Social comparison opportunities in digital health interventions: Are we using theory and evidence effectively?

By Dr. Dani Arigo, Rowan University and Rowan University School of Osteopathic Medicine

As a clinical psychologist who studies the role of social process and perceptions in health behavior change, I’ve been both delighted and overwhelmed by our increasing ability to use digital tools that connect users to each other. So much of our daily lives are spent engaged in social interaction (or pondering social experiences), and there is huge potential to use the social environment to promote health. But it seems that we still have a long way to go before we can capitalize on this potential.

For instance, literature on intervention components of digital health tools – particularly work that describes mobile apps for physical activity and weight loss – indicates that a significant proportion of these tools uses “social comparison” to promote behavior change. (See here for an example.) Yet “social comparison” can mean a lot of different approaches or techniques. When researchers say that social comparison is used in an intervention, what does this mean in practice? Moreover, is this work maximizing the vast body of knowledge on social comparison theory and applications to health contexts?

Social comparison refers to the process of self-evaluation relative to another person or group. The ability to size ourselves up next to potential allies or competitors is thought to be innate and protective; it often happens quickly and implicitly, whenever we’re exposed to relevant information about other people. As a result, any digital health intervention that offers the opportunity to learn about others’ health behaviors could facilitate social comparison. This means that features such as message boards, direct messages, profiles/feeds, or anything else that lets users share text or photos with each other could be categorized as social comparison.

But simply providing information about others may not actually induce social comparison, as people (and therefore, users of digital health tools) differ in their tendencies to make comparisons or value the evaluations they provide. Here, concluding that comparison is a primary mechanism of action could lead us astray; other mechanisms such as social support and social reinforcement may be more powerful in these situations, or may interact with social comparison to produce behavior change. Features such as challenges (competitions) and leaderboards, which directly compare a user’s progress to that of other users, are more likely to induce the types of comparisons that could lead to behavior change.

Unfortunately, many existing reviews of digital health interventions do not specify what they categorize as “social comparison,” making it difficult to determine which features of a tool are most beneficial. To make things even more confusing, these reviews rarely indicate how users’ information is communicated to each other – via raw numbers (pounds lost or steps taken), data visualization (graphs), photos, videos, or avatars? Or some combination? Which of these is most effective for promoting behavior change?

But perhaps the most significant limitation of existing work in this space is the assumption that all opportunities for social comparison are created equal – specifically, that they will always have the desired positive effect. Social psychology theory and empirical work show that this is not accurate. As noted, people differ in their affinity for social comparison, meaning that facilitating or inducing this process via digital health tool won’t be very effective for some people. Even more importantly, for some people, comparison has negative effects. Anxiety, despondence, and frustration all are fairly common responses to comparison, and only some people are able to channel this negative affect into motivation for behavior change; many of us simply give up. (This could explain some users’ disengagement from digital health tools.)

Finally, differences in affinity for comparison or positive/negative response to a comparison opportunity do not exist just between people. Each of us fluctuates in our interest and response over time, depending on factors such as mood, stress level, and progress toward our behavioral goals. We’re continually improving the capacity for digital health tools to assess users’ dynamic preferences and needs, and respond to these in real time (e.g., JITAI designs), but this capacity has not yet been applied to tools’ social comparison features. We now have enormous potential to tailor social comparison features, which may provide more engaging and effective digital health interventions.

Questions:

• What is the best approach to assessing social comparison preferences and needs, in order to inform social comparison tailoring in a digital health tool?
• What steps are necessary in order to tease apart which social comparison intervention features and formats (e.g., text vs. photos) are most beneficial, for whom, and when?

Bio: 

Dr. Dani Arigo is an assistant professor of psychology at Rowan University and adjunct assistant professor of family medicine at Rowan University School of Osteopathic Medicine (USA), as well as a licensed clinical psychologist. Her research program focuses on understanding and harnessing social influences on health behaviors, with an emphasis on optimizing digital tools for assessing and intervening on cardioprotective behaviors among women. Follow her at @DrDaniArigo on Twitter or at drarigo.wordpress.com for updates on digital health, women’s health, and scholarly productivity.