Why Are Wearable Health Technologies Failing?

The goal of most mobile health (mHealth) devices is simple: help users track and change their health behaviors. Many types of devices have been released, but most still fail to achieve this goal. Why?

Supported by endless media hype, the stock of mHealth apps and wearable devices continues to rise. Samsung, which expanded its line of wearables in early June, has joined Fitbit and Apple in the never-ending quest to improve fitness, reverse bad habits, and increase productivity (and sell more gadgets).

There’s a problem, though: more than half of mHealth apps in the iTunes store have been downloaded less than 500 times. And according to one survey, one-third of people who buy wearables stop using them within six months. In response, a new field of science is trying to understand the interface between human behavior and technology. This field, which I call the “Science of Social,” is maturing slowly, but it offers a lot of insight into the future of mHealth technologies.

The Science of Social

The three most important factors in behavior change are easy to summarize:

  1. The power of social norms
  2. The power of role models
  3. The power of social support

Social norms strongly influence what we perceive as “normal” behavior. Do you silence your phone in the movie theater to avoid jeers? Have you ever listened to a genre of music you don’t like or rooted for a sports team that you don’t care about because your friends did? We value social support, so it’s common to adjust our behavior to what we think is expected.

Role models are responsible for popularizing behavior. New social norms spread when influencers adopt them first. For example, music trends in high school typically follow a top-down hierarchy. When I started to play bass guitar in 7th grade, I quickly discovered my favorite band—the Red Hot Chili Peppers—after hanging out with an 11th-grader role model.

Social support is key to sustaining behavior change. Friends and family fulfill key psychological needs, such as the needs to trust, fit in, and feel empowered. Successful offline programs like Weight Watchers and Alcoholics Anonymous include a strong element of community, so it’s not surprising that the top-downloaded apps are starting to include this feature.

These three simple principles determine the success of positive behavior change in the real world. Tech companies are catching onto this fact, but they’ve had trouble bringing all three elements together in one product.

How Tech Is Trying to Keep Users Engaged

One successful adjustment the mHealth market has made is using a reward system. The reward system can be complex, as in Zombies, Run!’s use of badges to unlock the next part of the story, or it can be simple, as in Fitbit’s growing flower that’s pegged to how many steps you take each day.

I’ve spent a lot of time advising companies on how they should incorporate reward systems into their products. The research shows that actionable goals (“I want to lose 15 pounds,” “I want to walk 15,000 steps today”) are key to making mHealth devices appealing to people in general, but especially to younger users. That’s why gamification and other interactive features that have a social element, like the personal coach found in Nike+ and other running apps, have helped increase the hype and sales of wearables. It turns out this age-old behavioral psychology technique—reward the desired behavior, or gamify it—is just as successful with us humans as it is with rats.

But gamification doesn’t always work, and there's still the problem of getting people to stay engaged. So, now what?

Using the Science of Social to Get People to Love Their Apps

At UCLA, we’re trying to improve the appeal of mHealth devices with a holistic model that includes all three elements of the Science of Social. This model, known as HOPE, targets one specific behavior to change.

Private community groups are the key to the HOPE intervention. People can support one another through group discussions, private messages, and “liking” posts and comments, just like Facebook or other social media sites. Interestingly, we’ve found that groups become actual communities after the intervention ends—they keep in touch, meet up with each other, and become part of each other’s lives.

In a nutshell, that’s the key to using the Science of Social to retain users: bridge the gap between online and offline worlds with social psychology. In order to do this, companies need to start being more aware of basic tenets of behavior change science, like the Science Of Social, and design around them. It’s encouraging to see health apps are going in this direction.