Healthier Together: Social

Approaches to Health and Wellness

Paul Resnick

Outline

• My Story

– Collaborations with people who had

complementary expertise

• Advice

• Social Nudges for Health Behavior

MY STORY

College

• Math SB, 1985

Grad School

• Computer Science, SM 1988, PhD 1992

LEARNING FROM COLLABORATIONS

Community

Development

Mel King

Human Factors

Bob Virzi

Distributed Systems

John Riedl

Law and Policy

Larry Lessig

Political Science

Bob Putnam Brendan Nyhan

Saguaro Seminar 1997

Saguaro Seminar 1997

Saguaro Seminar 1997

Saguaro Seminar 1997

Economics

Richard

Zeckhauser

Economics

Eric Friedman

Computer Science Theory

Rahul Sami

Social Psychology

Bob Kraut Sara Kiesler

CommunityLab

Advice

• Collaborate with complementary experts

• Go deep in fields you cross into

– (not necessarily broad)

• Learn math and programming in grad school

• Theory, Practice, and the Design Perspective

Wisdom from Kurt Lewin

“There is nothing so practical as a good theory”

“If you want to understand something, try to change it”

Advice

• Collaborate with complementary experts

• Go deep in fields you cross into

– (not necessarily broad)

• Learn math and programming in grad school

• Understand �� Change

SOCIAL NUDGES FOR HEALTH

BEHAVIOR CHANGE

THE OBESITY EPIDEMIC

Costs of Obesity

• In human terms

– Heart disease

– Stroke

– Type 2 diabetes

• In economic terms

– $147 billion estimated in 2008

– Mean $1,429/person per year more than normal

weight

Obesity Trends* Among U.S. Adults

BRFSS, 1985(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults

BRFSS, 1986(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults

BRFSS, 1987(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults

BRFSS, 1988(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults

BRFSS, 1989(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults

BRFSS, 1990(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults

BRFSS, 1991(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults

BRFSS, 1992(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults

BRFSS, 1993(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults

BRFSS, 1994(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults

BRFSS, 1995(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults

BRFSS, 1996(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults

BRFSS, 1997(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. Adults

BRFSS, 1998(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. Adults

BRFSS, 1999(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. Adults

BRFSS, 2000(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. Adults

BRFSS, 2001(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 2002

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. Adults

BRFSS, 2003(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. Adults

BRFSS, 2004(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. Adults

BRFSS, 2005(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. Adults

BRFSS, 2006(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. Adults

BRFSS, 2007(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. Adults

BRFSS, 2008(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. Adults

BRFSS, 2009(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. Adults

BRFSS, 2010(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

HealthierTogether.info

Collaborators

• Caroline Richardson

• Mark Newman

• Margaret Morris

• Erin Krupka

• Sean Munson

• Debra Lauterbach

SELF-TRACKING

The Quantified Self

Sleep

Physical Activity

Food

Moods

+ Gamification (Points + Levels)

THE POWER OF SHARING

BEHAVIOR CHANGE:

MAKING ACTIVITY FUN

Team Quests

Buis, L., T. Poulton, R. Holleman, A. Sen, P. Resnick, D. Goodrich, L. Palma-Davis and C.

Richardson (2009). "Evaluating Active U: an internet-mediated physical activity program."

BMC Public Health 9(1): 331.

Making the Behavior Social

Making the Tracking Social

• Richardson et al

• J Med Internet Res 2010;12(4):e71

• Individual tracking only– 66% completed program

• With forums– 79% completed

• Same step count increases– 4468 � 6948 per day

BEHAVIOR CHANGE:

MAKING ACTIVITY REWARDING

Encouragement from Others: Nike+

Helping Others

• Helping others may be very motivating

• Study design

– Obese teens

– Gift cards for completing walking goals

• You

• A friend you pick

• Split between you and friend

BEHAVIOR CHANGE:

ACCOUNTABILITY TO OTHERS

Feedback from Others

Accountability: Interventions

• OneRecovery

Accountability: Monitors

• Stickk

Accountability: Social Punishments

• Steps Commitments

DETOUR: POWER ANALYSIS AND

EXPERIMENT DESIGN

Experimental Conditions: 2x2

• Private commitments and results

• Public commitments; private results

• Private commitments; public results

• Public commitments; public results

Design 1: Between Subjects

• Each subject randomly assigned to one

condition

• Stay in the that condition for 14 weeks

• Analysis: more walking in some conditions

than others?

Power Analysis via Simulation

• Each of K times, run a simulated experiment with n subjects– For each subject

• Draw results from an assumed distribution– (e.g., condition 2 has 500 steps/day more on average than condition 1;

some assumed variance between people, between days)

– Run data analysis on the dataset• Record whether difference between conditions is statistically

significant or not

• Power = percentage of simulated experiments with significant results

• Try different values for n, to see how many subjects you need

Design 1: Between Subjects

• Each subject randomly assigned to one

condition

• Stay in the that condition for 14 weeks

• Analysis: more walking in some conditions

than others?

• Power analysis: even 90 subjects per condition

not enough!

Design 2: Partially Within-Subjects

Design

• Each subject starts with a no commitments baseline for a few weeks

• Then randomly assigned to one of the four conditions

• Analysis: compare difference from baseline, between conditions

– Factors our individual

• Power analysis: 65 subjects per condition �90% power

BARRIERS TO OVERCOME

Embarrassment

“I got people, you know, from my high school that I am friends with that I haven't talked to in 25 years. And I have no desire for them to know about my weight issues or weight status.”

“… I did not put that on because I didn't want everybody on Facebook knowing that my butt muscle hurt today.”

Newman, M. W., D. Lauterbach, S. A. Munson, P. Resnick and M. E. Morris (2011). It's not that i don't have problems, I'm just not putting them on Facebook: challenges and opportunities in using online social networks for health. Proceedings of the ACM 2011 conference on Computer supported cooperative work. Hangzhou, China, ACM: 341-350.

Spamming

“…mostly when I make things private, it’s more because I think they’d be boring or

insignificant to my friends, not because they’re actually things I wouldn’t want my

friends to know about. I just don’t want to clog up their Facebook with it.”

Munson, S., D. Lauterbach, M. Newman and P. Resnick (2010). Happier Together: Integrating a Wellness Application into a Social Network Site. Persuasive Technology. T. Ploug, P. Hasle and H. Oinas-Kukkonen, Springer Berlin / Heidelberg. 6137: 27-39.

Comparison and Competition

Avoidance

• Comparisons can demotivate

• Some people avoid them

• Active U

– 1 point increase in BMI � 1% decrease in

likelihood to join a team

Buis, L., T. Poulton, R. Holleman, A. Sen, P. Resnick, D. Goodrich, L. Palma-

Davis and C. Richardson (2009). "Evaluating Active U: an internet-mediated

physical activity program." BMC Public Health 9(1): 331.

Unhelpful Responses

• “Oh, you are counting calories? That will never work, you have to count carbs/fat/fiber etc...”

• “Oh, come on, it's a birthday party, you can have ONE piece of cake...”

• “Oh, you're fine the way you are, your husband loves you anyway, why put yourself through this?”

From http://www.sparkpeople.com/resource/article_comments.asp?id=87&type=1

Summary

• Benefits of tracking together

– Behavior change

– (Support)

– (Decision-making)

• Design Challenges

– Sharing the right stuff with the right people

– Matching social elements to individual needs

Conclusion

• Advice

– Collaborate with complementary experts

– Go deep in fields you cross into

– Learn math and programming in grad school

– Understand �� Change