That’s one of the central questions we at SkinVision explore when designing the app. In our quest to create a health solution that can help individuals overcome negative behaviors — such as getting excessive sun exposure without protection or putting off checking their moles — we’ve applied health theories that can enable people to replace unhealthy habits with healthy habits. This chapter of the Health Series will give you a better understanding of the factors that drive behavioral change and how they are applied in the app.
To examine these theories, we talked to Dr. Gerjo Kok, a social psychologist and professor of applied psychology at Maastricht University. Below, he shares his expertise on why it’s so hard for humans to change and the things we can do to counteract that.
What are habits and how are they formed?
Habits start with recent behaviors and over time they become automatic. For example, driving a car starts with lessons, and, at first, you are nervous and sweaty. But later, you are driving 70 mph without even thinking about it.
The problem is that habits overrule good intentions. People can say,“Now, I’m going to do something else” and then they automatically do the earlier behavior without thinking about it.
What is a theory and how can theories help people replace an unhealthy habit with a healthy habit?
Dr. Kok: Theories are what we think, how people behave and how people work to change their behavior. There are theories of why people behave the way they do and theories to change that behavior.
The Health Belief Model explains why people behave the way they do and Social Cognitive Theory is also about how you can change a person’s behavior.
How can health theories help us implement change?
Dr. Kok: If you want to change your behavior, a theory can help you understand how difficult it is and it can also show you opportunities for change. In breaking habits, there are some techniques that may work such as implementation intentions (if this happens – then I will…) or stimulus control (putting whatever you want to change in a different place so you realize what you are doing).
There are also methods that come out of theories that may help people change their behavior. For example, a theory may call out the need for self-regulatory behavior, meaning you monitor your behavior, and by doing this you may realize that the behavior is not what you want and you can then make plans to change it. In making plans to change, you have to think in advance when it will be difficult, what are the barriers and how you are going to deal with them.
If you do this in advance, the chances are much higher that you will succeed. One example of this is if you take medication two times a day and know that you are prone to forget, you can simply program a reminder on your phone. The key is that you have to organize around difficult issues and behaviors.
Do you think mobile health applications are an effective platform for carrying out behavior change or learning a new habit?
Dr. Kok: They can be very helpful if used correctly. Some are a complete failure though because the makers didn’t think enough about the theoretical conditions. But there are also a lot of examples of them being effective, they just have to be made with proper consideration.
What is important for mobile health applications to consider when seeking to apply theories?
Dr. Kok: One of the problems is that people don’t use theories properly — you really need to go in-depth when applying theory. There are some examples of apps that simplified everything so much that they made mistakes. Therefore, it is important that the whole reasoning of the theory is checked out by someone familiar with it. Also, it has to be adaptable to the situation of the individual. There needs to be some tailoring to the user so that they can explain what their unique problem is. This helps a lot. Many people try and if they fail two times their self-efficacy goes down. This is because, at the individual level, there are a lot of differences among people that mobile health app developers need to consider at each step. For example, if a person does want to change then they are going to react differently than a person who doesn’t want to change but needs help. It’s not simple, but we know a lot more today about how to help people than 25 years ago.
Let’s take a look at how SkinVision implements health theories within the app.
At SkinVision we have incorporated methods from the Health Belief Model and Social Cognitive Theory to help make our users successful on their path to better skin health. The Health Belief Model identifies health risks and barriers that hold people back from implementing health-related behavior as well as actions that can help people overcome these barriers. For example, a person may doubt that skin cancer is a serious condition, but by highlighting the life-threatening realities of the disease we help counteract that assumption and provide more information about their risk.
Social Cognitive Theory looks at how people learn behaviors from others and how, by confronting beliefs and using reinforcement, behaviors can be changed. In the case of SkinVision, this can mean showing people that through the simple act of repeatedly checking their moles, they can greatly reduce their chances of getting skin cancer.
Within these theoretical frameworks, we’ve implemented two specific methods in the app that can help make behavioral change easier for users:
- Observational learning:
- We help people learn by example when they first download the app by launching them into the camera onboarding process. This helps users understand how things work and feel confident in taking their first photos.
- We also encourage repetitive practice until mastery by informing users that they should capture all of their moles and skin lesions and reminding them to check up on them often to catch any potential changes over time.
- Emotional coping:
- Skin cancer can be a scary topic so throughout the app we use encouraging language and positive messages to help users deal with moments in the journey that can be particularly overwhelming and scary.
We hope this dive into behavioral change has given you more insight into how SkinVision works and the theories that help frame how we tackle the problem of preventing skin cancer.
Action tip: Set a reminder on a picture in the app so you remember to check your moles again. This will help you reinforce positive health behaviors and take control of your health.