Cognitive Design

The first round of competition for the M-prize on innovating innovation just closed. There are a 134 entries presenting hacks (disruptive ideas) or stories on how we can make innovation a natural act for organizations. It is a wonderful resource for cognitive designers looking for the latest thinking on improving innovation.

I submitted a hack, Create an Army of Innovators with 125 habit formation cards, that presents the work I am doing with Jason Becker’s  mobile app development team. We are creating an online marketplace for decks of knowledge cards  designed to create new habits that you can access from an iPhone or iPad.

We are going to launch in iTunes a bit later in the year with 5 decks designed to create the innovation habit and 2 decks for mastering personal change including a deck of Willpower cards. Additional decks are already in the works and we are looking to partner with others interested in creating knowledge cards to address a specific behavior change or skill building challenge.

An interesting study from Northwestern University suggests the answer is yes, at least when it comes to losing weight. One interesting thing about the study is its level of rigor – a randomized clinical trial.  Another is that the App had the greatest impact when combined with an existing education-focused weight loss program:

“People who used the mobile phone technology and attended 80 percent of the health education sessions lost 15 pounds and maintained the loss for one year. The average weight loss for the mobile phone group — including those who did not attend the education sessions — was 8.6 pounds. The control group — which received the education sessions but no mobile app — did not lose weight.”

The success of the App stems from  how it supports the cognition of self-regulation and learning from experience on a daily basis.

Focusing on small-step behavior changes and providing feedback on calories and activity it helped participants make better on-the-spot decisions about food and exercises.  There was also a behavior coach in the loop. The coach provided weekly calorie and exercise goals and received data from the App and could schedule 15 minute calls twice a month to advise. Researchers believe that someone “watching and caring” created a positive sense of accountability in participants.

This is an important results especially since participants were older (average 58 years) and some with no prior experience with Apps.

For the full story check out: Integrating Technology into Standard Weight Loss Treatment. or consider participating in the make better choices follow-up study.

Scientific American has a short article that does a good job summarizing the Three Critical Elements that Sustain Motivation.  While we have covered the elements  extensively on the Cognitive Design blog, it is worthwhile to review. The elements that sustain motivation include self-determination, value and competence.    To keep going on tough tasks it is important to feel in charge, that the activity is worthwhile, you have the skill to get started and those skills improve with time.  This helps to explain why some children avoid math and spend hours on video games.

While this seems simple, a complicating factor is that many of the challenges we face are forced on us by external factors.  There is a change at work that requires we learn new skills or the doctors tells us its time for a lifestyle change.  In both cases there is no sense of autonomy, a differed sense of value and a perception of incompetence.   Many of the motivational remedies offered seem straight forward but take considerable skill to use in practice, especially on groups.

For example, to help me feel like I am setting direction  my boss puts me on a team to help define the details of  the change or my doctor lets me select a plan of exercise and diet.  The hope is I will become engaged in making critical decision and develop a sense of ownership.  After a while I might even think it is my idea. Of course I need to have enough motivation to work on the team or make the lifestyle decisions.  And unfortunately,  I was assigned the task, won’t see the immediate value to it nor feel particularly competent at it.  Not much motivation for doing the task that is suppose to help me get motivated. A bit of a regress.

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Basis has designed a small-steps health behavior change program meant to fit into our daily lives.  You wear a wrist tracking device that  looks like a stylish watch. The device records optical blood flow to measure heart rate, the number of steps you take, perspiration to measure intensity of effort and skin temperature. All of these variables are tracked throughout the day and night, run through some algorithms and displayed in your personal health dashboard.  The dashboard reveals calories burned and other calculated values as well as trends in the physiological measurements.   From the patterns you can spot opportunities to add small-steps into your daily activities to get healthier.  For example:

Adopting simple but powerful healthy habits, such as taking a walk during a coffee break instead of sitting at your desk, are scientifically proven to improve your health.

Definitely an exciting idea from a Cognitive Design standpoint. Modifying existing daily activities rather than making significant and abrupt lifestyle changes has a much lower cognitive load. Plus there is plenty of data and many small-step options that you can experiment with – two essential features of learning new behaviors from experience.

I am interested to hear from any readers that are using Basis.

Wellness programs are a key application area for cognitive designers.   These programs seek to shift employee health behaviors in an attempt to lower employer costs and improve workplace productivity.   Wellness is big business as over 90% of larger employers have some plan in place and there are many provisions in the Affordable Care Act (aka Obamacare) that focus on health, wellness and prevention in the workplace.  So I am always on the look out for scientific studies of what works in wellness.

For example,  Rand just released a must-read report that provides a Review of the US Workplace Wellness Market.  They examine 33 studies and outline core elements in a program, itemize interventions used, provide uptake and participation statistics and draw some important conclusions.  It is clear that wellness programs have passed the “proof of concept” phase but we don’t have a clear evidence base for interventions that work.   The key conclusion on impact:

“Based on the available literature, we find evidence for a positive impact of workplace wellness programs on diet, exercise, smoking, alcohol use, physiologic markers, and health care costs, but limited evidence for effects on absenteeism and mental health. We could not conclusively determine whether and to what degree the intensity of a wellness program influences its impact.”

The report is quick to point out most wellness programs are not even assessed and those that are often lack rigor in assessment.   From a cognitive design standpoint we know that without frequent assessment and feedback at the individual level it is nearly impossible to do the learning from experience necessary for lasting behavior change. And this must go far beyond the individual health risk assessments wellness programs use. Same for the program level. Without frequent assessment and feedback at the program level it is not possible to do the continuous improvement  and organizational learning needed to optimize a wellness initiative.

More bluntly, you won’t get deep, broad and lasting behavior change at the individual and group level unless your wellness program is designed to measure and provide frequent feedback on physiological, activity, process, participation and financial measures.  The more transparent (shared) and real-time the better.

There are big opportunity for cognitive designers in wellness!

The answer is yes, at least according to a recent meta-study that reviewed five projects including some 9000 smokers.   More specifically,

“… smokers who used mobile messaging interventions were twice as likely to make it six months without smoking than those who didn’t.”

Messages included scheduled motivational statements, hints for managing  temptations and rapid response to texts about cravings. Motivation, skill and help from someone else when you are about to fail  is powerful cognitive design for making any type of behavior change.  Unlike many other health apps this solution  reaches out and engages the smoker acting as a nudge, reminder and coach.

Changing the behaviors of people that have problem with drinking and driving or drinking and violence is tough.  An interesting sobriety program in South Dakota claims to be having success with six years of data and an independent RAND study to back them up. Key features of the program include:

“…frequent alcohol testing with swift and moderate sanctions for those caught using alcohol reduced county-level repeat DUI arrests by 12 percent and domestic violence arrests by 9 percent.”

Frequent testing means two breathalyzers daily ( morning and evening)  and those that fail or don’t participate get a day or two in jail, no exceptions.   This supports the idea that daily crisp measurements that drive immediate and modest corrective feedback can reprogram even drug-based habits.

Imagine trying to design a program that convinces homeless youth to decrease binge drinking and marijuana use. How would you go about it?  The UCLA School of Nursing in collaboration with the California Institute of Art took that task on with a 154 drug using and homeless youth. One program they designed worked this way:

“The art messaging program gave participants the opportunity to create messages about health and drug use to influence other drug-using youths. Faculty from the California Institute for the Arts engaged the youths in an exploration of their thoughts and feelings through art, photography and video and encouraged conversations about good health, risky behaviors and ways to stay safe.”

After six months they measured a 25% reduction in alcohol use and a 20% reduction in marijuana use.  Exploring thoughts and feelings and using peer-produced multimedia messaging is powerful cognitive design!

Yes it is according to new study, “Still too Fat to Fight”. The report claims 25% of young adults are too overweight to get into the military and emphasizes the key role that junk food sold by schools (400 billion calories per year) plays in the problem.

There is little doubt that we need change the environment at schools and homes to promote better eating habits. Some interesting work from a cognitive design standpoint is the application of behavioral economics to lunchroom design.

We also need to explicitly teach kids of all ages impulse control and behavior change techniques so they can master the environment.  This is very different than teaching them about nutrition and health.  It involves techniques that apply to health but all other self control challenges as well.  I’m am currently working with a client on Behavior Change 101 for Kids. I’m hopeful they will let me share the results with readers.   Drop me an email – mark.k.clare@gmail.com if you or your organization have an interest.

Likeable people have more influence and get more offers. Likeable employees sell more products and delivery more satisfying customer service. Likeable leaders and managers are far more effective. It is little wonder that becoming more likeable and creating lovable products and services is big business for designers.

Likeablility is a bit illusive so I am always on the lookout for positions and studies that make it concrete enough to be useful for cognitive designers.  I’ve found six positions strong enough to offer a design framework and have developed two of my own.

For a good introduction I suggest you start with Likeonomics: The Unexpected Truth Behind Earning Trust, Influencing Behavior and Inspiring Action.  The book does a good job of clarifying the link between being liked and economic value creation in business and stressing that being likeable is not about being nice. It also explains how likeability is driven by truth, relevance, unselfishness, simplicity and timing. Each of these general principles is further analyzed. For example, being relevant (get people care)  is broken down into having a meaning point of view, active listening and working the surrounding context.

I am interested to hear from readers that have worked on likeability applications. What was the challenge? How did you define and operationalize likeability?

Source of  image: The True Storyof the Making of Likeonomics