, a little more than two-and-a half years later, Apple's app store announced its 10 billionth downloaded app.

•    Right around the store's three-year anniversary in July 2011, the number of downloaded apps reached 15 billion.

•    By the end of 2013, users downloaded about 50 billion apps.

That exponential growth reflects only apps via the Apple app store. The download rates for non-Apple devices have experienced similar growth rates. This purchasing curve demonstrates not only the increasing accessibility of apps, but also their fast-paced integration into our daily lives. By embracing Apps as a tool for creating a disruption and facilitating learning, the healthcare industry can harness a whirlwind of increasing consumer activity.

It is no surprise that apps' disruptive force on healthcare is a hot topic — that "behavioral change" within the industry similarly requires disruption. Apps are a large part of the external forces that are triggering and ultimately facilitating internal changes within the industry. (Read The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Healthcare by Eric Topol, MD, for additional insight into the industrywide disruption that extends beyond apps.)

The Patient Protection and Affordable Care Act ensures there will be additional external disruptions on the industry. People will be held increasingly responsible for monitoring and modifying their own health and health behaviors. Intuitively we know what many studies demonstrate: that effectively managing cholesterol, blood sugars, weight, stress, sleep and a handful of other indicators (e.g., smoking cessation) increases health and decreases healthcare costs. It is apps' ability at the individual level to guide, motivate and monitor the management of personal health — to facilitate sustainable changes in health behaviors — that is really exciting.

Meeting people where they are via apps

A driving mantra for us is to meet people where they are. Apps enable us to deliver educational experiences that meet people where they are both literally and figuratively. Because the literal aspect of delivery is obvious, let's focus on our mantra's more figurative meaning.

Basically, "meeting people where they are" means that learning experiences must be relevant and people must connect to their learning experiences both cognitively and emotionally in ways that foster a sense of ownership in learning experiences. It is often a disruptive force that establishes personal relevance and creates immediate mental and emotional connections. ("OK, I understand at some level that I need to adopt a healthier lifestyle, and to a certain degree, I am ready to invest some effort into making these changes.")

Then learning experiences must maintain and channel the impact of the disruption — in other words, without a relevant learning path, a person is likely to have only a brief and/or minor behavioral change. Any sense of ownership in making a change will wane quickly.

So, meeting people where they are must extend throughout the learning experience. In fact, "where they are" should change and progress along each individual's personal path toward establishing healthier habits. The internal trigger for fully embracing a behavior change and taking ownership of it will occur somewhere along that path, varying from person to person.

Here's where apps possess the incredible potential to meet people where they are — prompting disruption and facilitating behavior change. We can design apps to create personal learning paths that capitalize on these five key qualities:

•    Everyone has varying "currencies" that are key to driving motivation. Generally, carrots are more effective than sticks, yet even within these broad categories it is individualized. Meeting people where they are means tapping into their individual currencies.

•    Everyone has varying preferences for modes of learning, such as visual, auditory and kinesthetic. Meeting people where they are means facilitating learning experiences that capitalize on individual learning preferences.

•    Everyone has varying levels of baseline understanding of their health and their healthcare needs. Meeting people where they are means providing them with an inviting and appropriate "entry point" for their individual levels of understanding.

•    Everyone has varying desires for depth of understanding of their health and healthcare needs. Meeting people where they are means guiding them to a depth of understanding that satisfies their individual preferences yet is deep enough to prompt and sustain behavioral changes.

•    Everyone has varying timeframes and abilities to institute change. Meeting people where they are means guiding them on developing long-term goals that are broken down into accessible and appropriate mini-goals.

It is in fostering these individualized experiences that apps are an incredible (and effective) disruptive force relative to other learning tools. It is also important to note that the touch screen nature of app experiences promotes a strong sense of ownership of the learning experience because app users are literally guiding their own learning paths.

Of course, that's all part of the plan — we have designed the app to manufacture a disruption, to trigger the internal desire to change, and to sustain the change through effective motivation and guidance.

Topics Education is a Charlotte, N.C., company that specializes in strategic communications programs for nonprofits and other cause-focused organizations.

Novarus Healthcare is a Charlotte, N.C., healthcare firm that specializes in changing healthcare paradigms though the development of innovative technology tools.

Grace Lee Simmons is a student at Davidson College.

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