Why do I snooze my alarm? Understanding behaviour change & researching loneliness

Does tech drive positive or negative behaviour when it comes to our mental health?

An unhealthy night’s sleep, or social connection during lockdown? Photo by Shane on Unsplash

From abandonment rates on wearables to varying engagement rates & outcomes for digital mental health products, it’s clear that behaviour change isn’t simple. And yet we’re all living through huge changes in our daily lives, habits and how we engage with others. Solving problems responsibly requires research, testing and really understanding why we might not do the things we know are best for us. So that’s what we’ll dig into in today’s article, including a worked example for loneliness.

Next week 👉 What’s the link between race and mental health? What we can learn from the research

If you just landed here — this article is part of a ten-part series providing bite-sized expert insights on mental health topics (from world-class speakers via Zinc) and my thoughts on the role tech can play in addressing these themes (part of my day job at Kamet). All smart ideas come from the speakers and my peers — all poor phrasings and misunderstandings are my own.

What you’ll learn from this article 🧠

This week’s speakers were Dr Rachel Carey and Dr Farhana Mann who discussed the topics of behaviour change, loneliness and the scientific research process. The big ideas included how to use behaviour science to understand problems, and a worked example of research approaches in loneliness. Our discussion centred on the links between loneliness and culture, and the practicalities of building interventions for loneliness. Technology thoughts range from the choices of tech companies to drive or replace social connections; building ‘sticky’ products for good, and retaining healthy behaviours during COVID.

Big ideas 💡

• Dr Rachel Carey: using behavioural science to solve problems. Behaviour is anything a person does in response to internal or external events; these are physical events that occur in the body and are controlled by the brain. Behaviours take place within complex systems — interventions aren’t always directed at the target audience (e.g. directing parents to change childrens’ behaviour). Effective behaviour change understands a deep understanding of the problem, testing assumptions, selecting one target out of lots of candidate behaviours and clearly defining what the new behaviour will be. There will be drivers / barriers to each behaviour and frameworks (e.g. COM-B) can help make sense of user insights to reduce barriers and increase drivers
• Dr Farhana Mann: researching loneliness. Loneliness is different from isolation or solitude: it’s a subjective, unpleasant state where there’s a mismatch between the quality or quantity of social connectedness you have, and the level you want. We know it has significant impacts on physical health, such as immune function and health system usage. However, the link with mental health needs further research: more longitudinal studies and across a range of conditions. Getting this, or any, research right requires getting the right definitions, using validated measures, having a clear research question, a clearly planned approach and ethics consideration. The formal research approach might differ in a startup environment, where you can be more agile, but you should still aim to follow the same principles and work with others who can support.

Discussion points 🗪

• What impact does culture play on loneliness in society? E.g. should we expect a difference in cultures with ‘extended families’ like the Whānau in New Zealand? Whilst there’s limited research on different cultures, the BBC’s Loneliness Experiment showed those from individualistic cultures (especially young men) reported more loneliness than collectivist cultures — however there are still methodological challenges here (e.g. those from collectivist cultures living in individualistic-learning cultures). In addition, it can be hard to work out causality.
• Who is responsible for reducing loneliness? Given behavioural interventions take place in complex systems, are there others (friends, family, local councils) who could play a role — and do they have the capability, motivation and opportunity to do so? In 2018, Theresa May launched the UK Government’s first loneliness strategy, conducting a review of the evidence on interventions, you can find their evidence scope here

Tech thoughts 💭

• How do we ensure that tech enhances, rather than replaces, social connections? I feel this question is especially pertinent for digital natives: The Atlantic showed the launch of the iPhone coincided with a number of shifts in behaviour and emotional states of American teenagers compared to previous generations. For example, since 2007, the percentage of teenagers who hang out with their friends has fallen dramatically; there was a rise in those who feel left out or lonely; and more struggles with good quality sleep. Organisations like the Centre for Humane Technology aim to shift the mindset from which persuasive technology systems are built. This is a big topic — I wrote a separate blog post on it here (and I’ll probably dig into it again…)
• How do we build ‘stickiness for good’? If you’ve watched The Social Dilemma you’d be forgiven for thinking that with the right team and funding you can create a truly addictive product. But even companies like Fitbit, with a £1.8bn market cap, still see a huge abandonment rate, which some researchers estimate to be one third within the first year. If we move away from prevention to treatment and care, how do we ensure that patients stay engaged with digital health? One approach is to embrace the limited ‘engagement window’ and use a shorter period of time to embed habits. Companies such as Second Nature drive long-term behaviour change to prevent T2 diabetes through a 12-week program, equipped with group chat, an on-hand dietician and daily educational articles. It seems that this approach can work — participants on average showed weight loss of 6.14kg after 12 months.
• Can technology help retain healthy behaviours during COVID? Virtual consultations have of course spiked, but there’s huge concern for delays to in-person screenings and treatment. Companies such as Skin Analytics who can bring cancer triage outside of a hospital setting can play a role in reducing these delays. And as our work and lives are increasingly interconnected, Headspace & Microsoft have teamed up to provide a ‘virtual commute’ for separating the two. Gyms and fitness companies are starting to pivot to be ‘wellbeing brands’ that can meet consumers’ needs anywhere and everywhere, with a blend of in-person and online activities and communities (e.g. Instagram TV workouts, used by large brands as well as up-and-coming fitness influencers).

Reading list 📚

• Habit Formation and Behavior Change — Oxford Research Encyclopedia of Psychology
• SSCR Scoping Review 14 : Social isolation in mental health
• The history and future of digital health in the field of behavioral medicine
• BBC Radio 4 — The Inflamed Mind
• Analysis of environmental deprivation: cognitive and social development in Romanian orphans
• Have Smartphones Destroyed a Generation?
• Video Games x Healthcare — Out of Pocket

Speaker bios 🔈

• Dr Rachel Carey is a behavioural scientist with a background in health psychology. Dr Carey leads a programme of work that is user-centred, problem-led and interdisciplinary — aiming to develop a new, innovative model of R&D for the social/behavioural sciences. She also has an honorary role at UCL, and continues to be involved in a range of teaching and research activities with the UCL Centre for Behaviour Change.
• Dr Farhana Mann MB BS BSc MRCPsych MSc is a clinical academic (Wellcome Clinical Research Fellow) at the Division of Psychiatry, University College London. She is a medical doctor (psychiatrist) in London, and has won numerous awards and distinctions. She is always keen to promote better public understanding of psychiatry and mental health problems, and has shared expert insights in the media including the BBC and MTV. Before medicine, she presented children’s television and radio, and she has been involved in various initiatives to make mental wellbeing more accessible to kids.

If you’ve made it this far, thanks for reading! You can find out more about why I’m writing this series here. Have something to add, want to give your views or just continue the conversation? Hit me up on email / LinkedIn / Twitter.