Of goal-setting and mountain-climbing in digital health

By Dr. Elizabeth Lyons, Associate Professor at the University of Texas Medical Branch

Physical activity as a health behavior is typically not enjoyed by a substantial portion of the population. For many people, physical activity hurts and is boring. A conventional health promotion program/intervention might try to make activity easier, distract from the pain, or provide some rationale for why engaging in this unpleasant behavior is important. But over the years, my research has started moving toward a different methodology.

In the past, I used digital health tools like games and apps as a method of either distracting people from pain during exercise bouts or as a method of making exercise more fun. However, I think I was overlooking a very important and basic aspect of games: people do all sorts of boring and unpleasant things as part of playing games, and they often do them willingly! A unique element of games is the ability to reframe some obstacle from an inconvenience to an interesting challenge without obscuring the difficulty or unpleasantness of overcoming that obstacle. Similarly, exercise does not cease to be painful, but that pain can be given meaning within a new, interesting context.

If we use climbing Mt. Everest as an example, the goal of the climber is to reach the top. A logical way of making it easier to achieve that goal would be to ride in a helicopter rather than climb. But erasing the rules that make achieving the goal difficult makes achieving the goal a lot less interesting. I have been guilty of using a “helicopter” to bring my participants to the top of their own metaphorical Mt. Everest, which robs them of some really rich opportunities. If you ask any mountain climber – they don’t climb mountains because of step goals, they climb them because they are there for them to climb! There’s something inherently fun and exhilarating about overcoming a major challenge.

So now, we have begun experimenting with creating games that explicitly use physical activity as a rule of the game rather than a daily goal to be achieved. Goals might include taking a photo of the biggest animal party you can find in your neighborhood, making a silly picture on a map by walking with a GPS tracker, or discovering new parts of a story as you follow in the virtual footsteps of a famous explorer. Each of these goals requires substantial physical activity and promotes hard work for a greater sense of accomplishment (hopefully!), but none of them involve assigning numbers or scheduling appointments. We are hoping that this method may help our participants genuinely enjoy physical activity not in spite of their perceived dislike of it but because its difficulty is meaningful and interesting to them.

I do not want my participants to walk 10,000 steps because it is step goal that I gave them. I want them to climb mountains (metaphorical or otherwise!) because they are there.

Questions:

• What are some ways that projects you’re working on could be reframed, taking advantage of the inherent unpleasant aspects of a behavior?
• What are some ways you’ve been making things easier for your end user without realizing it? Do you think making it easier actually had its intended effect?

Bio:

Elizabeth Lyons is an Associate Professor at the University of Texas Medical Branch. Her research involves using technology and gaming principles to make health behaviors more meaningful and fun. She is particularly interested in using games to improve physical activity among cancer survivors.