Designing for Sustained Motivation and Behavior Change Jeffrey T. Kullgren, MD, MS, MPH VA Center for Clinical Management Research VA Ann Arbor Healthcare System Division of General Medicine University of Michigan Medical School May 9, 2018
Translational behavioral science
Translational behavioral science Bench to bedside
Translational behavioral science Bench to bedside Lab to living room
The leaders and best (or just like the rest)? 35 30 25 % 20 15 10 5 0 Overweight Obese Chronic back pain High stress Physical inactivity
How can we motivate change?
Overview Motivating from the outside using insights from behavioral economics Financial incentives Precommitment Choice architecture modifications Motivating from the inside using insights from selfdetermination theory Autonomy Competence Relatedness Example of how these approaches can be integrated Questions and answers
Motivating from the outside
Behavioral economics increases the explanatory power of economics by providing it with more realistic psychological foundations. -- Colin Camerer and George Loewenstein Camerer, C.F., Loewenstein, G., Rabin, M. Behavioral Economics: Past, Present, Future. http://www.cmu.edu/dietrich/sds/docs/loewenstein/beheconpastpresentfuture.pdf.
The behavioral economics toolbox Financial incentives Precommitment Choice architecture modifications
Financial incentives
Present-biased preferences Overweighting of near-term benefits and costs We will forgo large future benefits in order to experience small benefits now Leads to conflicts between long-term goals and near-term behaviors
Incentives for smoking cessation
Effects of incentives on cessation Higgins ST, Washio Y, Heil SH, et al. Financial incentives for smoking cessation among pregnant and newly postpartum women. Prev Med. 2012 Nov;55 Suppl:S33-40.
Evidence for other applications Weight loss Physical activity Substance abuse Health risk appraisals
Precommitment
The recipe for precommitment Recognize future temptation Commit future self to a course of action Make it hard to break this commitment Achieve goal
Quitting smoking Set quit date Tell family and friends Plan for challenges Remove triggers Consider medications https://smokefree.gov/quitting-smoking/prepare-quit
Evidence for other applications Weight loss Physical activity Saving money
Choice architecture modifications
Contextual factors shape our choices Status quo Fast vs. slow thinking Emotions Social norms
Improving beverage choices Thorndike AN, Sonnenberg L, Riis J, Barraclough S, Levy DE. A 2-Phase Labeling and Choice Architecture Intervention to Improve Healthy Food and Beverage Choices. American Journal of Public Health. 2012;102(3):527 533.
Effects of labels and convenience Thorndike AN, Sonnenberg L, Riis J, Barraclough S, Levy DE. A 2-Phase Labeling and Choice Architecture Intervention to Improve Healthy Food and Beverage Choices. American Journal of Public Health. 2012;102(3):527 533.
Evidence for other applications Physical activity Calorie labeling Health plan choices
Motivating from the inside
Our 3 innate human needs Autonomy Competence Relatedness
Types of motivation Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68 78.
Types of motivation Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68 78.
Types of motivation Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68 78.
Types of motivation Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68 78.
Example of SDT in action
Intervention components Silva MN, Vieira PN, Coutinho SR, et al. Using self-determination theory to promote physical activity and weight control: a randomized controlled trial in women. J Behav Med. 2010;33(2):110-122.
Effects on weight loss Silva MN, Vieira PN, Coutinho SR, et al. Using self-determination theory to promote physical activity and weight control: a randomized controlled trial in women. J Behav Med. 2010;33(2):110-122.
Evidence for other applications Ryan RM, Patrick H, Deci EL, Williams GC. Facilitating health behaviour change and its maintenance: Interventions based on Self-Determination Theory. European Health Psychologist. 2008;10.
Targeting motivation from both sides
Financial incentives for weight loss Target present-biased preferences Shown to be effective in the short term Can be scaled to large numbers of people Insufficient maintenance after incentives end Potential to crowd out autonomous motivation
Continuum of extrinsic motivation Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68 78.
Continuum of extrinsic motivation Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68 78.
Continuum of extrinsic motivation Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68 78.
Incentives tailored to aspirations Elicit information about aspirations Tailor framing of a financial incentive to connect the incentive and the incentivized behavior to achievement of aspirations Incorporates insights from both behavioral economics and SDT Could be readily integrated into existing incentive programs and health risk appraisals
Aligning incentives with goals and values
Aligning incentives with goals and values
Summary Motivating from the outside using insights from behavioral economics Financial incentives Precommitment Choice architecture modifications Motivating from the inside using insights from selfdetermination theory Autonomy Competence Relatedness Each approach has strengths and weaknesses Opportunities for complementary strategies
Thank you! jkullgre@med.umich.edu @JeffKullgren