Cognitive Design

Creating designs that help people manage issues of self control and regulation is a central challenge in cognitive design.   Staying on a diet, doing your exercises, avoiding smoking/drinking, saving rather than spending or making other value laden decisions requires willpower. 

Some believe willpower is a character trait not a brain or cognitive function. Fortunately, researchers at the California Institute of Technology may have dispelled that belief by pinpointing the Mechanism of Self-Control in the Brain.  

They found:

“While everyone uses the same single area of the brain to make these sorts of value-laden decisions, a second brain region modulates the activity of the first region in people with good self-control, allowing them to weigh more abstract factors–healthiness, for example–in addition to basic desires such as taste to make a better overall choice.” 

Looking at the diagram (Credit: Caltech/Todd Hare) the green region is the self-control center and the red region is the area that supports making the value laden decision.  We all have the red region but not the green, at least not to the same extent. Those with more green have more willpower!

Although this finding does not providing specific guidance for cognitive designers seeking to “design for willpower”, it does provide some support for believing such efforts will be effective.

Details about the X-prize for healthcare were released about 10 days ago. The prize is designed to inspire radical innovations that will dramatically improve health value (community health index / total cost of care) for a population of 10,000 people.  If you can design, simulate and implement with assistance an “optimal health paradigm” that improves health value by 50% or more in a pilot community you run a good chance of wining the $10M prize.

The details on the design of the prize can be found here. Comments from the public are welcome until the end of May. 

This is an excellent way to structure the challenge. Anything less than a 50% improvement in quality/cost in a real world setting (population of 10,000 and all health issues) will not solve our healthcare crisis.

Cognitive design plays an important role at two levels in this effort.

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Tuberculosis (TB) infects and kills millions of people every year around the globe. TB can be neutralized by a 6-month long daily regiment of antibiotics. But people still die, not so much because they cannot get the drug (even in poorer countries) but because they fail to comply with medication regiment. They don’t take the meds regularly enough for them to be effective.

An innovative solution (and excellent example of cognitive design) based on Take TB Meds, Get Mobile Minutes has been field tested in Nicaragua. Here is how it works: 

“To get around that problem, Jose Gomez-Marquez, program director for IIH, and his collaborators developed a simple paper-based diagnostic that detects metabolites of the TB drug in urine. The papers are dispensed from a device every 24 hours; when the diagnostic comes in contact with patients’ urine, the metabolite reacts with chemicals embedded in the paper. That reaction reveals a code, which the patient then texts to a central database every day. Those who take the drugs consistently for 30 days are rewarded with cell-phone minutes.”  

I am part of a small team of cognitive designers working on a similar concept for improving foot care for high-risk diabetes patients here in the US.   (more…)

Time Magazine has an interesting article on how Obama and his staff are using principles from  behavioral science to make change happen on a national level.  For example, using the principle that people want to do what they think others will do shaped a key campaign message “A Record Turn Out is Expected”.  

Although this principle and the other techniques discussed in the article (e.g. Nudges) are nothing new to readers of this blog, what is new is the fact that they are being tested on a national scale. We can expect to see them put to work in healthcare reform, finance reform, education and other aspects of Obama’s change agenda.  

What an opportunity to advance our scientific understanding of behavior change!

Violet has developed a very interesting application of RFID technology. You stick an RFID stamp on any object and then program what you want it to do.  When you wave the object over the reader, called the mirror (shown below), it triggers the programmed action on your computer.

[image source: engadget] 

This is a quick way to extend the functionality of the original object to include a wide range of computer mediated functions – pull up files, send an email, update your facebook status, run a program, show a picture or map, listen to your favorite iTunes and so on.

This could be a real accelerator for cognitive designers.

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Earlier I blogged on a design contest sponsored by the Robert Wood Johnson Foundation and Ashoka focused on designing for better health. The idea is to design artifacts that nudge us into making healthier decisions.  Definitely cognitive design in action.

I submitted an entry on Health Change Cards and described the achieving healthy weight loss deck that Mark Pierce and I developed.  Check it out and please leave comments. You can find example cards, the workbook for achieving health weight loss (all 24 cards) and more info on the cognitive design of the change model HERE. 

I was talking with a group of educators the other day and they were explaining how pay-for-performance (P4P) programs are becoming popular in their field. The idea is that we give students money, prizes or tokens to engage in and perform well in the learning process. 

As a cognitive designer this caught my attention –  How do extrinsic rewards support or enhance the cognition of learning? 

There is literature on the issue but it is mixed. A recent article in the New York Times, Rewards for Students Under A Microscope,  offers a brief review and confirms what I heard – the question stirs a lot of emotion and programs that pay for performance are growing at a rapid rate.   According to the article, 

“Reward programs that pay students are under way in many cities. In some places, students can bring home hundreds of dollars for, say, taking an Advanced Placement course and scoring well on the exam.”

And some are showing some interesting results.

But others are failing….  

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As we work our way through healthcare reform, innovative designs that help people with chronic conditions change their behaviors (learn self care techniques) are absolutely essential.  This point is made forcefully in a short review of the George Halvorson’s book, Healthcare Reform Now! on the Influencer Blog: 

“Halvorson’s book targets five common chronic conditions—asthma, congestive heart failure, coronary artery disease, depression, and diabetes. Together, these five conditions account for 75 percent of our healthcare spending. We would save $77 billion if we could successfully treat even 1 percent of the people with these chronic conditions. And the key to treatment is influencing behavior.”      

In my course of cognitive design we reverse engineer some of the most successful chronic disease management programs to see what makes them tick.

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With President Obama’s signature on the stimulus bill we have decided to spend some $19B to scale up the use of electronic medical records (EMR) software across the nation.  This might not be good news.  According to a recent study by the National Research Council the current products and implementation approaches fail to provide the “cognitive support” needed to improve clinical outcomes and administrative efficiencies. 

Scaling up current EMRs will likely not produce the benefits we need to improve healthcare in the US.   We must redesign the EMR so that it supports the cognition of clinicians and behavior change in patients if we want a return from our national investment.   A true challenge for a cognitive designer!  In answer, I have developed a position paper describing the motivation, principles, building blocks and economics of a redesigned EMR or EMR 2.0.  

You can review the full paper or a one-page executive summary.

We need to move quickly if an EMR 2.0 – designed for how minds naturally work – is to be ready for the first round of stimulus incentives in 2011.   I am currently selling this vision, building a business case, recruiting a team and seeking funding to build a prototype.   Should you have any interest or comments drop me a note at mark.k.clare@gmail.com

One of the major causes of unwanted behaviors (unhealthy habits, over consumption, unsafe practices, corruptions, etc.) is that the artifacts we define to manage them – everything from weight loss programs, workplace incentives and government policies – don’t reflect how our minds actually work.  They operate in a way that fails to respect the importance of  low cognitive load, support for the psychology of self-regulation,  emotional energy in behavior change or the non-rational calculus of visceral factors (meanings, urges, cravings, etc.) that strongly shape our cognition.  

Ignoring how the mind works in the design of your artifact for behavior change is a fatal flaw.  Indeed, designs that change behavior put cognition first.    

The recent issue of Science Magazine focused on Education & Technology offers some insight into this point. They discuss why innovations such as using video game effects to design educational programs have not taken off.    Education is an important element of many behavior change efforts and video games have proven to be one of the most naturally powerful devices for accelerating cognition.  Yet the attempt to develop serious games, or games designed to teach and change behaviors rather than just entertain, have not scaled up.  

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