Welcome to the Behavioral Sun Podcast.
My name is Samuel Salzer. I'm here with my Co host, Eileen
Holsworth. Hey, Lynn.
Hi. Hi.
Hey. So I thought we could start
before getting into the guests of the episode to talk about
something that I feel like has been kind of emerging.
I don't know when it started, but I started seeing this
article basically declaring you know the death of user research,
the death of the end of UX, the end of XYZ, end of the sign
thinking. Did you notice these articles as
well? Oh yeah, and and of course all
of these declarations are coinciding with the massive
layoffs in in these fields, right?
With with UX being I think maybe the the largest largest.
Sort of sub field of of layoffs in the past year, a couple of
years and then of course with IDO recently laying off so much
of its workforce. Yeah, that does seem to be at
least the conclusion of the media that that these fields are
diminished or or disappearing. Yeah.
And also this kind of interesting some sort of like
introspection as well within the fields because I think going
back previously there's been this tendency before in in
previous kind of financial downturns where you know, a
company looks at kind of like OK, should we fire the sales
people or should we fire kind of the the sign, UX sign people or
so on and then they're like. Well, which one more directly
contributes to revenue or the programmers or you know,
Excellency. So it's kind of an
understandable thing to maybe you think about like, OK, do we
really use research if we have to cut something, like maybe
that's what we should cut. If you're a company that seems
to be in some ways a mental model that a company has had,
companies has had for a while. But what is happening, you know,
I feel like it's reserved. There's some some interesting
questions and potential criticism as well, some
limitations and so on. I feel like you you found
something there as well that you share with me an article with
some some criticism as well. Yeah I think there's there's
plenty of of valid criticism and I'd love to get into that.
But I but I also at the same time feel like there is a
tendency in hard times to really sacrifice any sort of long term
work towards improving products for for short term Really really
kind of short sighted means right in in terms of you know,
how do we stay afloat in the next.
Every month or or or even a year but in the long term you like
that's really a not very good way to go.
But you know on the other hand as you pointed out there are
plenty of problems with with any of these fields and you know
it's it's you can talk about UX, you can talk about design
thinking, you can talk about all the other sort of human oriented
practices that kind of fall into the same category.
But what? No.
Yeah. No.
I mean, behavioral science has, has been on the chopping block
as well. I know it's not that easy for
behavioral scientists to get jobs right now.
And I think the large part of that is that people, so, so many
people have different definitions of what behavioral
science is and people disagree on on on what it is and maybe
don't see the value as much. Yeah, unfortunately, yeah, for
sure. So I think.
I think the the criticism falls into a few different categories.
And specifically, if you think about design thinking, one of
the major areas of this is is this idea of empathy over
expertise. So this idea that you as a
designer can basically from going from nothing, with a
beginner's mindset, can approach a problem and say, well, let me
let me think. Really hard about this problem.
Maybe talk to a couple people but mostly just just sort of
brainstorm on post its and and you know like like let the let
the creative genius inside of you figure out how to solve this
problem and going into a problem without knowing anything about
it and without really really talking to anyone any of any of
the the people who are affected by that problem and not really
looking into the research that's already been done.
And with that, that seems like a something that is just bound to
fail. Yeah.
And I guess like in some ways what you illustrate is maybe the
straw man. Maybe in some ways I guess you
could like even if you based on what you said, like even if you
then also had like let's say in this setting like traditionally
like a focus group or any user interviews and maybe some type
of like ethnography or like kind of following users along or
doing something like that to kind of further collect data.
I guess it could still. You can still argue that that
data combined with that kind of idea of empathy could still
leave you with a lot of missing pieces in terms of, yeah,
explaining what causes the behaviour to happen.
Yeah, I I think. I think some of these these
methods can sometimes get you at what is really just a
superficial understanding of users and their behaviour and
their context and and really the complex.
Systems that are at play, especially when you think about
some of these entrenched norms and and cultural expectations
that are have, you know, go back for many, many years.
These are not things that you can understand in very quick and
simple ways, which I think is the hope and maybe the false
promise of some of these methods where you just kind of jump into
a problem and understand it, try and understand everything about
it, and then throw out some solutions and then you know
you're out, right? Yeah, Also kind of like the lack
of experimental tests was it as well?
From a behavioral science perspective.
A huge gap in in many of these these design design practices is
you know, you might see some sort of prototyping and
presenting a solution to users and say hey do you like it,
would this be good? But you know, not so much
rigorous experimental testing or trying to understand well like
what are the what is the actual outcome if we compare version A
against version B. But I think even beyond the the
lack of experimenting are if we were to to present this idea of
empathy to one of our past guests, Paul Bloom.
He's actually written extensively on empathy.
He has a a book called Against Empathy.
And one of the the main themes of that book is the idea that,
like, we're not, we can pretend to empathize with others, but
actually as a species, we're not very good at it.
Yeah, I guess it's the question then is like Ellen, do you think
it is true or do you think that this is this is the end of the
same thinking like this is the end of of this or how do you
think about this kind of in the current state of things?
No, I don't think, I don't think that's the case.
I think that you know, sure you can say there are problems with
with any particular approach, but I also think that often in
the media you you can, they can take this more sensationalist,
almost doomsday perspective, right?
Where you know that you try and you try and take down design
thinking with with one article and say, well, let's just
discard you know that the entire, the entire field.
That doesn't seem fair to me. You know, you see some of the
same things having happening with behavioral science.
But the answer is certainly not that the world is better
without. You know, design thinking
without behavioral science and so on.
I think the solution, and I feel very strongly about this, the
solution is to fix what isn't working right, not to get rid of
it all. And maybe as as our our guest
today really makes a case for maybe the solution, partially at
least, is combining these approaches, right.
So you don't have design thinking on its own, and you
don't have behavioral science on its own, but you can actually
merge these qualitative and quantitative methods.
You know we can we can work on the the problems where there are
problems and and try and try and fill those gaps, but really to
to better design patient experiences.
For example, Arthy makes a case for really combining, combining
these methods and in particular marrying, design thinking and
behavioral science together. Yeah.
And for me, I think that's such an important take away here is
that I I had a presentation, this was a few years ago.
But basically trying to compare this like what is a someone
coming for more from the behavioral science side of
things versus someone from maybe more of the design thinking side
of things. When they do use the research,
what do they do similarly or differently?
And I use this kind of metaphor of that like whenever we do use
the research, we're kind of like stumbling in darkness.
There's so much in the context that we're trying to kind of
make sense of it. It's like it's kind of a big
darkness initially and we're trying to like pick at things to
understand like what's going on. And I can't use this like old.
I think the allegory of sort or metaphor or story of this, like
blind man walking along a trail and then you know they sum up on
something And one person, one of the men says, oh, I I think it's
it's a, it's a tree. And then the next person says,
oh, I think it's a rope. And then the third person
screams like, oh, I think it's a snake.
But obviously what they fail to realize is that this is an
elephant. It's they're all touching the
same elephant, but one is touching the trunk and one is
touching the tail and and so on. And I feel like that's kind of
the the big risk we have if we're like too staunch, like too
stubborn in in coming from like one of the lenses of sort of
trying to understand the problem is that we're we used to become
one of the blind Mens where we we think we've found something.
We think it's like, oh, it's a, it's a snake, whatever.
Yeah, we're we're deciding for that snake.
But actually if we had combined our expertise with kind of in
the case of this, you know, combining mixed method approach,
understanding the behavioural, attitudinal, qualitative,
quantitative types of insights, mixing that likelier we might
actually understand what's going on, like what is the thing we're
we're kind of approaching this darkness of, of trying to
understand user behaviour. Beautiful.
Yeah. So I don't know, this is maybe a
primer in terms of thinking about this stuff.
But obviously now we're going to jump in to talk with Arthy and
so do you want to introduce Arthy?
Yeah. Yeah.
Let's introduce our our guest Aarti Rao.
So Arthy leads Behavioral Insights at City Block Health as
their Vice President of Behavioral Insights and
Strategic Engagement Innovation. And before that, she founded the
Design and Innovation lab at CVS Health.
So as with all of our guests, very impressive.
And she's had quite a bit of success at City Block merging
human centered practices like design thinking and behavioral
science. Yeah, so very much on the topic
of what we have kind of started talking about here.
And in episode we dive deeper into this.
We talk about how to reach hard reach communities.
We kind of explore a very interesting product, deep dive
and yeah, much, much interesting stuff.
But we also want to hear from you as well, this discussion
about the end of various disciplines or how to make sense
of the landscape that we're currently in.
It's super interesting to hear what you think.
So you can always reach us and tell us what you think via
podcast at haveaweekly.com. So feel free to reach out there.
But now it's time to start episode.
So cutie music welcome to another episode of
Behavioral Design podcast. And I'm really excited to say
welcome Aarthi Rao. Thanks for having me.
I'm excited to talk to you both. Yeah, really great to have you
here. Yeah.
And we do this thing where we kind of jump in feet first.
And given that we're really interested in understanding the
applied side of behavioral science.
And the first question is usually what is your most
favorite or hated applied or behavioral design in the wild
example that you can think of what what sticks out in your
mind as kind of a good, a really bad showcase of putting
behavioral science to practice. The fun, fun question, maybe
I'll start with the good over the bad.
I think for me my favorite examples probably reflecting
kind of to your point, my applied sort of business
background are things that are addressing the behavior, but
also just delightful sort of like customer member patient
experiences that give. Value to the actual user that
something's targeting and that are also sort of ROI positive
and scalable and will last at scale for a while.
And so with that in mind, a couple of the things that I
think are particularly good examples that have given me a
lot of energy. One is from the financial space.
I think what's been really cool to watch over the past, I think
it's been a couple of years now that this has been happening at
scale are these sort of robo index funds that make it really
easy for people who are not familiar with investing, not
familiar with stocks to put a little bit of their money into
the stock market and actually see and experience some growth
and kind of make that whole process.
Less intimidating? Less frightening.
Are you talking about Robin Hood?
Not not Robin Hood. I'd say the lower stakes,
friendlier ones, but things that just feel like I think like Ally
Bank has a great a great interface for this, But you
know, they help you understand your own risk preferences like.
Introduce you to what are the basics of doing this and then
just make it very simple to put in a little bit of money and
watch it sort of move over time. But in in very stable sort of
like index funds and things that don't have a terrible amount of
risk attached to them. And I think it's great because
it's sort of taking friction out of that experience.
It's very scalable. It's last.
It's the lasting kind of application.
And then it lets people have sort of a entry point into that
experience. They might go deeper and get
into it and sort of learn more about it, or they might just get
an extra couple percentage points of interest over what
they might otherwise have in a savings account.
But driving a lot, I think of good impact for folks.
Then if I'm allowed, can I can I add something to that?
Because I think it's a great example.
Yeah, quickly I just add, so it's one thing that I think is
my favorite part of that. It's also that as this kind of
like friction of once you put money into that account for
example, it's much harder to kind of move it back usually to
kind of your spending account. So it's it's much also better
protected from you kind of like should I buy a new you know
express machine or something. So I.
Like a camouflaged saving account?
Yeah. So it's a great example.
Totally. OK.
I have I have a question that that pops up as you share this,
as you share this example. I'm wondering if having that
access to or having that experience with in a low stakes
environment and seeing your money grow could actually have
an effect on your risk appetite or your risk tolerance and
actually encourage you to to go further and further as you see
like oh look, I'm magically making money.
Maybe I should put everything over here because my money in my
actual. Savings account isn't
accumulating much interest. Do you, have you seen anything
like that or do you feel like that might happen?
I guess, I guess it's a potential risk.
I haven't, I mean this is very anecdotal because I don't work
in the financial services thing from the focus.
I know who've kind of gone through those experiences.
I haven't sort of seen like a sudden change.
But I think that's also why it's nice that they have those sort
of assessments that help you understand your own risk
preferences because there are sort of like quizzes or
structured questions that help you think about what's important
to you, like what's the time frame that's most important to
you. So typically I think it won't
let you change those preferences without taking that kind of like
assessment quiz experience again.
Which would hopefully like jostle you out of any like short
term lately less well thought out decision making.
But yeah I could I could see that being a risk for sure.
We can always refer to as well we had Dan Egan who is I think
VP of Behavioral Science or Behavioral Finance that
betterment on the podcast before and so we can maybe forward that
question to him as well if you want, but that's a great
example. Did you have another good or bad
example that you want to share? And I'm allowed to share too.
I have one other good example, this one a little bit more drawn
from my personal experience from CVS when we were rolling out the
COVID vaccine sort of much earlier on in the pandemic's
trajectory when it was still limited eligibility Phase one
sort of just targeting. At risk folks and seniors.
But we were just doing a lot of thinking about like what is the
messaging, what is the approach, sort of the program design
intervention strategy that's going to drive the most uptake
for the right populations given the limited supply and sort of
all the different eligibility constraints that were in place
at the time. And one of the cool things that
we realized is that one way to help seniors access the vaccine
was to actually target outreach and messaging.
To younger folks. So people who are likely to be
grandkids neighbors to seniors have sort of seniors in their
social network who are actually very very far from being
eligible for the vaccine in the near term.
But really just a call to action to help help your neighbors,
help your grandparents like access the right websites,
register and then potentially like help them get to the
appointment if needed and. It was cool because I think it
really brought together understanding like what's that,
what's the experience of the senior, what are their pain
points. But then how do you like design
a solution in a very, very constrained time frame that's
going to actually be effective for some of their digital
barriers, knowing we didn't have a ton of time to design like
other ways to register and access and schedule.
So that's just like another cool example I think of like bringing
together. They're sort of like delightful
customer value driving experiences with sort of core
underlying understanding of what's going to cause friction
and a behavior. Yeah.
And I like the combo of, you know, as you say it reduces
friction and and helps overcome those barriers, but also
increases probably motivation because you suddenly have some
form of like social accountability or social support
in in doing that as well. So it's like a yeah, a really
nice intervention, I think. I bet it even increased
motivation among the younger folks who may have been on the
fence. But after going through that
process of, like waiting on the phone for hours and hours and
seeing like, you know, how in demand the vaccine was in order
to get one for grandma and grandpa, now they're they're
more, they're more likely to get it themselves, too.
I love that. Yeah, that That's a really cool
sort of. Example of an indirect
application. I feel like like that sort of
creativity is sometimes lacking in the world, but I love that.
I love that you did that. Awesome, cool.
So I I think we should go ahead and get to our our sort of key
question of our podcast. A lot of what we talk about is
sort of hinged on the the product and you know we're very
much about, you know, how do we use behavioral science to
improve. Products in general and and for
you we've chosen a a specific one and and we thought that your
background and experience might might speak to having some some
more creative solutions to to think about how you might design
this thing how you would improve it using both you know methods
and also findings from behavioral science and and of
course your your product is the pill bottle so we'd love to hear
how you might use use these behavioral design methods to
actually. Like, you know, if you could
overhaul the pill bottle to make it, you know, more more likely
for people to take their medication, for example, that's
probably the one behavior that we're looking for with a pill
bottle. What would you do?
How would you think through this this whole thing?
Yeah, I can add like that it's important to.
I think if you're not in this conditional health realm, you
might understand how low medical adherence or like medicine is.
And even for situations where people really, really need to
take their pills, they still don't always do it.
And so, So it's very important also like context and
intervention, yeah. Yeah, absolutely.
I'm probably butchering the stat, but I think it's something
like 50% of people will not take a medication as prescribed and
those are folks who have at least started medication.
There's a huge drop off between what's actually prescribed and
what actually what actually gets picked up for the first time.
It's a hugely important problem, very exciting question because
I've spent way too many years of my life narrowly thinking about
medication adherence. Good.
I have a lot of ideas on how to strengthen the pill bottle.
I will. I will caveat this in like a
non. This is a no constraint answer,
so assuming that there's ways to do all of this cost effectively
and scalably would. Love to really think about how
do you introduce design choices in that model that get at sort
of the many different fall off points when it comes to
medication adherence. So there's things like the
forgetfulness, reminders is kind of the most obvious chunk that
people often think about, but there's a lot of other drivers.
So there's side effects and sort of saliency drug interactions
just like making it. Available to you like How do you
get supply in your hands at the right times?
Really easily making things discreet and also finding ways
to bundle medications, given that a lot of folks managing
chronic disease have to take multiple medications together.
And so I have ideas on all of those things I think remind.
Let's do it. Again, I'm probably gonna end up
with a $50 pill bottle at the end of.
We have all the money in the world.
It doesn't matter. We don't have to worry about it.
But I think so. Reminders is probably the most
straightforward one, if there's some way.
In the bottle designed to actually visually cue if you
haven't taken a medication that or it's like pending.
So it could be a color or sort of some other thing that changes
on the bottle that gives you sort of that nudge, that
reminder that you actually need to take the medication.
Can I can I think about in terms of that how do you think about
overcoming this kind of reminder to feel not a nagging reminder
but kind of a. Because obviously it can be
perceived in as a nagging way of like, oh, it's kind of like I'm
being reminded to do something but you might forget why they're
supposed to do it and actually the reminders are helpful
reminders, like actually they're to potentially save their life.
Do you have any thoughts on how how that can be incorporated
someone? Definitely.
I think one important thing with the reminders is to actually
make it subtle. So more of something on the like
a on the bottle that. So like, if you glance at it, if
since let's say you have it in a prominent place, you sort of
know like, oh, it's red. Like, I'm going to make that
mental leap that I've forgotten to open it today.
But one thing that's actually not super effective is texting
someone like 3 * a day to tell them to take something.
Or like making it really in your face.
That actually might be helpful for the first few days that
someone's starting a medication just to, like, reset a routine.
But you're quickly going to tune it out like very overbearing.
And it's like who is this random, whether it's your
pharmacy, your doctor, your Bell ball company, Like who is this
random entity trying to harass you on a daily basis?
I do think sort of the the next bucket of impact on adherence is
that building, understanding, making information salient and
relevant to you. So to your point, like a lot of
folks actually don't know why they're on a medication.
Their doctor might have told them at one point, their
pharmacist might have told them at one point.
But if you think about the experience of a 15 minute
doctor's appointment, like they tend to be pretty rash, like
information isn't sticking. If you're on multiple
medications, it can easily get confusing, like they look
identical. So what is this one doing versus
that one? And so ways to make information
about your medication salient in the right moment, I think will
actually drive a significant amount of impact on behavior.
So if you can explain if you can scan AQR code on that model, or
you know you could, you can make it very tech forward like launch
an AR experience when you scan that model, but provide like 2
minutes worth of content that just reminds people.
This is what this medication is like.
This is what it's for. This is what it does in your
body. And like, hey, these couple of
side effects are expected. Here's some like OTC approaches
or other approaches to address those side effects.
That's going to be really helpful because you want that
information. In the moment that someone's
thinking about their medication, they're not going to go back to
a pamphlet they were handed. They're not going to call their
pharmacist. They're not going to call their
doctor and ask those questions. But if you can make it really
easy in the context of interacting with that bottle to
see like a quick spiel about those questions, I do think like
that would be that would be much more impactful than a reminder
in isolation, Yeah. And it's kind of the idea of I
guess nudging folks will call that like boosting in a way as
well where you're kind of not only trying to, you know be
fraternalistic in in, you know, you should do this thing, but
actually supporting people and better understanding why they
should do it and have that information and turning that
into knowledge and. And yeah.
Definitely, and ideally that video or audio script or
whatever it is pops up in your language that you're most
comfortable with, because I think that's the other fall off.
Point is, you're often having English mediated appointments,
but that may or may not be your first.
Language. It made that be the language
that it's easiest for you to consume health information in.
I'm imagining now because we said, like, no budget for this,
this kind of Blade Runner esque avatar that just comes up, you
know, from your bottle and speaks to you.
But yeah, Ali, what were you going to say?
Yeah. Well I I think it it also should
be the the information has to be specific to you.
So if you think about the same drug is prescribed for all
different kinds of conditions sometimes it could, it could be
very confusing to hear the general spiel of especially if
you're kind of a a sort of off use indication that that could
really throw you off. But since we have an unlimited
budget that would be no problem to personalize it that
specifically. OK, so we have.
Reminders. We have personalized information
that's very convenient about the medication.
What were What were our other categories?
I think my next big one would be making it easy to help people
avoid drug interactions. So that's another thing.
Your doctor probably warned you about it.
Your pharmacist probably warned you about it.
If you're taking a medication over years, like hard to keep
that information top of mind. So, you know, I think they're,
again, expensive ways to to help make that experience easier.
If you could actually add some sort of functionality to a
bottle where if you were to put it next to a bottle of an OTC
medication or another prescription medication, where
there would be an interaction and that could sort of give off
some kind of cue. In this case, it might actually
be appropriate to send a text message ping or an app nudge to
a phone because it is a more sort of like urgent imminent
risk that you want to make folks aware of.
And it's a one time not repetitive risk that could help
people just manage those interactions better because
again, it's not something that's top of mind to you and then in
an everyday way. So if there, I think there are
sort of tech based solutions to that that could just make it
easier for folks who are managing a lot of different
medications to to avoid those interactions stay safe.
And again, it could at least be a call or reminder for them to
at least check in with their pharmacist or check in with
their provider to see if they if they can make those choices.
Would you extend this also to certain foods that have
interactions? Like if someone is about to eat
a grapefruit but we know that they like that interacts with
their blood. I forget which one it is.
I think it's blood thinners like are not as yeah, great, like
someone's about to eat a grapefruit and your like phone
starts like jangling. Stop.
Put the spoon down. Yeah, that's like the next
level. Start with the meds.
But yeah, if you can pull in those food interactions, then
you get pulled in. Awesome.
And then I think there's sort of the, again just to make it easy,
so having access to enough supply at the right time and not
having to think about it has a pretty big impact on adherence.
So the bottles like smart or connected device in some way and
can just initiate a refill without you having to do
anything and then that refill quantity shows up.
You know, on your doorstep, in your mailbox at the right time,
in the right moment. That's sort of another way to
keep people consistently on their therapy without having to
worry about going to the pharmacy or getting online and
initiating a refill in some time.
Sarah Click shopping. Exactly, yeah.
I mean there's there's a risk there, like that you end up with
a stockpile of someone's non adherent and just take
humiliating meds. But this bottle can tell if if
that's what do you want to say? I promise these are my last two
features of this. Now I think it's wrapped like
$100 pillow bottle and it's actually like physical packaging
and form factor of of what what the container is itself.
I think making it discreet could help a lot of people actually
carry their medication around with them with a little bit less
stigma, so you can sound, proof it or even just kind of disguise
it in some way. So it's not obviously a pill
bottle. That's another way to just make
it a little bit more likely that someone feels comfortable
slipping into their purse, slipping into their briefcase so
they have it accessible to them. If they're going to be out of
their home or not in their normal place, particularly for
conditions that might carry a little bit of stigma, I think
anything we can do to just make it easy for people to manage
those things discreetly will will help them.
And then the last again is thinking about people with many
medications. So we know multi dose packaging
and blister packaging have really positive impact on
people's ability to take. Sort of many meds over time at
the right, in the right way. So thinking about what is the
particular sort of like dosage guidance for this patient for
this set of medications, Is there a way to bundle the
packaging making a little bit easier for them to manage and
take? It could also be pretty
impactful, yeah. And I thought it was
interesting. I don't know if there's a
conclusive evidence on blister packaging here, but I remember
seeing this correlation between introducing that and a reduction
in harm from overdosing or risk of overdosing, and also related
to children overdosing from parental medication, for
example. So I don't know if that's maybe
another another component of blister benefits.
That's a great point. Just add a little friction of
popping the actual medication out slows people down.
Yeah. Well this is a really amazing in
$100 you know is relatively cheap comparing to having a full
life and and being happy and so on.
So we we maybe could add some more things even further to this
and two things that I had in mind to hear what you think
about is one is financial incentives.
Have you any opinion on the idea of adding kind of some form of.
I know there's been some experiments where either people
are kind of getting some maybe a dollar if they take their their
medication or they're kind of like doing from a reverse
version where they kind of have a certain amount of money that's
kind of in their balance. And if they fail to take the
medication, something is kind of withdrawn from that and and it's
also financial symptoms. Yeah, I'm I'm very colored by
the US landscape for this because it is actually.
From a regulatory perspective, like very challenging to test
incentives for medication adherence in any way.
So this is all conjecture, but I suspect that financial
incentives would be best for short term acute medications or
things where you're only on them, you know, like complete a
course of antibiotics for example, or taking them for a
time to find time sort of period.
I think they would probably stop working for most chronic disease
medications over time. Like you might see a boost in
the beginning and then it'll level out.
Particularly for things that are have a lot of side effects or
introduce any kind of discomfort or inconvenience in some other
way, you probably need a pretty high incentive to to overcome
that and have it stick over time.
OK. So what would you suggest for
those kinds of drugs and that people are actually in are
incentivized not to take because of the side effects?
How might you encourage them? I think going back to the
earlier part of our conversation like that, making information
salient and relevant to the person and connecting it to
their to their own goals and sense of well-being, I.
I think we'll build more intrinsic motivation that will
last over time than a financial incentive.
But again, unless you go really large, I'm sure if you were to
pay like hundreds and hundreds of dollars for someone to adhere
to something, you could probably get a pretty a pretty good lift.
But then when those payments stop, like what happens, I
suspect there'd be a pretty big fall off.
I also have the feeling that even on in our world of infinite
funding, that like like doesn't seem like the right approach,
right? Yeah, exactly.
And I I think there's a lot to be said for positive
reinforcement as well, not not from my CVS days, but from work
I did in the global health space in Tanzania.
One of the things we realized about HIV both treatment
adherence and appointment attendance.
Is that people in the health, in their healthcare experiences
mostly get bad information, right, That you're told like
you're doing really badly on the like these three like tests or
hey, you're not taking this appropriately.
You're like, hey, you missed this last thing.
There's lots of negative reinforcement.
There's actually a very few moments in someone's healthcare
experience where someone that you respect and trust or your
provider says. You did a great job.
Like you're actually getting better.
You're making the right choices. Like I know this is hard.
So building in some of that positive reinforcement in
addition to making sure someone understands sort of how how that
medication fits into their life, I think there's there's value
there and sort of a little bit more like a social incentive.
But I again. So financial incentives will
work if they're large and lasting, but I think some of
these other tools could be useful assuming that that's not
going to be available indefinitely.
Yeah, well that's interesting because I think also with with
kind of this payment has become a little bit of in vogue in
behavioral science to do like micro payments as a way of like
getting people to go to the gym. I think in the big Katie Milkman
ET al program that was kind of the at their twenty different
variations that was the most effective.
You could go like a dollar to go to the gym or something.
At least for returning to the gym.
Yeah. Yeah exactly.
But I I, I fully I'm I'm on your side here in terms of I also
think there's yeah especially for as a chronic chronic
medication it's tricky and to belong the social.
Another thing I've seen is providers trying to have some
form of solution that the patient kind of takes a photo of
them taking the pill and send that's that's like I've taken it
kind of thing and yeah what's your.
It's interesting. I mean, it reminds me a little
bit of like dots, like TB therapy in the global health
world of you have to like, directly observe the treatment
happening. It's an interesting idea.
I don't know like how scalable or practical it is.
Again, I'm very colored by my U.S. healthcare variance.
But just knowing how much providers have going on, like
will they, will they view those images, will they respond in a
way that going to actually Dr. motivation and reinforcement for
that person. I think there's a lot of
potential. I don't think I'd respond very
well. Yeah.
And for the context, I'm taking this as an example from I think
it's San Francisco based startup that's doing this and I think
they're doing some form of I guess more machine learning
algorithm to to to kind of check the photos and so on.
But yeah, it's always, I'm very happy with what you said because
I I I had a very similar kind of thought of like here are some
people that has taken an idea. From the sepia for science and
then, you know, run a little bit too far with it in maybe a
different context than it was kind of initially thought of.
And I think this is it goes back to my I love things that work.
They're delightful to the user, but also scalable and work in
the context in which it'll be delivered.
Because that discussion about medications and adherence is
going to be. One minor subtopic with their
provider and they're going to have so many other things to
triage with the providers. So like, is it practical that
you would put all of the attention on that one behavior
when you're also going to be talking about lab tests and sort
of other lifestyle modifications and things you need to be doing
to be successful managing a condition?
And sort of does that sort of patient experience make sense
overall? Yeah.
And by the way, I was going to move us to the next.
Topic but first of all this is really fantastic.
This is really great to kind of explore this product and who
knows what it will cost but it seems like a good a good product
that we have kind of you know with you kind of explored.
So thank you for for sharing your thoughts on the pill bottle
and what you can reference now. I think would be interesting to
explore in terms of designing for for equity and.
I know with your New York it's it's been something that's been
very important for you and I think it's interesting to to
kind of you know beyond your thinking about we're talking
about pill bottles but but in in brothers terms of designing for
a let's say under resourced community that obviously
requires good healthcare and good healthcare experiences.
What's your thoughts on how to? Kind of use payroll science to
build trust in that context or or kind of support that
happening in in good ways. Yeah, I think for me what's been
most important in thinking about these sort of vulnerable
communities or hard to reach communities is definitely
pulling in some of the principles from like human
Centered Design and Design Thinking and.
Investing in that sort of Co creation and understanding
upfront versus jumping straight into a solution design or
program design, assuming that there's sufficient evidence that
already exists that you can just sort of build from.
I think building that shared understanding and doing a little
bit of prototyping and that Co creation together is incredibly
important. Before launching straight into
the behavioral design of something, or even then turning
that into an experiment, I haven't found a way to design
solutions that are useful and compelling for folks without,
without that stuff, and without doing that first and so often it
leads you to. It's just like a different
route, right? It might mean steering away from
a digital approach. If that's not going to make
sense, it might mean focusing more on Alien to your point,
like what are the drivers of trust and how do you address
some of those drivers of trust in your solution design.
So I think that investing in that stuff is really important
for for any kind of audience that's.
I would say vulnerable, but really just different than you
like for any any user that's not you exactly.
Or different from the research traditionally like in terms of
you know. Exactly we.
Have a history of certain groups being kind of left out of
certain research and and and so on as well.
So we might just have limited, limited view on understanding
because of that as well. Yeah.
Trying to design a large scale health intervention.
And then you're kind of trying to target under resourced
communities, for example, and understanding that in order for
this to work, you don't only have to reach maybe kind of the
end person, but also maybe the community leaders within the
community. You might have to align with
their kind of doctors, with the maybe some some like bigger
system challenges. Maybe that is too big of a
question to get into now. But but I just found that as a
challenging part sometimes of like how to get all of those
different stakeholders from the individual to the doctor to the
maybe community leader to whoever else is involved to to
get this medication to be the whole health system, the
government in the world. Yeah.
I think there's a difference between taking the time to
understand the universe. So like which are those
stakeholders that are going to really impact the behavior and
decision making and what's their level of impact going to be on
the outcome And then selectively deciding like which can you pull
in in the context of which intervention versus?
Assuming you can pull in all of them every time for every
design. So I think there's sometimes and
I think COVID is a great example of this where a COVID
vaccination is a great example of this where it really was
worth it to invest in building relationships with community
based organizations with faith-based leaders and they're
going to have outsize impact on people's decision making.
And so that that was definitely. A stakeholder that you had to
draw in in the moment to be successful, and you could
probably even like model the business impact of not doing so
or what would happen if you didn't do so.
But that doesn't mean in that same moment you need to engage
like every single stakeholder in the stakeholder networks.
I don't know if it's being a little bit pragmatic about
making choices, about when you invest where you have to be,
right. You can't do everything all the
time. But yeah, I like and I I think
that's a that's a good distinction.
In the case of the COVID vaccine, it really felt like
more of a community issue where like we need everyone to do this
thing together right now. Whereas sometimes with
individual health issues like it's it's, it's challenging to
think about how would that even, like how would you even
operationalize that like this person needs to take their
cancer medication and this person needs to like get to more
exercise and so on. So yeah I think that's that's
that seems like a good distinction.
Cool. Well I think we're ready to move
on to a fun game. This is called would it
replicate? And we're basically going to
throw some some hypothetical sort of made-up research
findings at you and we're going to ask you to tell us whether or
not it would replicate. And you know, you can share like
a couple sentences and and you know why you think that's the
case or any of your own thoughts about the thing.
So I will go 1st. And this is meant to be, you
know, just kind of a thought experiment.
You don't have to be we don't take it very seriously.
Great. So you're ready.
Awesome healthcare professionals who regularly read fiction have
more empathy for their patients. I think that would replicate.
But I also am very biased because I wanted to be a
novelist for a large part of my life.
So I believe very strong motion of power.
OK, we'll see if you're biased on this one.
Rock climbers take more risks in their regular lives.
Wouldn't. Wouldn't replicate.
Why not? Because the definition of like
who's a rock climber has become so diluted recently that it's
like basically analogous general population.
I see. So it's like if you, if you
belong to a rock climbing gym, you're now a rock climber.
You you used to have to climb to Mount Everest, but now anyone?
Exactly. Cool.
OK? People who have lived in
multiple countries report being more content with their current
living situation. I think that would replicate
mostly because your your norms, you're like baseline norms
change and you're no longer pegged to just what you've grown
up around, so. Very interesting.
Patients living with a partner are more adherent to their
medication. Regimen that would replicate,
mostly because we've seen a lot of the impacts of like social
isolation on health outcomes and health behavior.
So I think just. Having that social support
available, assuming that you'll have some baseline like respect
and like of this partner, yeah, I would I would hope, yeah, I
feel like maybe there is some research on this that that we
can pull up if we really tried. OK.
Dog owners are better prepared for the challenges of having a
child, I guess like more than non dog owners.
Would not replicate. I say that from my own
experience, having owned a dog and being very ill prepared.
I love it. Nice.
OK. Innovation teams that pair
design thinking with behavioral science methods have better
outcomes than teams who use either approach on its own.
I mean I I don't know what are the outcomes, like what are the
outcomes that? We're holding these teams too.
Is that profitability, let's say actual health outcomes of their
their community of of interest? Health outcomes, I think that
would that would replicate. Assuming you could like do these
like organizational design studies in some kind of
controlled way, on this podcast we can do anything.
Great. Yeah, all right.
When it comes to the relative importance of different social
determinants of health in the results of a marshmallow test,
economic stability has a greater effect than community context.
So essentially having more money that matters more or the amount
of money that you have matters more than where you live in
determining your your marshmallow test or
self-control, your quote UN quote self-control results.
I think that wouldn't replicate, because what if some communities
just, like, really hate marshmallows?
Or like have a strong, strong averse.
Yeah, you you took that to a very different place.
We know that in in. In Tennessee, people hate
marshmallows for sure. Yeah, the anti Smore community.
Awesome. Yeah.
OK. Final one.
In responding to online patient questions, AI language models
are more likely to be rated as showing more empathy than
healthcare professionals. I don't think that would
replicate. I think it's probably, I saw
that headline recently, but I think there's something about if
people become aware of that providers are likely to invest
more like in their own empathy. Or at least the perception of
their own apathy maybe just providing longer, longer
responses, right? Yeah.
It's a very interesting one, yeah.
We're using AI to write the first draft of their yeah,
that's funny. Yeah, I guess, I guess there's
there. Well in this case I think the
the responses were generated by real real doctors at least
Reddit doctors pre ChatGPT. But that is an interesting sort
of future case of like doctors, Doctors just put their answer
translated into longer form using, using AI and then that's
the that's the better version of it.
OK, we have one final question for you.
This is a really big one. So get ready, put your seat belt
on. What is your most controversial
opinion in behavioral science? My most controversial opinion?
I think probably that sometimes in behavioral science we
oversell what we're doing or the novelty of what we're doing and
sometimes don't acknowledge. How common some of the
approaches are in other fields that might just not have the
same language for it or same ways to like disseminate and
share the approaches for it. I think there's just been so
much done in the global health space and implementation science
base, even just in marketing and sort of more standard business
disciplines and sometimes the way we frame or sell things like
won't acknowledge the. The contributions or like
baseline purchase and some of those other spaces, Yeah, that
that that's very I I definitely have that same reaction
sometimes where I'm like, this isn't special.
We've been doing this for thousands of years.
Yeah. Like what are you talking, what
are you bragging about at the same time?
Like I feel that drive or or or push to to kind of sell
behavioral science so that people will adopt it so that we
can run experiments so that you know like the the ultimate sort
of it's almost like the the ends justify the means of overselling
is is sort of how it feels sometimes but yeah.
Yeah. And I guess it also just feels
good to think that you've come up with something unique and
it's probably you know. We have silos in many ways in in
research and in application, but but even even with that, like
the incentives for going outside of your silo, it's often times
in that case maybe bad because you can end up finding out that
something that you think you're very original around or thinking
about is actually being done by someone else in other fields or
you know, has been around before.
And I think that's the same issue.
You just invented the not invented here bias.
Like, it's like so meta. Awesome, cool.
This has been really fun. Thank you so much for joining
us. And yeah, we'll we'll talk to
you later. Yeah.
Thank you so much, Arthy. We really appreciate it.
Thank you guys. This is awesome.
Time to wrap up another episode of the Behavioral Design
Podcast. We hope you enjoyed the show.
Oh, and I am an AI. Yeah, welcome to Uncanny Valley.
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