Autonomy is one of the three precursors of motivation as defined by self-determination theory. It can be difficult to support a user’s autonomy in the context of health, because achieving healthy outcomes often requires a specific set of behaviors that may not align with what a user actually wants to do. One intervention that I think has done a nice job of supporting user autonomy within a reasonable behavior change framework is Mindbloom’s Life Game.
At a high level, having autonomy means having control over your own decisions. When developing interventions, you can support your users’ sense of autonomy by giving them as much choice as possible within a framework–constrained choice. Another way to support autonomy is by orienting people to their personal values and goals, and helping them to contextualize other behaviors in line with those.
The Life Game hands the user the reins from the get-go by asking her to define what areas of life constitute wellness in her eyes. As I’ve mentioned before, the idea of wellness can (and in my opinion should) go beyond the absence of illness to include happiness and thriving. The Life Game acknowledges this by including not just physical health but also other domains such as creativity, career, and spirituality among the areas of wellness a user can focus on. In addition to offering the user choice of areas, this set-up also immediately establishes the idea of value-consistent behavior change by setting the context of “What matters to you?”
The Life Game continues to offer choices within the program. Once the user selects the areas of wellness he or she wants to work on, the game encourages the further selection of specific actions to advance those goals. Users can browse standard actions under each category heading, or add their own. Then users have the option to schedule the action steps on a calendar and enroll in email reminders. On the plus side, this system gives users essentially unlimited options and flexibility about how to work toward their valued goals. However, on the flip side, we also know that too much choice can be overwhelming and demotivating.
Slightly more concerning with respect to health and wellness, too much choice can also override clinically correct procedures. The simplest example is that losing weight always boils down to eating less and moving more, so giving users of a weight loss intervention choices should focus on those domains. By removing the restrictions around choice, you introduce the risk that a user could select activities like “watch less tv” or “read books on weight loss” as action steps for losing weight, then be dismayed to not achieve the intended effects. My recommendation for Life Game or similar programs is to maintain much of the current autonomy support, but blend in scientifically-based guidance that increases the odds of users achieving their goals.
Now whether the Life Game actually changes behaviors in a meaningful way is an open question. According to one 2012 press release Life Game players followed through on 60% of the commitments they made. That’s pretty good, if it’s accurate, especially considering that following a partnership with Aetna, the Life Game had over 125,000 users and 340,000 mobile app downloads. More recently, Welltok acquired Mindbloom for use in its IBM Watson-powered CaféWell Concierge program. This is surely a vote of confidence in the power of the Life Game. Still, economic buyers will want to see a real return on investment in terms of reduced health care costs or improved outcomes.
Whether or not the Mindbloom Life Game is able to achieve that ROI, it remains an excellent example of how a health and wellness intervention can operationalize autonomy support to engage users. It’s not perfect (what intervention is?), but it’s doing some important things right. You can’t get results without engaging users.