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Digital Nudging to Influence Health Behavior

In last month’s Direct Connection, we discussed the importance of identifying the right individual for healthcare support through the use of person-generated health data (PGHD). But after identifying the individuals through the accurate assessment of measures that matter to them, how can they be activated to take the desired action? Increasingly, behavioral economics is being applied to health. Nudging is aimed at influencing a predictable behavior that is beneficial to the individual, while respecting the individual’s own preferences and freedom of choice. 

To accomplish this, individuals must be offered a tailored experience to encourage engagement with the information they generate or are provided, and motivated to pursue evidence-based action with as little friction as possible. Digital technologies are being shown to facilitate these desired behaviors.


A group of researchers at Weill Cornell Medicine in the United States conducted a meta-analysis of digital mental health apps for depression and/or anxiety in an effort to understand which features increase sustained engagement with the apps. Based on the analysis of 25 studies involving over 4,000 participants, they found that apps that used a greater number of engagement features showed larger clinical effects. They concluded that incorporating elements of social support and principles of behavioral economics may be particularly promising and the most likely way to engage patients suffering from mental health issues.

Interestingly, in a randomized clinical trial that draws from behavioral economics, it was found that incentive structures such as financial gains, affects physical activity when incentives are offered. This structure is applied in Evidation’s Achievement app through financial incentives. The behavioral economics of financial incentives in apps specifically is a growing field as illustrated by Harvard Business School Working Paper here

In a separate review, funded by the National Heart, Lung and Blood Institute, researchers compared self-monitoring approaches in overweight or obese adults across 39 randomized controlled trials with over 8,000 participants. In this group of individuals, they found that engagement was higher with individuals who self-monitored via digital versus paper-based methods, and that passive (e.g. via sensors and wearable devices) resulted in higher engagement than more active forms of self-monitoring. In addition, they found that more frequent self-monitoring via digital health tools led to greater weight loss in behavioral obesity treatment.

A team of researchers in the UK recently reported on the RESCUE trial, a small feasibility study in 41 participants following an exacerbation of COPD, comparing app-supported care versus usual care. Despite experiencing a significant clinical event, 85% of the participants randomized to the app-support group chose to download the app. The digital application was found to be acceptable to patients in this care setting, improved the inhaler technique,  and was associated with detectable signals of improvement in disease control.

Other Good Reads:

Nudging to Change: Using Behavioral Economics Theory to Move People and Their Health Care Partners Toward Effective Type 2 Diabetes Prevention | Diabetes Spectrum

Development of digital measures for nighttime scratch and sleep using wrist-worn wearable devices | npj Digital Medicine

A novel digital approach to describe real world outcomes among patients with constipation | npj Digital Medicine

Apple, University of Michigan share first results from Apple Hearing Study | mobihealthnews

Aura receives first of its kind European CE mark for early detection of COVID-19 | Empatica

Digital Health Consumer Adoption Report 2020 | Rock Health

The Biggest Wearable Technology Trends In 2021 | Forbes

What we’ve been up to:

Announcements: We are thrilled to announce our $153M Series E funding round, which will allow us to rapidly expand virtual health programs on our Achievement platform, providing personalized, evidence-supported guidance to motivate and empower individuals to manage their health and conditions. This focus on virtual health management and returning insights to patients is a natural extension of our established expertise in conducting research for biopharma companies. We are excited to use this funding to develop tools designed to return insights back to individuals. Read more about the announcement here, also featured in Bloomberg here

At Evidation Health, we put individuals first, challenge each other and state good intent, and go fast while maintaining quality and integrity. We are honored to be recognized in Forbes’ Best Startup Employers 2021 here

Research: In partnership with Sanofi, we conducted the first study to explore the everyday impact of constipation, a commonly overlooked condition, quantifying symptoms, behaviors, and medication usage. Through our connected population, Achievement, we recruited over 1,500 individuals with lower gut health issues. Our work with Sanofi is another example of how person-generated health data (PGHD) can be used to develop outcomes and messages that matter to patients, and can get patients on the right treatment faster. Read more about the key findings in npj Digital Medicine here

In partnership with Omada Health, we invited participants from our connected platform Achievement, to help Omada’s research team evaluate the impact of a digital diabetes self-management education and support (DSMES) program on hemoglobin A1C for people living with type 2 diabetes. Early evidence shows that a digitally enhanced DSMES program improves HbA1C and disease self-management outcomes. This study highlights how person-generated health data (PGHD) can be leveraged to engage and support individuals in developing their disease self-management skills. Read more about the study on JMIR Publications here

In collaboration with authors from Digital Medicine Society (DiMe) and Takeda, we published an article that highlights the processes and key concepts of developing and validating digital measures. To support the successful adoption of digital measures into internal decision making and evidence generation for medical product development, this article presents a unified lexicon that highlights the steps of bringing a successful proof of concept to scale. Read more about the key takeaways and use cases of trailblazing digital measures and patient engagement in the field on Karger Digital Biomarkers here

Thought Leadership: Leveraging person-generated health data (PGHD) and technology can more effectively manage heart health conditions. We recently hosted a webinar on the Achievement for Heart Health partnership with the American College of Cardiology and how remote patient monitoring and digital health programs can build a new, better system of patient care with our panel of experts, John S. Rumsfeld, MD, PhD (American College of Cardiology), Kalahn A. Taylor-Clark, PhD, MPH (Sanofi), and Mikki Nasch (Evidation). Moderator, Bray Patrick-Lake, MFS, summarizes the rich discussion the panel had here.


Further reading