Cognitive Design

An interesting (and free) article, Directed Attention as a Common Resource for Executive Function and Self-Regulation was just published in Perspectives on Psychological Science. The author’s argue that our ability to consciously control our attention is key capacity for both the executive function (planning, thinking) and self-regulation (control of thoughts and behavior). Further consciously controlled or directed attention is a limited resources that is quickly depleted. It can be restored by sleep, meditation or the use of involuntary attention instead of directed attention.

Of special interest to cognitive designer is the claim that nature-based activities (e.g. walking in the woods and gardening) have strong restorative effects on attention and therefore the ability to self-regulate, plan and use other higher cognitive functions. In the authors words:

“What is particularly remarkable about this study is the effect of a very modest intervention (an activity of at least 20 min carried out three times per week) on a problem that, according to the literature in this area, has the capacity to undermine people’s lives for a matter of years (Blesch et al., 1991; Winningham et al., 1994).

Clear implications for those designing programs to help with chronic disease management or other high self-regulation challenges.

Managing diabetes often calls for significant lifestyle and behavior change. Creating programs to help patients and family members make these changes requires a sophisticated understanding of how minds actually work.   Diabetes management is a major cognitive design challenge so I am always on the look our for fact-based insights into how the minds of diabetics work.

Late last year the IIT Institute of Design held a Diabetes Innovation Fair including three sessions on platform strategies, persuasive technologies and wellness experience research. They just released videos of each session.

All three sessions offering valuable insights for cognitive designers.

Procrastinating or putting things off when it is not in our best interest to do so is a common problem. According to research reported on Psychology Today:

“Everyone procrastinate sometimes, but 20 percent of people are true procrastinators. They consistently avoid difficult tasks and deliberately look for distractions, which, unfortunately, are increasingly available. Procrastination in large part reflects our difficulty in regulating emotions and to accurately predict how we will feel tomorrow, or the next day. Procrastinators say they perform better under pressure, but that’s just one of many lies they tell themselves. Since procrastinators are made and not born, it’s possible to overcome procrastination—with effort.”

This makes procrastination a major cognitive design challenge. As with all such challenges the first step is to understand the underlying cognitive processes and needs.

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A website from Philips, GetInsideHealth, offers an interesting TEDMED video summary of some of the innovative products that are designed for behavior change. You may need to register to get access to the video.

An excerpt from the transcript:

“The exponential rise in chronic disease associated with obesity and a sedentary, modern lifestyle is exerting unsustainable demands on health budgets world-wide. But, whereas public policy initiatives, aimed at prevention, are slow to take hold, a raft of recent technological innovations appear to be having a real impact in terms of shifting people’s behaviour and nudging them toward a healthier and more active lifestyle. This video focuses health-related technology advancements, such as DirectLife, and includes interviews with Tim Brown, President and CEO of IDEO; David Pogue, Technology Columnist of the New York Times; and Deepak Chopra, Chairman and Co-founder of Chopra Center for Wellbeing.”

The McKinsey Quarterly has an excellent article, Engage Consumers to Manage Healthcare Demand, that offers some insights for cognitive designers working on changing health-related behaviors.

The article looks at three approaches to changing behavior:

1. Education about health and preventative care
2. Encouraging increased role in selection of healthcare provider and services
3. Incentives and disincentive for health behavior change

Nothing new for readers of this blog. But they also point out:

* Effective education requires integrating information from multiple sources and customizing on the basis of an individual’s psychographic profile.

* Encouraging consumers to be more proactive about making choices about services and providers requires providing objective (third party) information on price, quality and availability

* Providing incentives must be targeted on behaviors that are open to incentives (not all are) and should be combined with support programs.

Such refinements reflect an increased understanding and willingness to meet the cognitive needs of the healthcare consumers.   We need another dose or 10 of that!

What we see strongly determines how we think, feel and ultimately act. A common sense statement but when you understand the specifics you have a powerful tool for priming and influencing behavior change.

Take for example the research results in ScienceDaily on Play it Forward: Elevation Leads to Altruistic Behavior.  They demonstrate that if I see someone being helped it will cause me to feel elevation (a positive feeling of being uplifted) and that in turn causes me to help others.  To quote:

“The results of this second experiment were striking — the participants who viewed the uplifting TV clip spent almost twice as long helping the research assistant than participants who saw the neutral TV clip or the comedy clip, indicating that elevation may lead to helping behavior.” 

This suggests that cognitive designers able to create products, services, experiences or other artifacts that elevate, will produce not only a distinctly positive think-and-feel but will also trigger prosocial behaviors.

Yes if we can preserve the cognitive factors that make them work.

Mississippi is in trouble when it comes to health and healthcare.   According to the National Institute of Health (NIH) they have the highest rates of obesity, hypertension and teenage pregnancy in the country. Their infant mortality rate is 50% higher than average and 20% of the population has no health insurance.

They have spent millions but report in a recent NIH news story:

“We’ve been attacking this problem over and over again with just heartbreaking results,” said Shirley, chairman of the Jackson Medical Mall Foundation, a one-stop health care facility for Mississippi’s underserved.

Now they are trying to import a health service delivery model, called the Health House from the middle east.  The Health House developed during the 1980-88 Iran-Iraq war is simple but apparently very effective.  

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Self control or the ability to regulate our own thoughts and emotions to achieve a behavior change is a complex high-load cognitive process. In the best case, when designing programs for behavior change, we invoke groups, devices and environmental factors to help distribute some of this cognitive load.  Leaving all the mental work for behavior change with the individual is likely to lead to failure.

So I am always on the look out for new scientific studies that shed light on how to distribute the cognitive load of behavior change to other people, devices, workspaces and even smart machines. Found an excellent post describing a new scientific study on Self-Control and Peer Groups on the Frontal Cortex.  To quote:

 ”…according to a new study by Michelle vanDellen, a psychologist at the University of Georgia, self-control contains a large social component; the ability to resist temptation is contagious. The paper consists of five clever studies, each of which demonstrates the influence of our peer group on our self-control decisions.”

 In short, under many circumstances, watching someone else exert self-control increases the likelihood that we will exert it too.  No surprise to the cognitive designer but such studies lend scientific evidence to the view.

I occasionally work with graduate students at Northwestern University to reverse engineer designs that have exceptional impact on cognition or how we think-and-feel. The goal is to discover what unique set of cognitive needs they satisfy and what special features/functions they deploy that move our hearts and minds so effectively.

A student recently sent a link to Questing for Well-Being at Weight Watchers, that reveals some insight into the unique set of cognitive needs the program satisfies:

“We find that among Weight Watchers members in the United States, the support group acts as a venue for angst?alleviating therapeutic confession, fosters the enactment of the support group as a benevolent system of therapeutic oversight, and facilitates a revitalizing practice of autotherapeutic testimonial.”

In short it relieves negative emotions associated with set-backs, makes members comfortable with surrendering some control to the group and promotes wellbeing through helping others.  Weight Watchers is effective at achieving sustained weight loss for its members.  One reason it works is that it attends to cognitive needs that other programs fail to meet.

The NIH and AHRQ are spending $15M to find out.  

Comparative effectiveness research in healthcare, or studies on the relative cost and benefit of specific diagnostics and treatments, is a hot topic. Doing this type of research will empirically determine, for example, if there is any clinical benefit to a more expensive or frequent diagnostic imaging technique.

Doing the research is one thing, getting providers to use it in delivering care is another. And that will be a big problem. To help solve the problem, the National Institute of Health (NIH) and the Agency for Healthcare Research and Quality (AHRQ) are offering $15M in grant money to purse clinical trials on Using Behavioral Economics Research for Nudging Comparative Effectiveness Research.

Here is the purpose of the grant as specified in the executive summary:

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