Counting steps and calories, apps that give you advice on a healthy diet or tell you when it’s time to exercise more. There are so many apps for a healthier lifestyle nowadays that it’s almost impossible to know which one to choose sometimes. And when you’ve finally downloaded an app, there’s a serious risk that you’ll lose your enthusiasm for exercise after about three weeks and drop out. PhD student Raoul Nuijten wanted to know what contributes to the succes of mobile health (mHeatlh) apps and decided to investigate the role of so-called energizers.

These are very important, Nuijten explains. “A stroll in the woods, a ray of sunshine on your face or an interesting conversation can give you a positive feeling and trigger a burning fire inside. We all have our own energizers, but I’m convinced that a healthy lifestyle can be a source of energy to us all. Since a lot of people have difficulty adopting a healthy lifestyle, I’ve tried to influence their behavior via their mobile phones, so that they will be able to make healthier choices. And in order to do so, I’ve analyzed the effectiveness of gaming elements in mHealth apps.”

New approach

Nuijten often compares the behavioral influence he is so keen to bring about with the act of making music, he says enthusiastically. Because apart from his scientific career, he’s also making serious headway as a musician; his family band Nuijten&Son – in which he and his father sing and play piano and guitar as core members – is very well-known in and around the town of Moerdijk. “As a musician, you have an enormous freedom to inspire your audience. At the same time, everyone experiences music in a different way, which makes it very diverse. But there’s still a range of aspects you need to take into account when you make music together: what instruments do you choose, and in what key and rhythm do you play? That’s what determines how good it all sounds. You can analyze the various aspects of a health app in a similar way and determine what strategy works best in what context. Health apps are the focus of a lot of research, but this particular focus on individual components is new.”

Gaming elements

Nuijten used an app created by himself to separately analyze four so-called intervention strategies that are commonly used in the world of gaming. How do rewards, social comparison, adaptive goal setting and personalization influence the behavior of participants in two separate target groups? It turned out that desk-bound office workers who have a higher risk of cardiovascular disease and other health issues due to prolonged inactivity responded particularly well to financial rewards, Nuijten says. “We were able to determine for each participant the extent in which they were triggered by the app. Think of logging in, swiping, or recording health activities in the app. An intervention strategy also leaves room for considerable leeway. Do you reward people with a badge, for example, or do you offer them a digital or financial reward? How big should the reward be, and what do you have to do to earn it? Office workers, for example, didn’t need to be continuously rewarded financially; a lottery proved to have a similar impact on active behavior. That’s good to know for organizers.”

Influencers

The second target group that Nuijten focused on – school children from a lower socioeconomic class with a higher risk of health problems such as obesity and diabetes – performed better when the app offered participants the opportunity to compare themselves against each other. A ranking list, for example, or messages about each other’s results, linked to a reminder to take action. Nuijten also concluded that a role model yielded additional good results. “A teacher or experienced coach can provide that extra push.” Influencers could definitely contribute to this as well, Nuijten believes, and he hopes to further explore this in his new role as assistant professor in his current research group.

New habit

Still, Nuijten stresses that energizing people isn’t a matter of black and white, and that the main goal of his research is to inspire people. One thing is clear for sure: a gamification strategy can bring about more continuity, as a result of which people are less inclined to drop out prematurely. “It takes time to get into a new habit. Apps can provide a response to that challenge by engaging people for a longer period of time. Not with a single three-week course, as is still often the case today, but with shorter programs offered to people during a period of several months.”

Flames

In order to determine what strategy might be most effective in any particular situation, Nuijten launched the database SciModeler, which needs to bring together as many studies on intervention strategies as possible. “Target groups and contexts are never the same, you always need to experiment and finetune to find the right way to (re)kindle the flames.” Nuijten himself doesn’t need to think long about what energizes him. “Family, friends, making music.” Happily, that’s exactly what he and his band will be doing a few weeks from now, during their first concert in a long time.