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FUTURES 2020WEARABLE TECHNOLOGY

A NEW PATH FOR PUBLIC HEALTH?Ogilvy CommonHealth Worldwide 2015

David Davenport-Firth Lexi Fletcher Matt Balogh Ritesh Patel Simon Stebbing

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Unless you’ve been living on a desert island recently, chances are you’ve been unable to escape the noisy arrival of wearable technology. At Ogilvy CommonHealth Worldwide, we’ve been watching the hype unfold with mixed emotions. On one hand, the influx of devices and apps seems like a modern day marvel – after all, for how many years have we waited patiently to harness the true power of digital health? However, at the same time our behaviorists just can’t help wondering what the next steps will (or rather should) be.

There’s certainly a lot to be excited about – every day we come across awesome apps with fabulous functionalities that tick many a behavioral change box.

But as a company concerned with building better health outcomes, it’s not enough for us to rate devices based on a purely subjective analysis of their pros and cons. Because at the end of the day, there’s just too much at stake. Wearable technology has the potential to deliver public health support on a previously unimaginable scale. Which means that we’ve got to make sure we are not only asking the right questions, but that we’re getting the most scientifically satisfying answers.

So how about a few questions to get started… Which devices are the most effective, and why? What behavioral change techniques should developers be basing their designs on? And how far can we push technology

to provide a perfectly personalized experience?

We don’t pretend to have all the answers. But we do want to start the conversation – and we’d like to invite you along for the journey. In Part 1 we’ll be taking a look at the situation ‘Today’, analyzing what developers are currently doing, and asking ourselves to what extent this aligns with current thinking around behavioral change. Part 2 will then take us on a whistle-stop tour of the forces and possible scenarios that will be shaping ‘The Future’ – so get ready to step inside the time machine and let your imagination run wild. Finally, if you just can’t get enough of the design detail, in Part 3: Wearables Highlights’,

we take an in-depth look at four popular devices and their apps.

Before we begin, a big thank you to everyone who has contributed to this report. Apart from the authors, fact-finders and designers, the research would not have been possible without the blood, sweat and tears of our very own lifestyle-tracking guinea pigs.

So that’s all from me for now. But if you, like us, have a hunger for health behavior change and want to find out more about the wonderful world of wearable health technology, keep reading!

Matt GiegerichChairman & CEO,

Ogilvy CommonHealth Worldwide

FOREWORD

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Foreword 2

Today 4

Developed for Dan 5

Let’s get physical 6

How to behave better 7

We’re all individuals 10

CONTENTS

The future 12

Up for the challenge 13

Future scenarios 17

Coffee bean counters 18

A ticket to your health 20

Shop ‘til you drop 21

An education in exercise 23

Work it 25

Sleep hacking 27

References 29

Wearables highlights

Fitbit Flex 30

Jawbone UP24 42

Misfit Shine 64

Withings Pulse O2 74

Colophon 93

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Part 1

TODAY

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Meet Dan. Dan’s got a little bit of a wearable technology obsession, at least that’s what his girlfriend says. He can’t get enough of the flashing gadgets, the whizzy graphs and the constant stream of positive data. He loves working out, and he loves being able to see just how good he is at it. For Dan, each app he downloads and device he doles out for is an investment in himself, an extension of his preoccupation with all things physical. Being able to track the miles he’s run or the calories he’s burned is the best invention since (wholemeal) sliced bread. But let’s be honest for a minute. As glad as we are for Dan, the truth is his health was never exactly in question. The hip new world of wearable

DEVELOPED FOR DAN

technology might be boosting his motivation, but with or without it, he was always going to hit the gym. So what about the people whose health really is at risk? One aim of this thought piece is to encourage those who are driving wearable technology development, to start thinking beyond Dan – a man who perhaps is as young, male and healthy as they are.

First, a word of clarification. When it comes to wearable technology, a fine line exists between the devices we ‘wear’ and their associated apps. It’s pretty much impossible to discuss the former without the latter, which is why in this report you’ll see us freely flipping from one term to the other. Not only is this

intentional, it is actually necessary – because when it comes to wearable technology, device and app should be seamlessly interchangeable.

To remain focused, we’re also going to concentrate on certain topics: obesity, diet and physical inactivity. The majority of devices and accompanying apps that are currently available do seem to address these health issues in one way or another, though they appear to be targeting a fairly homogeneous audience. It could be that developers believe that the wearable technology market will follow the usual digital pattern – a few early adopters (like Dan) will pave the way until everyone is happily swiping away.

But there’s much to suggest that the adoption of wearable technology, in relation to health, specifically public health, will not follow the same path taken by smartphones or tablets. After all, health is as personal and nuanced a topic as you can get. What works for Dan may not work for Dorothy or Debra or Diego. So if we want to pull wearable technology out of its data-tracking, techno-wizardry niche and into the public health spotlight, we’ve got to start asking ourselves what the savviest solutions will be. How can devices and their apps become truly useful to the masses, and invaluable to those engaged in public health?

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We all know the stats. Worldwide obesity has nearly doubled since 1980. Back in 2008, 24% of adults over the age of 20 were classified as overweight with a further 11% classified as obese. And as recently as 2013, 42 million children under the age of 5 were already in the same condition.1

What else do we know? We know that obesity is preventable. Across the member states of the World Health Organization, governments are busy setting targets and forming plans to help tackle what many consider to be the most significant public

LET’S GET PHYSICAL

health issue of our time. And of course, increased physical activity is advocated (alongside dietary modification) to be the most effective way to not just deal with excess weight, but to reduce the prevalence of many non-communicable conditions such as cardiovascular disease, cancer and diabetes. But even knowing all this, the global crisis remains – one in three adults simply doesn’t move their body enough, and physical inactivity is the fourth leading risk factor for death worldwide.2

If developed smartly, wearable technology could help individuals autonomously manage what they eat and how much physical activity they get – reducing the pressure on their personal health as well as the overstretched healthcare systems designed to support them. But just how wise can wearables be? Out of the 250 or so devices thought to be on the market, more than 100 of these claim to be fitness related.3 Which begs the question – which brands are the best at encouraging users (that’s Dorothy, Debra, Diego and Dan) to start increasing their physical activity and reducing their weight?

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FITBIT FLEX: 21 BCTs MISFIT SHINE: 15 BCTsWITHINGS PULSE O2: 25 BCTsJAWBONE UP24: 34 BCTs

The fact is, one-third of US consumers, for example, stop using their wearable technology device within the first six months of ownership.4 As of yet, no one seems to be certain of the exact reason for this drastic drop in user numbers. But at Ogilvy we had a little hunch – could it be that today’s apps and devices function more as purveyors of data, rather than changers of health behavior? Of course we know that there are a host of techniques that can drive behavior change, and that many of these have been successfully applied

to more ‘traditional’ health programs. But just how far have these techniques trickled down into the world of wearables? We decided to take a closer look. Our starting point was the impressive ‘Behavior Change Technique Taxonomy’,5 a catalogue of 93 behavior change techniques (BCTs) organized across 16 categories. We selected four of the most popular devices, alongside their accompanying apps, and studied them for evidence of each

technique. The top line results: Jawbone UP24 (34), Withings Pulse O2 (25), Fitbit Flex (21), and Misfit Shine (15).

The majority of our data capture took place from August to October 2014, and therefore our observations reflect the available versions of the companion apps at this point in time.

HOW TO BEHAVE BETTER

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In parallel to this analysis, we put the wearable technologies to test against our panel of lifestyle-tracking guinea pigs (who clocked up an impressive 23,040 hours of data collection time across their devices). What was particularly fascinating to discover was that each app clearly had its own fitness angle – there may have been similarities across the board, but each brand retained a particular personality.

Fitbit really brought out the Darwinian drive in some of our users: “We might have started taking the competitive side of the challenges a bit seriously at work, there’s certainly a lot of trash-talk! It’s great fun though”

“Talk about pressure to keep walking!”

Jawbone was admired for its insights: “I really like the personalized tips... They do motivate me to try and keep my daily steps up”

“I followed the ‘today I will’ recommendations to get more sleep… and it actually worked!”

Misfit added a touch of style to the proceedings, especially amongst our swimmers: “It looks much better than the rest, you don’t feel embarrassed wearing it”

“Even the way it shows your data is clean and minimalist.”

Withings satisfied the data addiction of our very own self-confessed ‘Quantified Selfers’:

“It really makes you look at what you do each day in detail. A desire to ‘better’ yourself on each day’s results”

“I’m going to keep using this… checking my weight graph reminds me what I’ve achieved. There’s no way it’s going to curve back up now, ever!”

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By bringing the results of these two pieces of research together, we started to build up a pretty good understanding of the four devices and their accompanying apps (a more detailed analysis of which can be found in Part 3: Wearables Highlights). But this was not enough for us. We also wanted to incorporate evidence from the scientific literature, in order to understand

Fitbit Jawbone Misfit Withings Flex UP24 Shine Pulse O2

which specific BCTs, or combinations of BCTs, have the greatest behavior changing potential. In one recent study for example, it was found that six BCTs were particularly effective at changing a person’s level of physical activity.6 We’ve summarized these below, including which of our four devices seem to support them:

Facilitating social comparison (explicitly drawing an individual’s attention to others’ performance to elicit comparisons)

Action planning (specific detailed planning of when, where and how the specific behavior is going to be performed)

Provide information on the consequences of behavior (benefits and costs)

Reinforcing effort towards behavior (praising or rewarding participants for their attempts at achieving a behavioral goal)

Provide instruction (on where, when and how to perform this behavior, e.g. by providing information on local places people can access for exercise)

Time management (teach the person how to manage their time in order to make time to perform the behavior)

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So that’s that, right? Well no. Because there is another interesting piece of research, the results of which add yet another dimension to our quest for success. In 2013, a second team performed a similar study,6 the only difference being that this time their participants were all obese. And what did they find? That the BCTs that were most effective at increasing physical activity were not necessarily the same – the obese subgroup had responded differently to their healthier counterparts.

At the end of the day, the conclusion we can draw from all this is that the business of

WE’RE ALL INDIVIDUALSbuilding effective wearable technology (which focuses on behavior, not data), won’t be satisfied with a one size fits all solution. And there is perhaps no BCT more sensitive to this issue than that of ‘facilitating social comparison’.

Whilst some people love to share victories within a ‘team’, others may prefer not to reveal their intimate data, especially if success is particularly challenging. In fact our own user testing on Jawbone also bore out this interpretation: the triumphs of others can be viewed as either a magical motivator, or a total turn-off.

I love the Jawbone updates on how much activity everyone is getting up to. It makes me do mad things like take the dog for a walk at 11pm

The team performances exceeding their goals just added to the negative here – rubbing my face in the fact that I wasn’t exercising

I hated wearing the Jawbone this week as I know I wasn’t active and it heavily reinforced that fact. I actually would have preferred to take it off

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Knowing where to draw the line on sharing is a tricky path to take, for we feel certain that some element of socialization is undoubtedly motivating for a majority of users. Furthermore, even if people don’t want to share with close family and friends, anonymized networks could still be an alternative support option that more subtly tap into social norms. Which makes us wonder – perhaps digital solutions for health have to completely rethink what we conventionally understand by the phrase ‘social networking’. One thing’s for sure; any app hoping to successfully support health behavior change will have to figure out a strong (and specialized) approach to being social.

Now for some good news – a quick glance at the market suggests that some companies have already twigged that individual users will respond differently to certain BCTs.

77% of people want information that lets them ‘exercise smarter’PwC 2014 survey9 of what 1000 people wanted from wearable technology

For example, is it pleasure or pain that keeps you motivated? If it’s the latter, you could try one of the initiatives, where instead of having your good behavior reinforced through a traditional reward system, you are punished for failing to meet a goal. This sanction may come in form of an automatic donation (perhaps towards a prize fund that is shared between more successful users). From a behavior change perspective, such initiatives can be effective as we dislike losses more than we like gains of an equivalent amount.8

So where does all this leave us? Well instead of trying to tick every BCT box, what we need to do is think of smart ways to utilize the most advanced wearable (and even implantable) technology, whilst maintaining a focus on changing individual health behavior. It’s time to look to the future.

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Part 2

THE FUTURE

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Alan Kay’s impassioned words remain as relevant today as when they were yelled out back in 1971. Taking them as inspiration, 2015 will see Ogilvy bring together a crack team of behaviorists, choice architects, creative technologists and data visualizers with one clear goal in mind: to start inventing the future of public health.

We’ll be looking to collaborate with the smartest businesses out there – so if you’re interested in contributing to the project (or just want a front row seat

for the show), head over to ogilvycommonhealth.com and register today. But if you can’t wait until then, don’t worry! In the pages that follow, we share some of the main ideas and themes that we plan to question and explore. We hope you enjoy the read…

In Part 1, we raised an important question: how can we create wearable devices and accompanying apps that deliver BCTs in a way that is flexible and smart enough to truly change individual (and therefore public) health behavior?

But wait a second! Don’t we first need to discuss the myriad of different issues that arise around any solution that involves the sharing of personal health data? Well yes, but for the moment however, we will just assume that these topics are an integral part of the conversation, and save the detail for another time. This allows us to drill straight down to our most pressing concern: what ‘forces’ must we leverage in order to achieve effective public health behavior change?

Don’t worry about what anybody else is going to do… The best way to predict the future is to invent it. Really smart people with reasonable funding can do just about anything that doesn’t violate too many of Newton’s Laws Alan Kay, speaking at a meeting at the Palo Alto Research Centre, 1971

UP FOR THE CHALLENGE?

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Here the key word for consideration is ‘ecosystem’. When it comes to wearable (and implantable) technology-driven health behavior change, this can have a two-fold meaning.

In one sense it refers to the involvement of multiple stakeholders: interventions that have taken this approach, for example the Ensemble, Prévenons l’Obésité des Enfants program,10 seem to have enjoyed great success.

At the same time however, ‘ecosystem’ can also allude to the emerging ‘internet of things’, in conjunction with its supporting platforms. It’s worth noting that as things currently stand, no overarching standards or guidelines exist to control access to data or even its accuracy: each exists autonomously from the rest, making it difficult to join up the behavior change initiatives of the many devices on the market today.

CENTRAL STAKEHOLDERS

• Ministries• Health groups• Non-governmental organizations (NGOs)

• Private partners

LOCAL STAKEHOLDERS

• Political leaders• Health professionals• Families• Teachers• Local NGOs• Local business community

But it is when we connect these two ecosystems that things start to get interesting. In the months and years to come, it is likely that standardization will increasingly become the norm, as technical ecosystems begin to merge. There will no definitive ‘owner’ of the system, rather specialist companies and organizations will take on specific roles and be valued for the degree to which they can deliver on their niche. A powerful recipe for effective public health behavior change will arise when behaviorists and technologists come together to deliver individualized, contextually-responsive, bundles of behavior change techniques that are mobilized through the stakeholder ecosystem.

FORCE #1 Engage ecosystems

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This is where we become interested in the unconscious nature of behavior. Recent learnings11 suggest that apart from our known motivations and intentions, a number of environmental factors influence how we act. Much of what we do is automatically triggered by events in our surroundings.12 So any wearable technology or behavior change apps wishing to convince the scientific community of their merit will need to embrace the fact that not everything we humans do is consciously driven.

So how could this second force manifest itself? Well for starters, any wearable technology that incorporates environmental change trackers has the potential to be more interactive. The detection of ultraviolet (UV) exposure, outside temperature, humidity, barometric pressure and even light and sound levels are all within the grasp of many devices in the pipeline today. Just imagine the behavioral change potency of technology that understands how you generally eat more and move

less on a rainy day for example, or that associates how a lack of sunshine not only increases your stress levels but leads to specific negative health behaviors. Now imagine such technology pointing you in the right direction perhaps without you even realizing it. It may seem logical when you think about it, but it would a huge step forward for public health.

The next generation of activity trackers won’t just simply count steps, they will monitor levels of exertion and recovery rates.

And that’s not all – there are many more automatic bodily responses that future devices will be able to measure. Newly integrated technologies include photoplethysmography (PPG), which measures continuous heart rate, respiration, stress or relaxation, and galvanic skin response (GSR), which can determine stress, fear and anxiety by evaluating the amount of sweat-induced moisture on the skin.

FORCE #2 Embrace automatic responses

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And last but not least? Well ideally we want devices and apps that are able to quickly spot what is working well and adapt accordingly. Future wearable technology and supporting ecosystems will integrate with contextual platforms capable of creating personal profiles built up from all our browsing, purchasing and geolocation histories, as well as our psychographic responses and reactions when making health related choices (both on and offline). This means that from the moment we activate an app, it can start to monitor not only our physical activity and biometric data, but also which BCTs we are actually engaging

with (and when, where and how this engagement takes place). Which is unquestionably useful, since as we saw in our research, not everyone reacts in the same way to every BCT.

Overall, at an individual level, apps will be able to start learning which BCTs (in which contexts) are most capable of driving behavior change. In aggregate, devices will generate huge amounts of data relating to which BCTs are best at driving behavioral outcomes among people with a specific profile and in which circumstances. And this won’t just be data based on a few thousand people. This will be data based on hundreds

of thousands, even millions of users… real life data churned out by mini research engines.

What’s more, as consumers we’ll be able to trade this precious data in exchange for greater conveniences, lesser costs and healthier lifestyles. In fact, it won’t be long before we’re thinking of ‘steps’ in the same way we currently think about air miles. Want a discount on your health insurance? Well you can already get that. But what about a free chai latte at your local coffee shop or a 10,000 steps a day ‘gold’ card? To tap into these benefits, you’ll have to get moving.

Of course, we need to start building this smart analytical approach into our apps right now, in order to quickly learn which implementations of which BCTs work, and which don’t. And here’s the really exciting bit. In the future, just by knowing somebody’s profile, we’ll be able to provide them with individual, pre-selected techniques that are most likely to help them change their health behavior. Which as we’re sure you’ll agree, sounds pretty darn valuable from a public health perspective.

So the challenge has been set. We need to master these three forces of smart thinking – both in and outside of the app.

FORCE #3 Let technology do the learning

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For those individuals and companies determined to make a real difference in public health, the potential to change lives is limitless. Over the next few pages, we outline a handful of ‘future scenarios’. These aren’t by any means a detailed or exhaustive list of the possibilities. They are just food for thought – think of them as appetizers to whet your palate for the future. And safe to say, we’ll leave the calorie counting until later!

FUTURE SCENARIOS

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Meet Wilma. Walking past her local coffee store yesterday (yes, she knows it’s a chain, but she just loves the blueberry muffins), Wilma spotted a promotion in the window: sign up for our new healthy bolt-on app, and you’ll receive double loyalty ‘stamps’ for the next two weeks. Recognizing the opportunity to both get fit and receive discounts on something she loves, Wilma immediately clicks the download button. She’s pleasantly surprised to see that she doesn’t have to manually input much to get started – she simply gives the app permission to access the health information already stored on her smartphone. Wilma’s not surprised when

it quickly extracts data on her physical activity levels, diet and sleep (as these were already being tracked by her smart watch), but she almost thinks twice when it asks to access her phone’s GPS record. However she trusts this coffee shop, and the app does explain that the information will be used to build a profile of the places she frequents and the activities she does when she gets there. So she decides it’s a worthwhile permission to grant and ta da, registration complete! Time to start racking up those loyalty points then…

COFFEE BEAN COUNTERS

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Wilma’s two weeks go by in a flash – a few walks in the countryside, a couple of night-time jogs in the city and a handful of visits to the gym (where low energy Bluetooth beacons are used to log the time she arrives and the moment she leaves). The app has started to send her incentives specifically tailored to her lifestyle, and points out that even though her activity levels are not bad, she isn’t reaching her targeted 10,000 steps a day. Normally Wilma wouldn’t be worried, but the app promises her a free ‘treat-size’ (low-fat) blueberry muffin next Sunday (the day the location-based geo-fence has sensed she always visits the store) if she manages to

complete the goal over the next few days. Not only that, if she manages to obtain an overall calorie deficit in the upcoming week then they’ll upgrade the muffin to the ‘reward-size’ (which she has to admit, tastes just that bit sweeter).

All in all, Wilma’s pretty psyched with the coffee shop bolt-on. She’s walking more, and she’s spending less. Plus from time to time she’ll be sent a little hint or tip designed just for her – in fact it was only yesterday that she clicked on a link to read more about the health benefits of vitamin K (which incidentally, are what blueberries are packed with).

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Meet Walt. A city slicker, Walt has been taking public transport to work for the past ten years. He was one of the first people to sign up to the city’s NFC contactless payment system that now integrates with his smartphone, and he loves the ease with which he can speed from the subways to his desk every morning. Recently he’s noticed an increasing number of adverts aimed at encouraging him to walk more. Last month the campaign posters told him to ‘get off a stop early and walk the rest of the way.’ Even though it sounded like a good idea, he has to admit, time is money – and so the adverts had little effect. Yesterday however he spotted something that did catch his eye. A new scheme dreamed up by the city transportation company (in conjunction with local health authorities) is offering him a tasty incentive: a 5% discount on the cost of his weekly commute if he travels one stop less (or more) and walks the rest of the way.

Now Walt is a numbers guy, and that 5% was something he could really get his head around. Add that up over the course of a year and it’s almost the cost of a family holiday. Plus there’s no new technology to acquire – the payment system that is already integrated into his smartphone will track his stops and bank his cash. So he signs himself up, downloads the app, and well, the rest is history.

Before he knew it the new routine seemed like the norm. At first he was a little concerned about what would happen on a rainy day – but he shouldn’t have worried. The app links up to local weather reports and gives him a ‘free pass’ on those mornings when the walk could get wet. Furthermore, the app integrates with the snazzy new ‘stress-detecting watch’ that he picked up on sale last week. He usually drives to where he picks up the train, but when he saw that his stress levels increased during this traffic-filled first leg of the journey, he decided to try cycling on sunny days. So far so good, and the additional physical activity is adding extra points to his transport balance.

When the sky is clear the app sends him a choice of transport routes, some of which even highlight specific (and healthy!) rewards redeemable at shops or cafes. His morning bagel and coffee has been replaced by a fruit smoothie and a slice of banana bread – meaning that not only is he getting more exercise and keeping anxiety levels down, he’s also enjoying a healthier diet. Of course, all that extra energy takes its toll. But Walt isn’t losing any sleep over it – the app suggested an earlier bed time so he could wake up for his morning exercise, and whilst he doesn’t admit it to the guys at work, he’s feeling a whole lot better for it.

A TICKET TO HEALTH

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When Winnie logs on to shop, the app uses her weight information to provide advice around sensible choices. By combining certain products she can view how ‘green’ (i.e. healthy and nutritious) her virtual basket is looking. To be honest, she’s surprised by how many of their usual treats they can keep without turning orange (or even red!), but of course there’s definitely not so many bags of snacks and bottles of beer when the delivery man arrives.

Now she’s on board with the new app and can see the results both in herself and the weekly reports, Winnie’s hunger for

Meet Winnie. A fan of online shopping, Winnie has been ordering groceries on the web ever since her favorite supermarket started the service. A few months ago, Winnie’s doctor warned her that it might be a good idea if she and her husband (Wallace) did something about that ever-climbing number on the bathroom scales. He recommended some new smart-scales that could be connected to a couple of apps, one of which links directly to her online supermarket account. All the couple have to do is stand on the scales each morning (not together mind you!) and their data is integrated automatically.

health rewards seems to be ever increasing. Alongside the weekly delivery of groceries, the supermarket now sends articles and recipes designed with her and her husband in mind. By cooking these dishes she can use up leftover food (the app knows the status of her fridge) and earn bonus points for each recipe she rates and reviews. But Winnie isn’t the only one impressed with the new routine. Last week their daughter visited and commented on how good they were both looking – which has spurred Winnie on to drop a dress size in time for the summer holidays.

SHOP ‘TIL YOU DROP (those pounds)

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Before she sets off, she informs the app that she’s on her way. As a reply she is assigned a special parking bay, located 500 steps from the entrance (Winnie normally parks as close as she can). As she makes her way to the sliding doors to collect her trolley another notification pops up – she’s earned bonus points for her parking decision and can earn another $10 off her shop if she clocks up 2,500 steps in store. And because the app is capable of matching the store layout to her usual purchases, it recommends a shopping path that will not only ensure she reaches the step count, but will lead her past a few personally enticing extras en route!

Winnie’s happy to let the app guide her through the aisles, dishing out recommended promotions and helping her to discover new products that are healthy and tasty. Feeling pleased with herself, she wanders to the elevator, planning on riding the two floors up to where the swimming costumes are. But just as she presses the button, a message appears (triggered by a Bluetooth beacon), this time advising her to take the

In search of even greater results (and now more comfortable with the program), Winnie decides to take it to the next level and make a weekly trip to the actual supermarket. The app has been recommending that she take this step for some time, explaining how with them at hand, the experience will combine the conveniences of online shopping with the benefits of getting to the physical store. It is a chance to discover new products or buy something special for the weekend, whilst getting a bit of exercise and even saving a bit of money.

stairs. Even more bonus points! And the interaction and incentivizing doesn’t stop when she reaches the bikinis. One particular brand offers her a 50% discount if she manages to lose 3kg over the next 3 months, whilst playing videos of women talking about their weight loss successes. The fact that these women seem just like Winnie fills her with confidence as she walks back towards the car.

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the device is quite cool looking, and is happy to wear it strapped across his wrist, but he’s also a little worried. He is all too aware that whilst he can talk a big game, when it comes to action he’s not the most athletic of his friends. What if the goals are too hard for him to reach? What if people laugh and compare?

But Wez has no cause for concern. After all, the smart technology in his new wristband doesn’t just blindly count steps. Each student has a device personalized for

their ability levels, with the understanding that running for 10 minutes will be harder for some than for others. Instead of purely tracking activity, it also detects effort and recovery times – cleverly tailoring its incentives to the individual.

Safe to say, Wez is happy. In fact at the start the device was so easy to use that he nearly forgot he was wearing it (plus there were too many other important things to discuss at break time). But now he’s had it a few weeks, the band is really starting to impress him.

Even if you haven’t met Wez yet, you’ve definitely heard him. He’s a loudmouth in the school yard, always yelling to keep his voice heard above the crowd. The only problem with Wez is that whilst he makes a lot of noise, he doesn’t make a lot of moves. His weight is not yet an issue, but it could be if he keeps trading his mum’s healthy packed lunches for whatever candy or snacks any other kid is willing to give up. Recently his school provided each student with a new ‘FriendlyFit’. Wez admits that

For one thing, no more boring sandwiches for lunch. When his mum (Wanda) found out that the device would automatically record what he chose to eat, she was happy to let him join the rest of the kids in the canteen. Through a report sent straight to her a smartphone, she can see exactly how many calories and nutrients he’s had at school – allowing her to adjust accordingly when she’s preparing the evening meal, ensuring that Wez attains a complete nutritional profile for the day.

AN EDUCATION IN EXERCISE

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but at least he could still munch through his favorite pizza. The next day, he made sure to clock up some steps instead of sitting in a corner and at lunchtime he was duly rewarded – a (small) portion of fries were his.

But there are other benefits to this new system. Double physics used to be Wez’s least favorite part of the week – nearly an hour and a half of pure pain. But now his teachers are warned when the students have been sitting still for too long, and they are all allowed a

five-minute break to do some stretching exercises on the spot. This has really helped Wez’s concentration – his grades have gone up and his mum can’t believe the change. Though that might also be to do with the nutrient-packed breakfasts she’s been giving him each morning – ever since she read the leaflet the school sent home about the importance of the first meal of the day, she’s chucked out the sugary cereals and started stocking up on porridge and other breakfast goodies.

The first time Wez queued up for the lunch he chose pizza, fries and a coke. However when he tapped his smart band to pay, a red light appeared. Bluetooth beacons in the playground had registered the amount of exercise he had done during morning break, and it seems it just wasn’t enough to afford all those high calorie treats. The dinner lady suggested he swap the fries for salad and the coke for the zero-calorie version – and the light turned green. He was a little sad to lose the accompaniments,

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Meet Warren. Apart from his once a week game of five-a-side, Warren is pretty sedentary (and has the spare tire to prove it). He has always known he should do more exercise, but his intentions to start seem to always focus on tomorrow. However even if he’s not Mr. Naturally Sporty, Warren is certainly Mr. Completely Competitive, especially when it comes to gaming. So when his office moves to a swanky new riverside location (tech’d out with inside beacons and outside environs), he’s curious to see what will happen. He’s not disappointed – from the first moment he is given his office branded wearable, he realizes there aren’t just health benefits to becoming a little more active.

Warren is automatically assigned to team ‘Marketing Movers’. Alongside his fellow colleagues, he now has a number of ways to increase his points level and help send his team up the tables. Now normally Warren would never dream of using the stairs in the morning, but if four flights means a lot more points (and a chance to get ahead of ‘Finance Fanatics’) then it’s goodbye elevator! At lunchtime and after work he’s signed up to soccer and squash – each game he plays earns him more points for Marketing Movers (and more respect for himself). At the end of the month, the team with the greatest points wins prizes and rewards (with the company also winning, as their healthcare costs are dropping).

And that’s not all. The firm has topped up Warren’s card with cafeteria health food credits – which he can use to purchase fruit, water and other healthy snacks. Of course, on weeks when he’s really active, he can choose a chocolate brownie or piece of cake – or a beer on a Friday afternoon as a reward. He’s been offered a stand-up desk (turning boring conference calls into point-earning play) and the company makes a charitable donation on his behalf every month (the size of which depends on the amount of movement he’s amassed). Warren’s in competition heaven, and he’s pleased to be helping out others too – he can see proof of where his donations and effort are going on the cafeteria widescreen.

WORK IT

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Meet Wendy. She considers herself to be a pretty healthy girl – she eats well, exercises regularly and (usually) gets enough sleep. Wendy’s got no major complaints about her reasonably well-established routine, but recently she’s been wondering if she’s in a bit of a rut. Sure, compared to most of her friends she’s practically a gym bunny, but to be honest it still feels like something’s missing – she just doesn’t feel as good as she used to. Wendy’s thought about adding another gym day, or increasing the length of those runs, but the truth is she just doesn’t have the time. It’s not like she ever deviates from her daily trips to the office salad bar, so it’s hard to know what else she can do to get results.

As luck would have it Wendy had a birthday last week and her family all clubbed in to buy her a new ‘watch’. She still refers to the item in quotation marks, because its ability to tell the time pales in comparison to its other whizzy features. She wasn’t overly enthused by its potential at first, integrating it into her routine but not bothering to even download her first trend report. After all, she didn’t need anyone to tell her that she was doing the right things! But when curiosity finally got the better of her and she stole a sneaky look, the results she saw made her do a double take. Not everything was perfect…

SLEEP HACKING

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All was in order when it came healthy eating and step count – gold badges all around in fact. But in the sleep category the report was far less glowing. Whilst Wendy was getting enough hours of sleep, each dose of sixty minutes was not as productive as it could have been. After she recovered from the shock of not receiving top scores across the board, Wendy realized that the result was actually a good thing – finally she had something tangible to work on!

By delving deeper into the report, Wendy discovered a list of personalized tips on how to improve sleep quality, each insight gleaned directly from her personal routines that the device had been recording. As it turns out, Wendy liked to exercise in the afternoon and finish up her work at night. The watch detected that this pattern was increasing her anxiety levels, making it difficult to fall asleep and causing her to wake up more often. Wendy didn’t need any more convincing – the very next day she swapped her schedule. Permanently.

Since then Wendy has continued to listen to the app’s tips and hints in order to fine-tune her optimal sleep routine. To her surprise, the quality of shut-eye isn’t the only thing that has improved. Gaining more hours under the covers has had a knock-on effect, giving her more energy when exercising and less anxiety when working. Without even trying to diet, she’s lost those few stubborn extra pounds, and all in all Wendy couldn’t be happier (or healthier!).

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Of course these six scenarios are just that – scenarios. Not everything will work for everybody, but that’s OK. What’s important is that right now we have a once in a lifetime opportunity to grab the gift of wearable technology and shape a fitter future for us all. So if you are as intrigued and passionate as we are about how wearables can deliver behavior change on a grand public scale – then get in touch. Visit ogilvycommonhealth.com or contact wearablepublichealth@ogilvy.com for a chat.

LET’S INVENT THE FUTURE TOGETHER

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1 World Health Organization, 2014a. Obesity and overweight. Fact sheet No 311. Available: http://www.who.int/mediacentre/factsheets/fs311/en/ [Accessed 22 November 2014].

2 World Health Organization, 2014b. Physical activity. Fact sheet No 385. Available: http://www.who.int/mediacentre/factsheets/fs385/en/ [Accessed 22 November 2014].

3 Herz, J C. 2014. Wearables Are Totally Failing the People Who Need Them Most. Available: http://www.wired.com/2014/11/where-fitness-trackers-fail/ [Accessed 22 November 2014].

4 Ledger , McCaffrey D. Inside Wearables. How the Science of Human Behavior Change Offers the Secret to Long-Term Engagement. 2014. Available: http://endeavourpartners.net/assets/Endeavour-Partners-Wearables-White-Paper-20141.pdf [Accessed 22 November 2014].

5 Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, Eccles MP, Cane J, Wood CE. The be-havior change technique taxonomy (v1) of 93 hierarchically clustered techniques: Building an international consensus for the reporting of behavior change interventions. Ann Behav Med 2014;46:81–95.

6 Williams SL, French DP. What are the most effective intervention techniques for changing physical activity self-efficacy and physical activity behavior—and are they the same? Health Educ Res 2011;26:308–22.

7 Olander EK, Fletcher H, Williams S, Atkinson L, Turner A, French DP. What are the most effective techniques in changing obese individuals’ physical activity self-efficacy and behavior: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2013;10:29.

8 Kahneman D, Tversky A . Prospect theory: An analysis of decision under risk. Econometrica 1979:263–91.

9 Pricewaterhousecoopers. 2014. Health wearables: Early days. Available: http://www.pwc.com/us/en/industry/entertainment-media/publications/consumer-intelligence-series/con-sumer-intelligence-series-pwc-hri-wearable-devices-form.jhtml [Accessed 22 November 2014].

10 Borys JM, Le Bodo Y, Jebb SA, Seidell JC, Summerbell C, Richard D, de Henauw S, Moreno LA, Romon M, Visscher TLS. EPODE approach for childhood obesity prevention: methods, progress and international development. Obes Rev 2012;13:299–315.

11 Kahneman D. Thinking fast and slow. 2011. New York: Farrar, Straus and Grioux.

12 Ariely D. Predictably irrational: The hidden forces that shape our decisions. HarperCollins.; Thaler R, Sunstein C. 2008. Nudge: Improving decisions about health, wealth and happiness. New Haven: Yale University Press.

REFERENCES

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Part 3

HIGHLIGHTSWEARABLE

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FITBIT FLEX

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Well this is one for the social butterflies. Or more accurately, the competitive social butterflies. That’s because this is the app that lets you share and compare – and it does so using a handful of rather compelling functionalities. Whilst in total it deploys 21 of the behavioral techniques (putting it in 3rd place, with 31%), it scored more highly than any other device against the categories of ‘Social Support’ and ‘Reward and Threat.’

Let’s see why…

FITBIT FLEX Behavior change potential

Fitbit Flex: 21 behaviour change techniques4 deployed

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The majority of our testers were suitably impressed with the simplicity and tailorability of the Fitbit dashboard (both the smartphone and desktop versions). As a user you can easily personalise your view, grouping and re-ordering the information most important to you near the top – and turning off any facts or figures you find less compelling. Apart from stopping you from feeling completely overwhelmed, this personal dashboard is highly intuitive – as you get closer to a goal, the horizontal progress bars fill up and change colour.

FITBIT FLEX Dashboard

I like how simply the dashboard provides all of the information I want to see

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Click on ‘Steps’ and you’ll be rewarded with some nice graphics to illustrate the general progress you’ve made that day, alongside a summary of the week to date and recently completed weeks. If you’re desperate to see what you achieved in the months that time forgot – it’s no problem, just keep swiping up and you’ll be transported back to the past. And that nice little green star? Well it lets you know that you’ve achieved a goal – and for some of us it’s reminiscent of good behavior at school.

It’s definitely more motivational to see the steps on the actual device on an ongoing basis, without having to sync it with the app

I like the subtle ‘vibration’ feedback mechanism on the Fitbit when I’ve reached my step goals, it’s much better than just a visual reward.

FITBIT FLEX Activity

When you tap the diagonal arrows a larger display will appear, showcasing the current days steps using an intuitive colour coding system (orange is low activity, green is high). There are as many options for display as you can possibly imagine – including per day, week, month or year. Choosing one of the longer time periods will display the reality vs. your goal – if you’ve successfully exceeded your aim the bars are green, otherwise they remain a rather depressing grey. Once again our icon-loving testers appreciated the cute little grey steps that accompanied the dashed grey goal line. Whatever keeps you motivated, eh?!

And it’s not just within the app that users can get feedback on their progress, our testing panel appreciated the visual and physical feedback the device provided.

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With Fitbit, the options for tailoring just keep on coming. The ‘Distance’ option allows you to see progress in metres rather than steps, whilst ‘Active Minutes’ allows you to see the times of the day you were most active and for how long. Once again, data is available for the

I enjoyed seeing my daily active minutes, it gave me a really different perspective on my activity goals

My favourite thing is how it displays my weekly steps too, that way if I have a bad day I feel like I can make it up later!

FITBIT FLEX Distance and active minutes

current day and week (as well as previous time periods) and stars let you know when you’ve reached a goal. Interestingly enough, for ‘Active Minutes’, the default goal is aligned with the Centre for Disease Control’s recommendation of 30 minutes per day.

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For those calorie-counters amongst us, Fitbit is a monitor’s dream. Using the same colour-coded format as for steps and distance (we love this consistency), you can see how many calories you’ve burned in any timeframe you desire (when you tap on those diagonal arrows of course).

On top of this, it’s possible to log food intake within the app or import data from MyFitnessPal to view calories in (yellow bars) vs. calories out (grey bars). Below this weekly chart we find a clever little dial that clearly indicates how many calories you’ve got left for the day, alongside a breakdown of calories consumed per meal. Like always with Fitbit, information for previous days and weeks is just a swipe away…

Fitbit and MFP worked really well together, whichever app I am looking at, the calories I’ve earned with Fitbit or the calories I’ve eaten with MFP are shared across both, which is great

FITBIT FLEX Calories

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So they’ve got food covered, but what about sleep? Well the graphs aren’t bad, but we have to say that compared to some other devices, there is room for improvement. An overall chart relies on colour coding to indicate when awake (pink), restless (light blue) and asleep (dark blue); a graphical approach to depicting sleep could perhaps have been incorporated.

Beneath that are the timings for particular sleep periods (in this case, night time as well as a sneaky afternoon nap). As per usual, specific data and charts are available per day, week, month and year, but a more complex graphical device could perhaps have been incorporated.

FITBIT FLEX Sleep

I found it interesting to be able to track how my total sleep changed over the course of the week – the sleep data is interesting although it is quite simple

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By now you’ve probably spotted the Fitbit pattern, and nothing much changes when we move on to weight, BMI and body composition (lean vs. fat). All three of these statistics can be accessed by clicking on the scale icon on the dashboard screen (which is accompanied by a lovely ‘Woohoo!’ if your goal has been met, or a target number of kilos to reach if this has not been the case). Data can be displayed for different time periods, and any goals appear as dotted lines.

Toggling between the three measures is with a horizontal swipe, and a tap on the diagonal arrows once again reveals data for longer time periods.

The quantity of data is great but we’d love the scale on the lean vs. fat chart to actually start at zero – there’s just a little too much green on that screen for our liking!

The options for recording different types of weight data got me thinking about what I could be measuring (I even bought some scales that show my body fat composition!)

FITBIT FLEX Weight, BMI and body composition

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No doubt all this tapping and swiping has got you thirsty, so it is lucky that Fitbit also allows you to monitor your water intake. Entering what you’ve sipped that day is easy and intuitive – either click on a glass size or adjust your drink by the millilitre if you want to be more precise.

As you drink more, the body fills up, and the dashboard bar progresses from blue through to yellow and then green (when you know things are really on track!).

I like the idea of tracking my water intake, but I found it too difficult to keep up with. The icon on my dashboard served as a nice reminder to drink more though!

FITBIT FLEX Water

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So we’ve seen some of what Fitbit can do. On top of this, the device’s community of ‘friends’ is a lovely little piece of functionality, and one that really sets it apart from the rest. For many users, the real-time ranking is a great motivating factor, as is the ability to cheer, taunt or simply message friends by tapping on their profile pic. Just like other social media sites, you can increase your circle of contacts by viewing (and then inviting) friends of friends, though some people found it a bit strange to get invitations off people they hardly knew.

I’m surprised by how much I’ve enjoyed the competitive element of the Fitbit challenges, especially as they are over multiple days so it really gives you something to aim for

But it’s safe to say – that the best is still to come. Fitbit has recently added the ‘Challenges’ feature to its trunk of tracking goodies. This greatly enhances the interactions between users, allowing you to target challenges towards your day, working week or weekend. You can start your challenges immediately, based on the activity you have already completed during that time frame, or you can set them in advance to give people a chance to prepare. Personally our users like the immediate start – it’s great fun to take up a challenge on the spur of the moment!

FITBIT FLEX Challenges

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Now this is where the fun really starts. Once a challenge has been set, Fitbit records contestants’ progress is an amusing and entertaining way

– also allowing for your own input (which can be as serious or as light-hearted as you wish). For our competitive users, there was nothing better than seeing a new participant announce their intention as being ‘in it to win it’ – they grabbed their trainers and headed straight back out the door! Granted, facing

off in such a down and dirty manner was not everyone’s cup of tea, but for those not afraid of a little healthy competition, Fitbit really hit the mark. By allowing us to set the tone of the conversation the device demonstrated a great understanding of how motivating the words and actions of others can be, and alongside the satisfying numerical updates, it provided an truly holistic idea of how they were progressing.

FITBIT FLEX Social challenges We might have

started taking the competitive side of the challenges a bit seriously at work, there’s certainly a lot of trash-talk! It’s great fun though

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Finally we come on to the Fitbit trophy – and what a nice one it is at that. The generous proportions, the rich colours – what greater incentive do you need to fight for a place at the top of the rankings? A simple swipe lets you see the full list of winners and the bar chart format really drives home the differences in achievement.

Of course for the winners, being able to see their face at the top (and those of their losing competitors at the bottom) makes the experience all the more personal. The only pedantic complaint we have is that those faces are a little small when a person cheers our success – we’d love to see who is praising us in full colour glory!

FITBIT FLEX Rewards

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JAWBONE UP24

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As the name suggests, Jawbone likes a good natter. Luckily for users, what the device has got to say is normally pretty insightful – it ranked number one in terms of quantity of behavioral techniques (with 34 in total, or 51%), and talked the trousers off the competition when it came to ‘shaping knowledge.’

Sounds like it’s time to get the conversation started…

JAWBONE UP24 Behavior change potential

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Jawbone UP24: 34 behaviour change techniques4 deployed

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JAWBONE UP24 Behavior change potential

Let’s begin with the app’s main menu. No less than seven options are provided from your menu, including Home (the main activity screen), User (your personal highlights), Goals (for ‘Move’, ‘Sleep’ and ‘Weight’), Trends (a longer term view), Team (those you share data with), Apps (a gallery of add-ons for enhanced functionality) and Inbox (where you receive comments from your buddies). That’s quite a lot of options, so we’ll take you through them one by one.

I love it! The app is the real star, as the Jawbone bracelet itself would be much better if it showed the daily step count on it

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JAWBONE UP24 Home

Straight away, Jawbone makes the user feel right at Home. This screen nicely displays your daily status at the top, using coloured bars to represent ‘Sleep’ (purple), ‘Steps’ (orange) and the unique Jawbone metric – ‘Food Score’ – in green. Later this colour scheme gets a little counter-intuitive (it changes in other places though remains static here), but for the moment we can’t complain.

Below this simple little summary we get our first glimpse of the famous Jawbone insights. As far as we can tell, these insights are also colour coded according to activity: orange = workout, purple

= sleep, green = food and yellow = mind. The insights seem to correlate with what Jawbone is recording for you, though some categories (such as ‘Words to Inspire’ can be opted in (or out of) via the menu. It’s a pretty neat example of personalisation – the device describes these particular tips as a way to “Prepare for anything life throws at you…motivational words curated by Jawbone.” Cute.

Anyway, if that whets your appetite – hold on tight – there’s plenty to come regarding insights, reflections on individual progress and tone of voice in a special section at the end of this piece.

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JAWBONE UP24 Timeline

A quick swipe up of the Home screen reveals your history (that day plus further into the past) and if you are in ‘All Activities’ mode then the timeline will display your own data as well as that of your ‘team’ (depending of course, on what they have decided to share with you…we’ll get on to that later).

A tap of the icon and you can concentrate on the most important person – YOU. We like the ability to get down and personal in this manner, with the reassurance that our friends are only a button away. And underneath ‘Your Activities’ you can see how long ago each event occurred – a technique that will make social media fans feel right at home.

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JAWBONE UP24 Steps

Take a look at the Steps panel. Can you spot the congratulatory ‘emoticon’ that a teammate has left underneath? Once again, Jawbone taps into the digital drivers that we are all becoming increasingly accustomed to. And when you press a panel in the timeline it opens up to show even more data – here we have a pretty clear graphical summary of various metrics, which can be further expanded if you are hungry for detail.

Plus the 7 day swipe is massively useful – it shows not only your goal but your average over the past week (notice those resplendent rays making an appearance once again).

I like the fact that you’re not overwhelmed with data but you can see it if you want

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JAWBONE UP24 Activity

And when Jawbone detects that your step count might be due to a specific activity, they’ll make a good guestimate of what it is – but let you manually input an alternative if their psychic vibes have been slightly askew. There’s a whole host of potential workouts you can chose from, including zumba, hiking and skiing. Which makes our usual daily walks look a little boring to be honest

– time to book that adventure holiday we’ve always been talking about!

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JAWBONE UP24 Sleep

Jawbone has obviously spent some time on its graphics – just check out the graduations of colour in the ‘Sleep’ display. Dark blue for ‘sound’ sleep, lighter blue for…well ‘light’, and some great statistical nuances in reference to how long you’ve been in bed, awake or how many times you’ve woken up in the night. Just like steps, it’s also possible to see your weekly progress for sleep.

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JAWBONE UP24 Food

Now Jawbone impresses us for a lot of reasons, but the ‘Food Score’ metric really lights our (calorie burning) fire. For one, it automatically imports data from MyFitnessPal (you only have to scan a barcode or click on a previously consumed food), and secondly, it’s not just about calories – it also focuses on that all important nutritional profile.

Tapping on the bar gives a horizontal timeline of colour-coded meals alongside an overall Food Score. Below this is a graphic to show calories eaten (green) and estimated calories burned (orange), followed by a breakdown of nutritional components.

Whilst this is all great, it wouldn’t hurt to see our weekly averages as well (to see how those ‘good’ days are cancelling out the ‘bad’). But overall, nice work Jawbone – and there’ll be more to say regarding food in a bit…

Maintaining a 500 calorie deficit of food intake vs burn has been fantastic. Tracking food is relatively easy and the real-time line of when you’ve eaten too much or not exercised enough to maintain this deficit is really useful

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JAWBONE UP24 Trends

It may not be as visually beautiful as Misfit Shine, but Jawbone is pretty ‘trendy’ all the same. By clicking on the Trends category you are able to view your overall history across 20 different metrics – relating to sleep, physical activity, calories, weight and nutrients consumed. Two categories can be displayed at the same time, one at the top of the screen and one at the bottom. It would be nice to choose how the data appears (bar charts can get a bit boring), but it is handy that you can decide whether each bar represents a day, week or month of data. There are no axis labels on the charts, which can make things a little hard to interpret – but if you swipe right so that the bar you are interested is at the edge of the screen, you can see its value in the little white ‘flag.’

It would be good to have 7 day rolling step total somewhere a bit more visible on the app like Fitbit

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JAWBONE UP24 Feedback

Now we get on to a little bit more of the feedback. The Jawbone timeline is awash with congratulatory panels that advise you when you’ve reached a certain goal, whether that’s short or long term. Here we see that one user has achieved a ’10 day streak’ (great for reinforcing self-efficacy) and another has managed 2.5 million steps since they started the programme.

Jawbone offers suggestions on how to learn from this feedback

“success as motivation to learn more about your own step routine”…we’d say that’s a nice bit of encouragement. However some of our users found there wassometimes a downside to being part of a team if the feedback you so desperately want refuses to show…

I found the info from Jawbone on what others my age are doing quite uplifting - I’m walking 16,000 steps more than your average fifty something

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JAWBONE UP24 Team

Team time! Just like Fitbit and Withings, Jawbone has a community function that lets you build up a group of supporting friends who can monitor your progress or challenge you to competitions. In fact, our analysis suggests that this is an area that many devices are investing time and energy to improve – new developments seem to be popping up every day.

In Jawbone you can view your friends in a list from A-Z, or (more effectively), see where they all sit on the leaderboard. If you are numero uno then there is every chance you’ll want to share this information with your fellow users. However if you are struggling (or just a bit of a wallflower), you can adjust your ‘Privacy & Sharing’ details through the ‘Help & Settings’ screen. The choice is yours – share everything (even your mood!) or remain a little more guarded. It’s a great example of personalisation, and evidence that Jawbone truly appreciates that users have different personalities and preferences.

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JAWBONE UP24 Inbox

As well as comments and ‘feelings’ appearing in your timeline from your teammates, they appear in your inbox too (inbox is accessed from ‘Home’ menu (slide 4)). Tapping on one takes you to the appropriate activity in your timeline.

And apart from appearing on your timeline, any comments or emoticons from teammates will also appear in your Inbox (which is accessed from the Home menu). As you’d expect, tapping on a congratulatory piece of information will take you straight to the corresponding activity in your timeline. That may drive some users towards success, but others found all this team talk a little too much to handle…

I wasn’t able to do any training, so I found the tracker pretty demoralising as I couldn’t log weights.

My team exceeding their goals just added to the negative here – rubbing my face in the fact that I wasn’t exercising

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JAWBONE UP24 Apps

So what about those add-on apps we mentioned earlier? Well with Jawbone you can build your own little ecosystem of health and wellness by connecting to a variety of 3rd party content. In fact, the device has the most exhaustive list of extras out of the four we reviewed, with the added nice touch that you can filter content by topic (e.g. ‘Fitness’ or ‘Food’) in order to more easily find what you’re looking for.

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JAWBONE UP24 Goals

Goooooaaaaallllll! Jawbone certainly lets you know when you’ve scored against one of your three targets – ‘Move’ (aka Steps), ‘Sleep’ and ‘Weight.’ For the first two of these there’s a handy ‘recommended’ zone, which you can decide to go for, or you can personalise your own goal. Our users liked the fact that they could compare their performance to the averages from the ‘UP’ community, but the slider function itself was a little clunky. Un-intuitively, the circle disappears when your weight is at target, and you can only bring it back by tapping ‘Edit Goal’ and then selecting whether to disable the goal, lose weight, maintain current weight or gain weight. If you choose to lose weight then you are clearly advised on the calorie deficit you need to achieve, as well as the number of weeks it would take at that rate to reach

the goal. And of course, this new calorie situation is then automatically reflected in the size of the green and yellow bars in your ‘Food and Drink’ display.

I love the Food Score…it’s how I lost 4lbs in just over two weeks. I knew exactly where I was and how much left I had to eat…a really simple but effective display

The Food Score is a great idea because it really makes you think about what you’re eating and what you have eaten…I had some surprises at the beginning that really made me think

Maintenance Weight loss

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JAWBONE UP24 Notifications and reminders

We’ve already touched on some of Jawbone’s fab personalisation touches (like the ability to adjust your ‘Privacy & Sharing’ settings). But the device also allows you to control the amount of automatic feedback you receive. For example you can set progress updates at intervals of 1,000 steps, and choose (to the nearest half hour) what time you want to receive your Moves summary. There is also the option to customise (through the device menu) the time of day you receive reminders, as well as the names of your workouts, medicines and meals. As you can see from the user comment below however, there is no such thing as too much personalisation…

A week at work when I was very busy, I found I was actually a bit depressed that I had no time to exercise and the Jawbone app was continually bugging me to be active. Maybe it needs an option where you take a data holiday in busy work weeks?

I think the vibration idle alert is such a clever idea. I’m sat at a desk for the majority of the day so I really appreciate the physical reminder to get out of my seat, as I don’t spend all day looking at my phone waiting for app notifications!

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JAWBONE UP24 Daily commitments

When it comes to Jawbone’s recommendations, we are in two minds. Sometimes the ‘Today I will...’ prompts are valuable and supportive, but at other times they seem to take things a little too far!

However it is certainly clever the way that Jawbone can identify a ‘problem’ and then set you a relevant challenge – for example when they realise you need to ‘eat more fiber.’

I really like the personalised tips... They do motivate me to try and keep my daily steps up

I really appreciated the idea behind the food challenges, but I feel like I have enough on my plate trying to do all my steps and eat the right number of calories!

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JAWBONE UP24 Insights

Now apart from tailored recommendations, Jawbone provides motivational insights that really seemed to resonate with our users – in fact, it’s what sets the device apart from the crowd. Some of these insights (like the one shown here), nicely summarise a user’s activity over the previous month. Others focus on different aspects, but all seem to be driven by the user’s data in some way or another (tick!), and are accompanied by a link to find out more (double tick!). Over the next few pages we will take a look the four categories of insights in more detail: Sleep (purple), Workout (Orange), Food & Drink (Green) and Mind (Yellow). We have to say, we find many of them rather intriguing and inspiring.

I was actually surprised to find the links that were included in the Jawbone tips often led to really interesting articles, I think the message stuck with me a bit more as there was a story behind it

I found the updates keep me motivated to try and ensure I stay way ahead of the average 50 something

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JAWBONE UP24 Insights – Sleep

First up, Sleep. A lot of the insights take a ‘Did you know?’ or ‘Try This’ format, providing you with a fact about the importance of slumber, advice on how to get more of it or tips on using the app. And as we mentioned above, each of these is accompanied by a tempting ‘Learn more’ or ‘Take Action’ link. However for our users, the most engaging insights belonged to the two more personalised categories: ‘A Closer Look’ and ‘Today I will.’ The former provide insights relating to your personal performance (e.g. an analysis of your recent sleep patterns) whilst the latter challenge you to take on a new goal or activity (e.g. tonight I’ll go to bed at half ten). Being able to opt in or out of the challenges (‘I WILL’ vs., ‘No thanks’ or ‘Not Today’) is a nice flexible touch.

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JAWBONE UP24 Insights – Activity

Now in the Workout category we have a great example of a ‘learn more’ insight. Yes, you might have been racking up the daily step count – but have you been making the most of those miles? The advice that you should perhaps ‘Pick Up the Pace’ is accompanied by a genuinely informative and meaningful ‘Learn More’ link – this time to a New York Times article on why a brisk walk is better than a stroll. This additional content gives credibility to the app and added value to the user: what’s not to love? The other highlight was an insight generated from a third party beauty app. The Estee Lauder LAB ‘Skin Hydration Challenge’ really drew in one of our reviewers (as young as he is wise), demonstrating once again that whilst steps matter, it’s often the thought of a better looking end result that keeps us motivated.

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JAWBONE UP24 Insights – Food

And so we move on to Food, or rather ‘Eat & Drink’. There are some great ‘Did you know?’ insights in this category, including one we saw that was mysteriously entitled ‘A Tall Toilet Tale.’ This was actually a myth busting insight, about the diuretic effects of coffee consumption. We also love the Fiber related ‘Today I will’ challenge. The level of personal detail they provide on your progress is pretty good – how much fibre you ate yesterday compared to the recommended amount for your age and gender. And of course, there’s always the option to take up the challenge tomorrow or to leave it for another day.

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JAWBONE UP24 Insights – Mind

Finally we have the Mind insights. These all take the ‘Did you know’ format (perhaps because anything more personalised might feel a little overtly psychological), but nevertheless the content is engaging. The ‘Learn More’ links take you to articles and videos designed to keep you motivated and on track. Our favourite insight is ‘Not Only the Number’, which reminds users that it’s not just the digits on the scales that count, but how your fitness regime is making you feel all around. And you can’t get much more insightful than that.

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MISFIT SHINE

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Well there’s something to be said for the old adage ‘style over substance.’ When it comes to Misfit Shine, we find a device that many would consider the most elegant available, though its behavior change potential leaves us wanting (we could only spot 15 techniques, or 22% of the total, during testing).

You can’t deny it, the contemporary, minimalistic visualisation of the data is a huge crowd pleaser (and none of our Apple fans would disagree), but there are a few improvements that could nudge it towards greater effectiveness.

I really like the way it displays your information, really modern, like what Apple might do

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Misfit Shine: 15 behaviour change techniques4 deployed

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Let’s start with what impressed our reviewers.

For the swimmers amongst you, Misfit Shine happens to be the only device waterproof up to 50 m – which is an attractive benefit for those pool addicts who are tired of having to manually upload their data.

And when it comes to goal setting and planning, Misfit Shine has it covered. Helpful guidance is given on how many Misfit points are needed to reach ‘kinda’, ‘pretty’, and ‘very’ active status in walking, running and swimming, plus the system remains flexible enough to allow users to adjust their goals in 100 point increments.

MISFIT SHINE Goal setting

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It’s simple. Increase your points goal, and Misfit Shine will automatically modify the work needed to achieve that goal – it might only take a 20 minute run to reach 700 points, but if you want to break a thousand then its clear to see you’re going to have to endure another ten on the treadmill. Effective huh?

Goals for sleep and weight can also be set in a similarly elegant fashion, but we’ll be getting on to those in a sec…

I especially liked achieving my goal before breakfast because I’d been to the gym on the way to work! But I know there are days when I could do better... and I’m actively trying to have less of those

MISFIT SHINE Goal adjustments

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Daily activity data is presented on an easy to read progress dial, with a prominent central display of current point status and what’s required to reach your goal. A light tap of the dial brings up step count, calories and kilometres – but for those of us primarily interested in these metrics, we feel there should be a default option to make this the main screen. Below the dial, the intensity of daily activity is presented as a timeline – with a trophy icon indicating when the goal has been achieved.

I actively check my fitness throughout the day and am keen to see how slight differences (e.g. route walked to the office) impacts the points achieved on the tracker

MISFIT SHINE Activity

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A smooth swipe of the screen reveals activity badges stamped with the time they happened. They’re editable, (but unfortunately only on that day) swimming, cycling, basketball, soccer or tennis – whatever you’ve been doing, you can see just how well you’ve been doing it.

After 2 days I found myself wanting to surpass the data from the previous day. On one Sunday I spent most of the day in the car and felt frustrated that I didn’t get anywhere near my usual point score

When a daily goal is achieved (e.g. 1,000 points), that nifty trophy icon reappears on the dashboard, once again stamped with the time it happened. So all in all you have a pretty neat sequence of badges to visually describe your day’s activity.

And if you’re linked up to MyFitnessPal, Misfit will also display, in dark blue, calorie status and calories consumed by meal. It’s a great perk, but we’re just not sure why this isn’t organised by time – our morning snacks normally come before lunch!

MISFIT SHINE Badges

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Talking of companion apps, if you’re a Runkeeper user then Misfit will kindly import that data so you can also see it on your dashboard. And that’s not all. Key milestones, such as lifetime kilometres and continuous day ‘streaks’ are displayed across the panel at the same time.

Tapping on each of these badges also provides a motivational message. So it’s clear to see why Misfit ticks so many boxes in the ‘feedback and monitoring’ category, however just like goal setting, this is pretty standard stuff for wearable tracking devices.

MISFIT SHINE Milestones

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So what happens when you tap that little calendar icon on the top left? Well to start with, your week-to-date activity and total Misfit points will appear in the progress dial (and you can tap that again to reveal steps, calories and kilometres). Below that you’ll find a graph comparing this week’s progress to your average (that’s the orange line vs. the grey line), and once again a handy green trophy marker lets you know whether or not you have reached your goal.

I enjoy comparing my activity from one day to the next. In particular, I enjoy looking at a working day vs the weekend and a gym day vs a day just at my desk. Seeing the differences in the level of my activity has motivated me to be more active and to get more exercise

A friendly swipe up reveals new goal and feedback goodies – this time you can view the number of goals you’ve ‘hit’ that week alongside a breakdown of achievement per day, and the percentage difference compared to your usual. 1% less active than last week? Must do better next time!

MISFIT SHINE Progress

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If all of that exertion has left you a little tired (it has us), then you’ll be glad to know that Misfit also takes care of your sleep patterns. It depicts night time activity much like its daytime counterpart, though now we have an alluring purple hue to remind us of last night’s dreamy slumber. Don’t be fooled by the prettiness however – each shade of violet corresponds to a depth of sleep, and how much quality shut eye you’ve managed to grab is depicted hanging down rather than rising up (other Apps take note).

I am particularly fascinated by the sleep information/movement as I am not conscious and it’s interesting to see how much I move about!

Want to tap that calendar icon? Of course you do, and your reward will be to see the week’s record of sleep. If your goal was to drift off for 7 hours, then this (in tasty turquoise) will appear alongside your actual data.

And they don’t just track the regular kind of sleep, but that coveted deep sleep as well – just take a look at that shaded line at the bottom. What’s more, if you tap on an individual day, you’re able to numerically quantify what percentage of your daily goal was achieved, and once again an attractive colour coding system will let you know whether you performed above or below expectations.

MISFIT SHINE Sleep

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Finally we get to that favourite (or not so favourite) topic – weight! Misfit Shine depicts this in their usual goal-orientated fashion – you see your current weight vs. what you dream to be (if only your metabolism behaved ;)). Once again, a simple line chart lets you quickly view monthly

progress against the chosen goal, and a swipe left lets the user see a day by day history. Not bad, but it would be great to also see 3 and 6 month progress on a single screen – in whatever shade of beautiful blue they so desire…

MISFIT SHINE Weight

Tracking weight was a nice feature, but I was actually keen to tone up, so it wasn’t really tracking what I was interested in

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WITHINGS PULSE O2

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If it’s true what they say about this being the era of big data, then Withings Pulse O2 is looking bang on trend. Analyzing digits and gushing over graphs may not be everybody’s cup of tea – but if it’s yours, then this is the device for you.

It seems our review panel contained a fair few ‘Quantified Selfers.’ For those people, data is king, so they just gobbled up the charts that Withings threw at them. And kept on throwing at them. For others, the numerical avalanche was a bit overwhelming. Either way, Withings was our second best scorer, employing 37% of the total behavior change techniques. How do they do it? A solid covering of the wearable tracking ‘standards’ (Goals & Planning and Feedback & Monitoring) alongside a spattering of ticks in the ‘Social Support’ and ‘Reward & Threat’ categories. Let’s see what our reviewers spotted…

Having used the watch I decided to buy the scales and blood pressure monitor - so it does encourage you to know more about your own health. Overall I’m loving it!

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Withings Pulse O2: 25 behaviour change techniques4 deployed

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When you join up to Withings Pulse O2, you actually join up to a whole world of monitoring excitement. The device itself tracks blood pressure, pulse and blood oxygen saturation, but by using the accompanying ‘Healthmate’ App to connect it to other devices (like scales), you can record and view a much wider range of information. This certainly differentiates it from the crowd.

Ready to delve into the data? Brace yourself… this stuff gets pretty complex, pretty quick, which is why it’s great that Withings gives you two different options to view your data at a glance. The beautiful summary dashboard (overleaf)and a much more technical (and we think fascinating) timeline.

The Timeline is Withings’ main data viewing screen. On the main screen you see today’s activity, including the % of steps you have left to complete, and your place on the leader board if you have buddied up with other users. Plus we find our first bar chart, a dark orange profile of your activity by the hour. Just below the main screen you have data for heart rate, sleep, weight and blood pressure – all time stamped for maximum accuracy. Start swiping up and you’ll enjoy a feast of data

– mini charts and summaries that build up to form a (very!) complete history of your days. And as a special treat, each Monday two extra panels are displayed – for ‘Weekly Sleep’ and ‘Weekly Steps.’

WITHINGS PULSE O2 Timeline

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If the timeline became too bogged down in charts and graphs for your liking, the dashboard view is sure to satisfy. Quantified Selfers might find the simplified info a little ‘light’, but for the rest of us the butterfly visual device is quite satisfying. The dashboard displays data for daily activity (orange), heart (green), sleep (blue) and weight (magenta). As you progress in each of the four areas, each ‘wing’ fills up with increasing ‘wellness’. The overall goal is to colour in all the wings – so can someone get this user a good night’s sleep please!

Tapping on the butterfly allows you to access a summary status for each of the four sections, and underneath the wings you can find connections to widgets and other third party apps. So if you’re a Runkeeper user you can see your weekly ‘Vigorous Activity’ and if you’ve bought the Withings Smart Scale you can see a history of ‘Air Quality.’ The current status of each wing is clearly visible, with a week view that let’s you compare your results to the previous week (greyed out in the background).

WITHINGS PULSE O2 Dashboard

I like the way the butterfly gives you an overall picture... I always click on each wing to see the commentary which always seems to be positive, perhaps too positive!

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Back to the timeline where we can access the most interesting and detailed data. Firstly to activity which is always displayed on top. A gentle tap on the graph and the full screen version appears – this time the bar chart is shaded to show activity intensity, a bit like Fitbit (but with less differentiation).

WITHINGS PULSE O2 Activity

It’s a shame that it only tracks steps - any swimming or activity in water can’t be tracked directly

Want to check how you’re doing so far this week? Click on the three circles in the top right to see the activity of the past few days in red, and of the entire last week in grey. A cumulative total of your weekly steps appears below, together with elevation climbed, distance, and both active and total calories. A bright blue number lets you know how many times this week you’ve achieved your daily goal. Our reviewers (especially the data driven males amongst them), thought they’d died and gone to heaven!

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Not enough detail for you? Well don’t worry! Pick a panel, any panel, and a quick tap will reveal even more data. Take heart rate for example - the blue band represents the normal range and the green outer circles represent peripheral capillary oxygen saturation (uh-huh). The first cool thing to notice is that the Healthmate app can measure pulse via your phone’s camera light (see overleaf). Neat huh? If you prefer, you can measure using

the device (though it can be a bit of a pain to remove it from its strap) or the Withings Blood Pressure Monitor – either way you’ll be presented with a vast range of display options. And when you are in the ‘all data’ mode, tapping on an individual point will bring up your heart rate and SpO2. Yep, we know. The Quantified Selfer’s dream.

WITHINGS PULSE O2 Heart rate

SPO2 HEART RATE

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WITHINGS PULSE O2 Heart rate

I prefer to measure my heart rate using my iPhone... it’s a really neat feature, much more convenient than taking the device out of its strap and clicking through to activate the monitor

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WITHINGS PULSE O2 Blood pressure

What about blood pressure? Same deal here really – all the stats you can cram in your head. Select different time periods to view different data permutations and tap a time point to show systolic and diastolic blood pressure as well as heart rate at a particular measured moment.

And of course, if you want to concentrate on a certain time of the day, you can chose to display only morning or evening data. Finally you can ping those numbers over to your doctor (or any other interested party) by a quick click to email.

I like the blood pressure monitor...

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WITHINGS PULSE O2 Weight, fat mass, BMI

Time to get heavy. Weight, fat mass and BMI can all be viewed over various time scales and the cleverly flexible graphs auto-adjust each time, maximising visibility (as well as the geek factor). 

If you want to check your weight is in an acceptable range, a blue ‘normal’ area can be toggled on and off. And to interact with more time specific data, just tap on a point to reveal weight and BMI. It’s great that you can set a weight

goal, but at the same time it makes us realise – what other goals can you control? Unlike other devices, you can’t input an individual step target, which seems a little, well, impersonal if you ask us.

I like the way the graph adjusts automatically... you can see everything you want to see and all the detail

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I love the way you can browse through your data to see how far you’ve come... makes me feel good about myself!

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Starting to snore with all this data? Well we bet the Quantified Selfers out there are wide awake. Here we have a colour coded summary of your previous night’s sleep – light, deep and awake – and once again the data dictators have provided extra stats including the number of hours slept, total time in bed and time taken to fall asleep. A click on the three circles allows you to view the current week (in blue) vs. the previous (in grey). But it is here that a couple of niggling complaints worm their way in. Our users couldn’t find a way to manually enter sleep, and the 8 hour goal is automatically set by Withings – once again suggesting that with goal setting in general, this device starts to lose some ground.

WITHINGS PULSE O2 Sleep

I don’t know why they don’t allow you to enter your sleep if you forget to set your device. You should be able to enter it manually and it should highlight that it is a manual entry... it’s really frustrating when you forget

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As we said upfront, Withings does tick a lot of boxes when it comes to feedback and monitoring. Not only does the Healthmate App let you know how you’re doing through activity insights, but it gives you the opportunity to respond and assess the accuracy of their advice. Insights can be positive or negative, but it was the former that had the most motivating impact on users (though as one reviewer rightly pointed out, there are always limits to artificial intelligence).

WITHINGS PULSE O2 Feedback

I really like the way the ‘Did you know’ tells you how you compare to all HealthMate users... being in the top 0.2% really motivated me

The way it said with only 11,693 steps it’s the least active you’ve been, together with a frowning smiley isn’t that intelligent is it? It should have said something like, ‘well done for exceeding the recommended 10,000 but not quite up to your usual par’ with a puzzled smiley. I felt that I’d caught the app out!

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WITHINGS PULSE O2 Feedback

One day I didn’t sync my tracker I got a pretty motivation-crushing message, which actually made me want to throw it in the bin!

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Badges are a key feature of Healthmate feedback and one that appealed to a number users. In fact many people wanted to know via their smartphone which badge was coming next, and were disappointed to find that this feature is only available on the desktop version. Wearable app developers take note – people just love a reward, even if it’s a virtual one.

WITHINGS PULSE O2 Badges

I only wish I knew what I had to do to get the next badge

I love getting a badge, it makes me feel as though I’ve achieved something

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WITHINGS PULSE O2 Badges

They’re nice and colourful, puts you in a positive mood. Often I’ll click through on the learn more or discover in pictures... is that sad?

DAILY STEPS LIFETIME DISTANCE LIFETIME ELEVATION

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Apart from blowing the competition out of the water when it comes to data provision, Withings also does an excellent job with it’s system of reminders. Gentle nudges and motivational pick-me-ups appear on the smartphone notification screen – which is nice, but the info felt a little dated. Our advice to Withings? Make the content less retrospective, and consider prompting actions at certain times based on learning from a user’s behavior.

Reminders also appear in the app itself, this time in full colour glory. Reviewers found them a great aid – they assist in habit formation and provide ideas for behavioral substitution. The best bit is that you can tailor them – by clicking on ‘Add a new reminder’ you can choose from 19 reminders organised into the 4 categories (weight, activity, heart and sleep).

By clicking on the reminder you can adjust its settings, deciding which days of the week and at what time you want the message to appear. A brief overview of the reminder is provided alongside tips on when to schedule it – for example you don’t want to be promoted to ‘Make calls while walking’ at a time when you know you’ll be in a hurry! It’s great that you can set different timed reminders for each day of the week, but from a behavioral change point of view what we really want is to take the concept one step further – by allowing users to create their own reminders based on implementation intentions (e.g. If you take a walk this afternoon, you’ll be able to have that glass of wine after work.)

Saying all that, when the reminders are set and summarised they do look quite fabulous. Colour coding makes it easy to see the category of reminder you have set up, and its great that you can have separate prompts for weekdays and lazy weekends.

WITHINGS PULSE O2 Reminders

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WEIGHT

WITHINGS PULSE O2 Reminders

ACTIVITY

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WITHINGS PULSE O2 Reminders

SLEEP HEART

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WITHINGS PULSE O2 Help centre

So what other tricks have our data divas got up their sleeve? Well the help centre is a nice support functionality, providing users with answers to every question they could possibly think of (though we still want to know why we can’t set more goals please!). The information is certainly comprehensive, but it could be made more prominent by putting it alongside the Timeline and Dashboard as one of the main app offerings.

I’ve only just come across the help centre which is actually really good in a lot of places... wish I’d seen it two weeks ago at the beginning

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Less driven by data, more by a yearning for first place? For the competitive users, Withings’ leaderboard proved to be an addictive add-on. You can invite friends to form a group, and then compare and contrast progress between you (i.e. check out who’s winning). Your can see how you’re performing at any time, with a handy summary provided at the end of each week.  Not only that but the feature will appeal to those Facebook ‘pokers’ amongst you. By tapping on a friend’s name you can cheer, taunt or simply message them. These notifications will then form (a hopefully motivational!) part of your friend’s timeline.

It’s a nice extra, but we have to say that other devices are doing it better. There is no automatic commentary on the progress of others – you only find out how well they are doing if one of you overtakes the other. It also would be great to see Withings include an option for competing against weight loss goals, or calorie intake vs. outtake on a weekly scale.

WITHINGS PULSE O2 Leaderboard

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COLOPHON

Writers: David Davenport-Firth

Lexi Fletcher

Matt Balogh

Ritesh Patel

Simon Stebbing

Design: Chris Chappell (Creative Director)

John Green (Art Director)

Angel Zhang (Illustrator)

No article may be reproduced or transmitted in any form without the written permission of the publisher.Copyright © 2015 Ogilvy CommonHealth Worldwide

For more information please contact: wearablepublichealth@ogilvy.com

Editor: Rebecca Salama

Sub-editor: Paul Williams