Aaron's Thoughts

I hear the word "gamification" a lot, especially in health related behavior technology discussions. If you sit down with a group of people to brainstorm an app idea, something engaging that gets people to do something positive for their health, it isn't long before you start talking about points / badges / levels / challenges, and on and on. I've shared a few thoughts and enthusiasm before for these kinds of app ideas, but I think there's something more core that we're skipping before we go out and "game-ify". That thing is a narrative.

I recently visited my parents and checked up on my dad's love for his Fitbit activity tracker. Now, my dad is no gadget guy, but he loves his Fitbit so much that he has lost 2 of them and immediately replaced them himself; that's 3 including the one I bought him. He does a good walk in the morning, and tries during the day to get more steps in than he did before. I was expecting to hear some new revelation about how he could get more steps in by doing some other activity / routine in his office day.

"I'm not wearing it anymore." "What? Like, you're just not in to it anymore, you don't care about how many steps you get in?", I asked. "No. I still do my walks, I get steps in during the day at work, but I know how many steps I'm getting in. If I do the walk in the morning and then my normal day, I know how many steps that is. Why do I need to wear the Fitbit to tell me that every day?"

Wow, I was shocked. It was such an about-face. Then he conceded, "I may wear it again, just not seeing the point right now". The something that would get him wearing it again is either a change in his routine that needs quantifying, or, a change in the reason for counting steps. Which got me thinking, if every day my dad pulls up to about 8,000 steps, what is that ultimately contributing to? It's aggregatable, averageable, mean distributable (?), comparable (to me and others on Fitbit.com), and bragable (he's been adding to this for a while). But, it doesn't contribute to a larger narrative that he can identify with. I'll concede though that some people are actively creating a narrative of streaks, bests, and challenges themselves, and for them, the Fitbit (data aggregation) alone works.

Perhaps what my dad needs is something that his 8,000 steps per day is contributing towards. Getting a repetitive high-range step count shouldn't be a bore, it needs to count towards some larger narrative. A game would work, but a game is just one kind of narrative.

Which got me thinking. Most persuasive technology does either one or both of two things:
1) Helps the user tell their narrative. It gives them a structure, an audience, a visualization, etc, of the story of their accomplishments and shortcomings (after all, a good story has ups and downs)
2) Allows users to better consume / understand the narratives of others - Often times, we consume the narratives of others we find interesting, inspiring, or that we feel good about comparing ourselves to.

So, to all those thinking about building apps the encourage people to change, think first about the narrative. Don't concentrate on dashboard view X, data input log Y, cool visualization V, or even game mechanism Z. Those can be part of the way the narrative is filled in, but if your idea of the narrative isn't compelling enough to your users, everything that comes before it isn't important.

For those asking what I'm up to with this new startup -- I'm building a narrative. One that I think people will be excited to do, even if they just do their same step counts every day. I'll be starting with the Fitbit at first. I think they have built the best device so far, and their API is all about getting people to add to the Fitbit experience. They do a few badges / challenge things themselves, but I'd venture to say that they're focusing on making the best device (and ease of use) that inspires a new wave of health related experiences. 

And now, back to work.

They say every good company solves a problem, or scratches an itch, yours or someone else's. The declining health in the country is an enormous challenge -- almost too big for a startup? I think not.

What's broken?

I was catching up with a good friend of mine a couple weeks ago, and among other things, I asked how his folks were doing (I love this family, I'd be a member of their clan if not for a Coleman). He told me a typical story that made me shake my head. His dad is overweight and probably needs to lose 40 pounds. He's been having some issues, amongst them is sleep apnea. Of course, it's pretty serious because your body is literally deprived of oxygen and your heart is put under large stress every night. This, and other ailments led the doctor to do what doctors sometimes feel is their only course correction tool: they scare the shit out of you hoping you'll go home and make a big life change. That's partly because of the system they work within. They can't be with you after you walk out the door. So, perhaps it's what we might label as the "wake up call" technique. It goes something like: "Your weight is going to kill you. You will probably not make it to birthday X, your odds of cancer are much higher, your odds of a hearth attack are high, your quality of life is lower, you won't live to meet your grandchildren, your spouse will be a widow..." Something like that, although I imagine that most doctors don't lay out all of those doomsday scenarios all in sequence.

The hope is that the patient goes home, re-evaluates their life and takes that downer message as a call to action to get on a plan like Weight Watchers or Jenny Craig, or even better, self-starts a rigorous routine of healthy food and marathon training. Yeah, that'd be nice. 

The truth is that mostly what happens is that even great people, people like my friend's dad that I have enormous respect for, don't know where to start. Further, they aren't given the tools to bridge the gap from that startling knowledge (not saying it isn't true, mind you), and the path forward. How do we help people start that journey? How to we put them on a life-long change of small daily habit changes that will divert them from the tragic closing scene just described to them by their doctor?

What has to happen

A lot has to happen to fix this problem. There isn't a one-size-fits-all approach to this either because different people's personalities gravitate to certain solutions over others. In the case of my friend's dad, he's got a lot going for him:

1. Great family and friend support
2. A physically-active son,  motivated
3. Good sense of common technology (email, mobile, SMS, maybe even Facebook)
4. A good job, upper middle class lifestyle (weekends / vacation)
5. Motivation -- just maybe not a clear path to action.

That should be good enough. So, where's the answer?

Experimentation

Over the next few months I'll be putting my thoughts and my best programming skills towards this. "Health" is an interesting, exciting, cutting-edge space. However, I sometimes feel like I've bitten off more than I can chew. For a computer programmer, the problems that have a concrete solution are the low-hanging fruit. If you want 'Banking System A' to process payment to 'Vendor B', that's more concretely solvable.  

So what about the big players? Should we wait for Google or Microsoft to give consumers the answers to their health? Something tells me that neither is too eager to get back in to health:

• Microsoft Ends Another Vertical Market Dalliance—This Time In Healthcare: http://techcrunch.com/2011/12/10/microsoft-ends-dalliance-healthcare/
• Why Google Health Really Failed—It's About The Money http://techcrunch.com/2011/06/26/why-google-really-failed-money/

It seems like there need to be lots of solutions to this for consumers to choose from. It's the very notion of the startup craze going on right now, that the little guy can disrupt the established brands and markets out there now. The entrepreneur says that things as they are now are not the way they should be and that he/she has an idea to offer to the mix.

My idea is coming along and I can't wait to share it with the world. What I want to do is make health behavior more about the journey than the destination. Diets don't work as big radical changes usually don't sustain. I think people need a metaphor that helps them see the small changes they make start to add up to big ones, and they need to start on that path with a system that is flexible to their needs and their current habits. It's a delicate balance. Push too hard and you'll lose them forever, push too soft and you won't see any changes. 

Compounded in the difficulty is how to problem of how to engage social support. In the era of online self-aggrandizing, how do we get people to collaborate (yes, a two-way street) on their health journey with other people using digital tools? I see lots of people posting their athletic feats to Facebook, but hardly never their struggles. 

What I'm Not Building

There are quite a few products out there that have already scratched some of the itches people have had. Here's a list of what I'm not building:

• a health dashboard
• a medical aggregator
• a food journal
• a fitness logger (although it's a part of it I guess)
• a share-to-facebook health app (although nothing will be stopping you I suppose)
• a diet and fitness community site

What I Will Be Building

• something fun
• something that conveys health is the journey, not the destination
• something that rewards collaboration
• something that rewards growth and mastery
• a sense of accomplishment and awesomeness
• an experience that adapts to the tools you have & use
• something that works well with cool devices like the FitBit
• something people my age would like, and that people my parents age would too

So, with that out there I'm going back to the drawing board. I can't wait to share what I come up with and along the way. I hope many of you get involved, either as beta testers or just to listen to me babble about ideas over a cup of coffee. Speaking of journeys, this whole startup thing is going to be a crazy one. Thanks for following along!