Persuading the Unpersuadables

The other day I met with a new startup company that has as its core purpose the improvement of the health of people with chronic and pre-chronic conditions via a cognitive behavioral platform. This is not the first of this kind of solution I have seen, I’m sure it won’t be the last.

By Clive Flashman, Health Industry Strategist, CSC

Invariably, they all seek to do the following:

  1. Aggregate a wide variety of data sources from wearable apps
  2. Utilize diaries, journals, and other ways of recording situational context
  3. Use prompts and notifications to “nudge” behavior
  4. Give access to relevant educational materials
  5. Link to care plan goals and involve referring clinicians in a “change” process

As I was taking to them, I tried to put myself in the shoes of a Clinical Services Director, someone who might be a buyer of this type of solution. What became very clear to me as the conversation progressed was this:

The sort of people who will check the app on a daily basis, log their activity, and respond to prompts are the sort of people that probably would have followed a physician’s instructions anyway, at least for a while. They are the same people who would have followed the nutritional diet plans and exercise diaries that a consultant might have given them.

shutterstock_188507768If that’s the case, and I believe that it is, how does the platform add additional value for the purchasing client, other than capturing more information digitally?

It is my view that the majority of people, perhaps 75%, will not consistently respond positively to advice and directions from their clinicians. The challenge is to stop these people moving up the chronic care pyramid, necessitating more and more costly treatment as their conditions become more acute. That is exactly what these sorts of apps should do, and yet it seems to me that they really only target the 25% who are already amenable to specialist advice.

So how do we reach the others, how to persuade the unpersuadables?

Maybe everyone has been looking in the wrong place.

Currently, the holy grail of this type of solution is to join up as many health-related apps as possible, taking the “quantified self” to the broadest and deepest form of data collection possible. The belief being that, if we join up as much personal data as we can, we will achieve previously unknown insights into a patient’s behavior and personal motivations, enabling us to start to change their approach to managing their health.

The problem is those people who not only won’t use the behavior change app, also won’t log the kind of information that the app needs to create the necessary behavioral “nudges.” However, many of these same people probably do use the multiple social apps, which record vast amounts of personal data.

  • Checking in on Facebook – we know where you are and what you are doing.
  • Capturing images on Instagram – we know what you are seeing, doing, eating, etc.
  • Posting a tweet – we know what you are thinking about a particular issue and which ones interest you.

So, what if a health behavior change (HBC) app could access the information gathered by the social apps you use, how might it use it?

You’ve just checked in to a Chinese restaurant on Facebook, the HBC app suggests what might be healthy options to choose from the menu. If you are diabetic, it could suggest how much eating a sweet and sour chicken and rice might affect your glucose levels, and the impact that might have on your body.

Perhaps you have recently been diagnosed with atrial fibrillation, and you Tweet about some nasty symptoms that you are now experiencing, the HBC app might suggest ways of managing this and direct you to some easily understandable literature.

Yes, it will be a fine line between being helpful, provocative, and annoying, but in a sector that is constantly looking for the next “disruptor,” what is really needed is a way to disrupt unhealthy lifestyles and to educate patients to be more informed consumers of healthcare services. And after all, we’re prepared to accept intrusive advertising in our social apps, so why not intrusive health information?


  1. The relevance of these monitoring apps will increase with broader systems interoperability. If left only for the wearer to interpret, the onus sits with a single entity. In the IT world, there are powerful benefits of real-time monitoring in taking preventative action, benchmarking systems performance, establishing and meeting SLAs and quantifying value to internal and external customers. Imagine the impact when this kind of data can be easily captured, form part of a living electronic health record, and when authorized become consumable by payers and providers. Once consistent, healthy behavior contributes to lower costs and better health profiles, imagine the possibilities! Interoperability is the key.


    • I agree Bill, interoperability is vitally important. The ability to bring data together from a range of sources that can be used to bring clarity to an assessment, a risk score or support a clinical decision is essential and a big gap at the moment. The ability of a patient to add their own data to this ‘pot’ is crucial. Their data may be significantly more up to date than that gathered by clinicians, and so can inform decisions accordingly.


  2. Very interesting idea. At the very least, it may reduce the number of people who tweet about their food choices…

    Liked by 1 person

  3. Paul Bocking says:

    An approach I try to use with my children… What’s in it for me…?
    It can be considered selfish, but it seems to me that we are constantly motivated by the rewards we expect to receive as a result of a course of action. In the area of health the optimal motivator for improvement is enjoyment of what one’s body can do. Whether games, sport, leisure .. Maybe health is best portrayed to people less as ‘avoiding pain’ and more as ‘obtaining enjoyment’. If we offer people better self esteem, better social and family engagement, better sex lives, better mood stability, peace and calm in their lives, they are more likely to want an app that will deliver it.


  4. The trouble with that is, can motivation be maintained at a certain level? Probably not, which is why the best of this Cognitive tools vary the rewards and how they can be used. Kate Moss the supermodel once said, “nothing tastes as good as being thin feels” but then she did get paid a huge amount of money for being thin!!
    I do agree that in the end, everything has to be personal. Playing to people’s own fears, desires and aspirations is key – finding them out can be the really difficult part.


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