Welcome to the Behavioral Design Podcast. I'm Samuel Salter and I'm here with my Co host, Eileen Holdsworth. Hey, Eileen. Hi. Hi. How's it going? Pretty cold, pretty snowy here in Stockholm. Oh man. Well, it is winter time, so I guess that's the way the cookie crumbles. There you go. As they say, as. They say yeah, but very early, early winter here, so trying to stay warm.
Yeah. We we have really interesting final product deep dive this week and I think it's a really interesting topic and this is a little bit of breaking the 4th wall or something, but I see in the notes that you've asked should we talk about our own medication use? Well see here's the thing like I like to start off our our deep dives by asking you some sort of relevant prompting question.
And so it's often about the product itself and and the the natural one since our since our product for this episode is the pill bottle, it is hey do you take any medications. But as I was thinking about this, I thought like is that way too private and personal of a question. And yeah, I think, I think probably it is I I don't think I'm comfortable asking you if you take any medications.
Well maybe we can do it do it like historically and said that there's definitely been periods where I've I've had to do that. And I guess it's it's interesting because you know both of us haven't worked long time in applied real science where we so often talk about this kind of intention action gap. I don't know.
It's just really fascinating when it regards your, you know, direct well-being and and often times some medication you take to save your life to really for really important purposes.
Not just some form of like on the lighter side taking some form of vitamin B during winter as maybe I should right now, but but really for for our survival and still maybe in our personal life, but also you know working a lot both of us in kind of digital health and similar kind of insurance pharmaceutical kind of challenges when it comes to supporting people in doing something that they have all the incentives to do. But exactly. That's the big conundrum, right?
Is like this is so important for you and yet there's still this gap. No, it's interesting. And over the years I've worked with so many pharma companies and this is always the number one issue that that they're interested in solving, you know, from a from a behavioral perspective. And so it's a really interesting one. I'm I'm excited to talk about, you know, how the pill bottle can can contribute to medication
adherence. And I think maybe the the first thing to say is that maybe it's not a a bottle at all, right. So like we've framed this in terms of a bottle, but as soon as you get to more than, I would say more than two medications, you really need a pill box. It's like a a bottle is no. Having a, you know, 3 or 4 bottles on your counter becomes really, really sort of burdensome.
And there's lots of evidence showing that just using a pill box alone has a huge impact on increasing medication adherence. Yeah. And it it seems like, you know, as soon as you start going from like taking one medication to two and three and and yeah, we don't have to go into healthcare systems and complexity. And and how they vary across
across continents. Exactly, but definitely, like you said, it's it becomes more of a increased challenge not only to ensure people take it, but also avoid, you know, taking the wrong things at the same time and and so on as well. So yeah, it is a really tricky challenge, but a fun one to dive into. And yeah, where? Where do you think we should start?
Well, I thought that we could sort of organize this conversation using a quick and dirty framework that I've stolen from the Behavioral Insights Team or or stolen and adapted. Let's let's say that and so of course probably all of our listeners know about E the mnemonic for easy, attractive,
social and timely. Just a way of thinking through you know what how to improve your your your interventions by you know making them these ways And you can think of all the different kinds of ways to make your product or a program or intervention easy, attractive, social and timely.
So I've sort of in my own work as a way of using this for almost almost kind of a sanity check to make sure have I forgotten anything obvious is to actually replace Timely with what I think is maybe the an umbrella category over Timely which is AP for personalized. And I think that for me Timely is just one way of being personalized and and you know timing is obviously very important.
But I think maybe the higher level category in in my own work has been personalization and that is has ended up being really important with I would say pretty much every product that that I've worked on. And especially these days with machine learning and and the the ability to more easily tailor to the individual. I think it to not have personalization as a top level category seems seems just a bit
short sighted. So even though ESP with AP does not like, no one wants to say that it's not a word. Can we say tailored, tailored or something like that maybe? Huh. That is nice. But having the same word, it's like. I feel like there are other problems introduced with that. Yeah, but I I think that's a great set up for for structuring things. And yeah, I actually used this, you know, often times for communicating. I think it's a useful framework when kind of like categorizing
and communicating things. So yeah, very good. And I like your kind of modification as well, so. Adaptation and obviously you lose all the nuance with these very broad categories. But, but you know, I think especially for, you know, maybe people who are just getting started in behavioral science or people who are not behavioral scientists, it can be a really useful sort of guiding framework. And for me, yeah, it's also nice to be able to categorize this in order to present it more
fluently, right. So we can go through the the easy category and then we can go through the attractive category and so on. And it just kind of, you know, chunks chunks these in a way that reduces cognitive load. Yes, you see, listeners, we care about your cognitive. Exactly. Look at us. So should we get started with E for for easy?
Yes, yes. So obviously you want to make your medication taking as easy as possible and and that includes all the steps along the way from you know, filling your prescription in the 1st place you know or even before that right? Like knowing which prescription to get, filling the prescription, picking up the
prescription. If you imagine the whole journey map and all the steps along the way towards perfect medication adherence, it's not just, you know, taking it in the morning and in the evening it's making sure that you have all the refills. And so if you think about how do we make every single step seamless and maybe automatic, that's sort of how you get to an easier medication management experience. And so one thing that this reminds me of actually is our conversation with Steph Habi.
If at at hand of diabetes a few episodes ago, right, she was talking about how the automatic titration, you know, where possible through the insulin pump can really help people. Of course, most medications aren't automatically titrated, but you can automate other things.
For example, so you you can you know there are some services that can load your pill box for you that can automate your refill process, and even if they cannot, you know, inject the the drug into your body, they can make this management easier in other ways. And I think that one thing that you see in medication adherence solutions is this concept of tracking, medication tracking. And I I think there there are some very well-intentioned solutions out there.
And the process is basically you log that you've taken your medication through an app or maybe you scan the bottle, you know some some way of of approving or not improving just you know, stating that you've taken your medication. And this to me often feels like the the benefits might not outweigh this this cost of the the tracking burden, right? There's a lot of friction to doing that.
And if you don't do it perfectly the 2nd that you don't do it perfectly, you have this this confusion about did I or didn't I? And that's another thing that that that maybe you can automate through the pillbox itself if tracking is important. Yeah, definitely a lot of automation possibilities and I'm thinking as well about because part of this is kind of like obviously making it easy from as we alluded to, finding ways to along the way and make everything happen by itself in some ways.
But I guess I naturally coming from kind of my habit background also think about kind of how do we make it easy and seamless to kind of integrate it into whatever daily routine or life and so on that to have. And I think, you know, this is a little bit more of like less cool and automatic in terms of like or how you say it's less cool in that like it's more some basic pure science stuff. But. It's less tech. Forward, yeah, take.
Let's take forward. Just just really reinforcing some level of implementation intentions, I think is sometimes kind of overlooked in terms of really understanding, OK, in terms of making it easy, how do we ensure that the person obviously knows what to do, have it integrated in a time and place when they will always be able to do it without much kind of other interference that could make it so that they forget about it or get distracted and X1C.
And how do, how do we create this, like really strong, kind of like implementation intention so that they can like start to basically understand the connection of like what they're supposed to do, when they're supposed to do it, how and so on. And yeah, I think that's all something interesting to kind of explain early, early phase of introducing this asks you obviously also like you say, I think you had a good examples of how you can still do a lot of
things automatically, but yeah, what do you think about that side of it as well? Yeah, yeah. So you established early on what is your cue for taking your medication and often it's something like you know my when I after I brush my teeth, I will take my medication and and that it works especially well if you have a a twice daily medication regimen, not so much if you have to take something at lunch but then you know maybe you can pair with your meals and so on.
But yeah, I think some some upfront design especially if your if your regimen doesn't change overtime, right. It can get complicated if it does but actually this does remind me of a of a study that I ran with Medtronic. This is back in my in my pattern health days where we we had a almost like it was a recurring implementation intentions.
So often when you think of implementation intentions you think of sort of one time set up in the beginning that sort of lasts and and is a consistent cue. But we the use case that we were working with was actually a a more inconsistent regimen. And so we wanted to be able to to make sure that people could on the fly based on changes in their needs for a medication could actually adapt to that and set an A different implementation over time.
And so we have this, this whole process for you know deciding on a basically a daily cadence, not every day, but when it was necessary to to change the regimen, when they would they would take their medication or or or step on the scale or or do the behavior change that was necessary. And so we it was, it was either paired with one of the meals or with toothbrushing. Those are really the common, you know, staples and everyone's daily, you know, daily activity
diet. And we found that that actually doubled their likelihood of of doing the thing which was just from a impact perspective incredible, right. Like you don't usually get that kind of that kind of lift from any sort of intervention. So we were, we were very happy with that. But yeah, I think that in combination with making it easy but having these sorts of cues to trigger, you know it, it doesn't work of course if if the person doesn't set their implementation intention.
And so you're you're still relying on on users to, you know, be motivated and and do the thing in those other ways. Yeah. So I I usually have this kind of basically when trying to decipher some of these things considering obviously you know how do we in a perfect scenario get things to happen where you know we drive up some level of
ability or motivation. So it's it happens But also understanding that there will be risk for whatever first cue or 1st signal that you're trying to kind of like build as strong as possible that it fails and then you can have some like mitigation strategies or worst case scenario people kind of completely fall off and you have some form of recovery mechanism
to get them back on track. So like for example, like what I want to come to is basically some level of escalation ladder of thinking about reminders or things. You know, there's like some things that's like that. You know, ideally they would kind of set up some form of implementation detention. It will kind of be reminded through the thing you connected to, like you say brushing your teeth or eating or drinking or athletic green, but everything people do these days in the mornings.
But but then like if that fails, you know, having some like level of escalation to like OK, how how can we ensure that happens? I feel like you're setting me up for this, but interestingly, that is. I've worked with a product that that worked in exactly this way back in my in my days at Duke we we worked with a company that was called Vitality and they had this this product glow caps. I actually I've recently tried
to find them and I couldn't. So we can think about what that means for for their product but but I'll tell you how their their product worked. They basically had this Bluetooth enabled smart pill bottle where where it's time to take your medication and they have this night light that once it's time to to take it a turn it changes color So it it it notifies you OK it's time and I think you know maybe it it starts with the orange and then it turns red once you pass your
time. So it's it's notifying you that it's time. But if if you sort of miss your your dosage time, then the bottle starts beeping and just making this big fuzz. And it's a it's actually a horrible sound. You know, I had to work with these in the lab and sometimes they would occasionally go off and everyone in the lab would just be like, Oh my gosh, what is happening? Is there a fire alarm? It was quite aversive. They really, they really had a, you know, the ladder went pretty far.
Exactly. Yeah, yeah. And. But this wasn't even the end of the ladder, right? If you if you then ignored it, at this point they actually had the ability to send a message to a family member or friend, you know whoever you designated either by text or e-mail as this additional step of accountability. And and so this definitely definitely fit into that category of Tears of Escalation.
But I am curious what happened to the Glow Cap and why I can't find any really any any product that does this exact yeah. I I do remember also, I don't know exactly when you did this, but I remember like working on some of these projects or similar things or hearing about some of those interventions and like five, 5-10 years ago like the Glow Cap. Yeah, this was like 10 years ago, yeah. OK. Yeah, I remember that being kind of like you heard a lot about that, but haven't as well heard
too much actually. One example that is much more how to say like simple of sort, but I actually is well done is with Duolingo. They have this now you know you can add like a widget to your screen and they do this quite well where they have like the widget updating across the day, I think maybe across maybe 15 or 20 iterations. And so in the in the beginning of the day you see like this kind of image of this, you know Duolingo, I guess some form of bird. It's an owl, right?
It's an owl, yes. And it's kind of happy. Or it's like abstract something like strange things going on just to kind of be getting your attention. And then as you kind of wait, it starts to become a little bit more and more desperate across the day. If I'm looking right now, it's kind of looking at me a little
bit like skeptically in a way. Like are you going to do this or not about 4:00 PM And then you know towards the evening and it will become like orange and then it will be like firestorm or like whatever and Hellfire scape of like do this now or all will be lost. And that is obviously happening only on my home screen when I'm happening to scroll through it or swipe through it on my phone, but actually surprisingly well. On the home screen of the app, or if you just open your phone,
it's. It's there with your. Yeah, so it's actually. It's a widget that you could add to your Yeah so it's a widget you can add to your your your main screen. And so it's I have it on one of my 2 main screens that I always swipe through and it's it's actually performed quite well, especially when things like notifications are hard to to get people to actually respond to
these days. And I feel like they are one of the few who has really been creative with kind of a really playful but but also well designed widget to kind of find some space in the home screen. Yeah, I feel like the the widget brings lots of opportunities for for more subtle reminders that that notifications were were not doing well at all. So that's good job on the the widget development front.
But it's funny though I the your description of the OWL and it's been a while since I've used Duolingo. I lost my strength a couple years ago and never went back. But but wait but we had you know, I'm tempted to say that the Duolingo stole this from Pattern Health who where we had a we had a a smart a pet the this, this little virtual turtle. And the turtle Virgil would also react to your adherence to your your your tasks and your care
plan. So if you would you know forget to take your medication for example, Virgil would not be very happy with you and and the turtle went through different a series of different states as you progressively lost track of of your care plan more and more overtime. Yeah you hear that Duolingo people give give credit to do they will OG I mean like they should come to you and say like hey you were you were first. Right, it's a. It's a owl though, so it was totally different from the
turtle. Cool. So we have now covered a few things to make it easier. Have you got any more ideas for ways to make it more more easy to take your medication? So I found one very interesting product that that does something I had not thought of myself and and this company, a Sobu basically takes a water bottle and installs a pill a like a a Monday through Sunday pill box into the water bottle itself And so it's just it's one water bottle with an attached. I know it's hard to imagine.
You almost have to. You almost have to look at the the, the image. But but think about it right this bundling you've got you when you take your medications off, and if they're pills, they you have to take them with water. Why not have the water conveniently there already when you're taking your pills? And I think that that this kind of solution could work really well if you're the kind of person who carries your water bottle with you everywhere, right?
It's not going to get lost. It's always handy, of course, if you're if you're the kind of person who doesn't carry their water bottle around with them everywhere. Or you know, I guess maybe if you if you left it by your toothbrushing station, maybe it could work. But the risk to me in this situation is you lose your water bottle and you lose all your medication. That's right. Or you leave it in the car and
and now. So I think in general the recommendation is like leave your meds in one place and know that they're always there. Yeah, But I actually looking it up now and seeing it, I think it is in a similar vein of trying to actually as also maybe with kind of the widget idea in some ways of trying to place your kind of daily medication taking into your natural life in some ways.
Whether that's through like being reminded of it in places you already kind of happened to be where that could be your phone, that could be your kitchen, that could be certain things that you're always going to be going to. But especially with this, like, I do admire the ingenuity in putting this together. It's very creative. And and if you think about, so you know, we talked about the recommendation to take your meds.
Well, when you brush your teeth, just to pair those behaviors together, just imagine that you had a combo toothbrush and pill bottle. You you had your pill box attached to your toothbrush like they're not going anywhere. There you go. Yeah, no, I I think, yeah. If you have any wild ideas of how we can combine products into some form of a toothbrush, pillbox or other things, you know, e-mail us.podcast@haveaweekly.com. It'll be awesome to hear what ideas come out.
But yeah, I think we've covered things in terms of payroll informed ideas and insights on how we can make it easier to to take the the medication and maybe we can segue to making it attractive. And I guess you're already talking about bundling now and I think a lot of people when they hear bundling, if they're in kinda call it the behavioral science space, they're very prone to now think about temptation bundling. Do you have any thoughts there?
Because obviously it's also lends itself to very popular metaphor or story used with temptation bundling, which is a little bit of. A spoonful of sugar helps the medicine go down. There you go. Exactly. So yeah, what are your thoughts about temptation bundling? I mean you could always take your medication with a spoonful of sugar, for example, I mean. Problem solved. Yeah, there are other ways to do
that, I suppose. I'm not sure that any medical professional would recommend this, but you know, you you could, if you don't drink juice normally and you want to give yourself a little treat to incentivize yourself to take your medication, you could. You'd always take it with the juice instead of with water. Yeah. It seems like a net positive in terms of for many of those
things. If you have like something that you know you you can, you can especially the whole idea is obviously that you have to be somewhat disciplined in terms of like only you know, in that case drinking juice when you take your medicine. Exactly. Yeah, that's your. That's your One Cup of juice for the day. And that's kind of what makes it also be less likely to be probably like a large scale successful intervention because you cannot.
It's hard to really engineer that type of level of commitment and motivation among users in the same way. You can probably like spark some of those ideas with kind of providing inspiration, but it's a little bit harder to probably implement. So what are other ways we can
make things more attractive? And actually before we move in there, is there something we need to say about attractive stuff We we're not talking about making things more say visually appealing, more like a generally generally. Do you think that that visual appeal fits into this category for sure? For sure. For sure. But you know with medication I think the the first thing you think about is the taste so so making it a more pleasant experience.
There are lots of ways that you can make it a more pleasant experience and and in line with the the spoonful of sugar idea. I think there are lots of other ways in the formulation of the medication itself. But if you, if you you know have a sweet coating on the pill or you know I haven't I have a lot of experience with gummy vitamins. Right. Gummy vitamins are pleasant to take. It's like you're eating candy.
They're. Taking over America, it feels like I feel like I see so many gummy varieties these days. Anytime I see like, yeah, that's funny. How many, how many gummy varieties would you have at home? I would just take 11 gummy multi multivitamin OK? OK. Or do you mean in terms of actual? Actual medication? Yeah, actual medication. Like, I'm just interested. Like, is there some, I don't know, is is there any too many gummies? Or is this more gummies better? Could we live in a world?
Where you Yeah, I think you can have too many gummies. I do believe that. I'm just trying to like, obviously we have this image of like what medicine looks like. Yeah, and I was just taking a step back and imagining a world where all medicine looks like gummies, and whether that's a good thing. And maybe it's not possible for obviously some things. But yeah, is it a problem if some things are gummies or not? Some things are not. Would you prefer if all things are one thing?
If you're multiple. Of this medication, for example. I mean if if you there are some medications that are that have a bad enough taste that you don't want them to be gummies I think or the amount of sugar that you'd need to compensate for the for the the unpleasant flavor would would make them a you know
too giant to eat. And so I do think that there there are some things that really should just be swallowed you know get it down as quickly as you can assuming that that the the user is capable of doing that. But there are there are other ways as well you know if it's in a in a non gummy situation that you can make something more pleasant to swallow. You know, there are. There are pills that are just far too big and are much harder to swallow. And two pills might be better
than one giant horse pill. But then there's also the opposite problem I've had, I've had medications before that are so tiny and light that it actually is hard to get it down your throat. You don't, you don't want it to be so light that it's hard to swallow and you don't want it to be so big that it's hard to swallow. You have to, you know, get into this, this, this nice sort of Goldilocks balance of getting the right like, I don't know,
like ingestion ratio. Yeah, I guess I should have done a little more research on. So Ray Kurzweil and Brian Johnson and the folks of like taking 60 pills every morning and every evening, like there's some people that are like really longevity focused that live by taking enormous amount of pills and I actually haven't looked into. I would be careful about attributing causation in that scenario. What are you saying? They're that they're living a long time because of these, all
of the pills they're taking. It seems very unlikely. I don't want to get into the to the whole longevity optimization. Yeah. I'm more it's just fascinating for me to see like someone is like yeah you know every day I take 100 pills in the morning like that seems like just a very unpleasant and difficult thing to do. OK.
So we talked about in terms of thinking maybe specifically in terms of the medication pills for example or you know that kind of stuff, how you can make that maybe more pleasant or more attractive as we're focusing on. But yeah, do you have any thoughts about packaging and the sign beyond that? Oh yeah. So, so we know that there's lots of emphasis placed on marketing and and you know the the formulation of medication itself.
But I think that the that thinking about clever ways to innovate on the the packaging and the the bottle itself the casing, I think there's a there's a real opportunity there this this really sort of often goes totally untouched, right. You you don't see much attention being paid to the pill bottle. If you think about the the the pill bottle that your medication comes comes in as a default. It's often very unattractive
right? Like it's almost the epitome of an unattractive thing sort of hard to read hard to find the relevant information. So, so lots of room for improvement even just in terms of simplifying and and making it easier to understand, right? But then there are there are also opportunities on top of that to to, you know, make it, make it even more attractive beyond the basics.
It could even be something fun. And if if you think about like if you were designing a pill bottle for children, maybe it it looks like something like a Pez dispenser or? Oh, you know, there's I love, I love Pez. When I was a kid, that was funny. But not anymore. Well, I haven't had in a long
time. I'm sure I would like it as much today, but I I do remember just that, like completely, you know, the the pest things are not that exciting, but because they were delivered in the way they were, it was like such a rewarding, rewarding feeling. It's just the delivery itself that makes it it exciting. So imagine you were taking your medication out of a out of a Darth Vader. You know, like a pill bottle like that would be so cool.
Yeah, I can't imagine it. I'm not a big Star Wars fan originally, but I I can imagine this this is working very well. And yeah, I I remember Arthy mentioned a little bit about just kind of making the packaging maybe more sleek, for example, so that it's a little bit more like maybe removing
some stigma. But like you might feel, you know, a little bit bad taking up this pill bottle that looks like it could be anything inside and you don't want to signal that you're sick or that you're not feeling well, for example, once it becomes this kind of, like embarrassing thing to bring with you. So just yeah, finding ways to make it more subtle could also work quite well. Sometimes, even though subtleness might work against, you know, something being salient, that's something you
remember to do any more. Any more things here? Any more packaging? Yeah. I mean you know beyond if you can think about other ways to make it fun if there were a game associated with your with your
medication taking right. So it it's not just that you've done it and you get to check it off the list but you've done it and you know and and there's there's something there's a fun challenge or it plays a song that that you have to guess you know like what is this song and if you if you if you guess the song correctly then you then you you can you start accumulating points and you know for the for the more are more gamification inclined users this could be a a really fun activity and they
want to rack up rack up their medication points. Yeah, yeah. I think it it's it's something where I feel a little bit like the piano staircase people might know about that example in terms of, you know, making more likely to. Hate the piano staircase. I do. I I I for some reason it's like the thing I have a strong opinion about, just because it's like it's a cool fun video to showcase.
But then who wants to every time they walk down the subway have this like really loud sounds and especially a lot of people running down those stairs, it's going to be like not the most pretty sound as well. So I feel like. I'll tell you who my toddler would love that and he would never get where he's trying to go because he would just stay on the piano stairs for hours and hours and it would never get old. But. Yeah, it's something that I'm, I'm, I'm more positive towards
IDEA. I think it's something that you shared ahead of this in some way. I think you meant something about like Jacobs or Louis Vuitton something. Yeah, so so I actually I I had this idea that that maybe you could you know go go the fashion forward route right for those who who who care about their appearance And actually I so I googled designer pill bottle to see does this exist. Does anyone make this? I did find a Louis Vuitton monogrammed bottle.
I also found a a pretty pill box recommended by Wirecut. It's it's kind of like this. It's very sleek and discreet, kind of looks like an eyeglasses case. It looks like just something you would throw into your purse. And yeah, it's like I I think this that that falls more into the discreet category that Arthy was talking about because you wouldn't know that it's a pill bottle unless you or a pill box actually, unless you slid it open and you saw the trays.
Well, yeah, I think, you know, for those who want to show off their medications rather than hide them, there are all sorts of of of fashionable approaches that you can that you could use to make your pill bottle more attractive.
Yeah, no, I I like that. And I'm now use thinking about various ways to kind of use signals to people's various types of also like identity kind of things whether that's being fashionable or you know maybe leading into some people that like are really wanting to optimize for their health in various ways. And you know if they are happened to be taking something like a leather greens.
I think what they've done well with those kind of supplements, which is still like unclear how well they actually work. But they sell the idea of of doing something positive for yourself taking like something every day that that's kind of a
vote for your healthier self. And I don't know if if there's some ways to kind of better align, you know, the idea because it's kind of like it's it's kind of framing problem in some ways where obviously the medication you take because you're sick or have high risk of getting sicker or becoming sick, but you're taking it to become healthier, as I'm most thinking. Like there's just some ways to frame it in a more positive,
more kind of empowering. Like what I'm doing for my health, not like what I need because my health is is, you know, in in jeopardy. Yeah. All right. I think we have totally exhausted the category of attractive. But to our listeners, if you have any other ideas of of how to make a a pill box or a pill bottle more attractive with behavioral design, please shoot us an e-mail and let us know. So, but what do you think about our our next category is social.
This was a little bit controversial. If we think back to our our beginning discussion about asking people about about their medications or or their health issues or their, you know that the whole category of of health itself, especially you know with the more medical side of health, not the more Wellness side, you know it's a little bit tricky territory. What do you think about making adding a social element to to medication management?
Yeah, well, it definitely feels like this kind of this thing that could either become like a huge ally or or increased chance of you taking medication or maybe potentially something that risks reducing it being kind of the people around the person. So how can they kind of in some ways create allies around them or supporters or people that can kind of like help them?
And it's a little bit tricky because things like, let's say crucial conversations or stuff like this, when it comes to supporting people in being better at kind of talking to their loved ones. I think it often comes up when it comes to something like let's say someone needs to change their diets, but then, you know they have a partner or you know kids and various things. And it's hard to renegotiate what's brought home and it's hard to figure some of those
things out. And it can be useful to get some advice and support on how to talk and how to maybe, you know get people on board with what you're trying to do. But at the same time it's something we naturally have a
lot of anxiety around. And and and it's it's tricky to to open up and talk about things like that even with you maybe sometimes your partner, but especially if it goes to kind of beyond the near family and you have to talk to your, let's say anything like friends, colleagues that can become like really exciting to you saying to kind of admit some of these things or you know talk about some of those stuff. So yeah, what are your thoughts about that?
Well, I think the the social category as a whole is a really good example actually for how essential personalization is. And really it's because the some, some people are really drawn to having accountability buddies and bringing in their family to their health decisions and and and and you know having those conversations and then other people really shy away
from them. And it just I think so much speaks to this need for not not having a one size fit all approach but personalizing to the individual's preferences and needs and so on and just understanding that that a social solution is not going to be for everyone. It's going to be really helpful for some people, but but
definitely not for others. Yeah. And do you have any bet in terms of obviously, again, we can think about this more personalized point of view, but you know this idea that you can either leverage some form of support that is some strangers, but they're happening to be going through something similar like you are.
So you know, it's something that you could, you know, come across at some form of like let's say as an example, I know Amada Health does this quite a lot where they have programs that kind of bundles a bunch of people that are trying to issue something similar. They can have coached by someone who has gone through that program before as a form of added support or coach, and then they're going through XML steps together. But they don't know each other
outside of this context. So they don't have to worry about kind of like will people talk about this stuff at work, will people, you know, Expo and C So you don't have to be kind of worrying about that as much. But at the same time, you can probably argue that like people that are actually in their social circuits will be more impactful in terms of helping ensure that they stick to whatever they need to follow on with them and really could potentially be even more able to
help them. How do you think about those two two type of social? Well, I feel like you're setting me up again because I've actually run this study with a a very large trial with Novartis back when I was at Duke. Unfortunately, I don't know the results because I left before it was finished. I haven't seen the seen it published, but it was, it was a very, it was a longitudinal
study. So it it it went on for many years, but we actually randomly assigned patients, heart failure patients to one of these conditions. So they they each had a each condition had a care circle and some of them one of the conditions had was asked to invite their you know their whoever they wanted right their their close family members up to a certain number of people.
So they created their own, their own care circle of people that they wanted to to stay updated in their their health plan. And then we had another group of exactly what you described it. It wasn't so much that the that they're that they were paired with people who had already been through their situation and we're now experts on that. But it was other people who are going through the same thing at the same time.
So other other heart failure patients were also in the study and the idea was like who knows what's you know the only way to find this answer is to test it. So I I would still love to know which is which is the more impactful route. I do suspect that the close family members are going to have a stronger influence. I think it's it's much easier to ignore strangers than it is is your family members.
Of course it's also going to depend on you know, how invested are your family members in checking in on you. Are they paying attention or is it just, you know, the information is flowing in and and you know nobody's, nobody cares about it. So yeah, lots of it depends in this answer and I think that's, you know, that's generally true for our health and and generally true for digital tools. And yeah, I wish. I wish I had all the answers.
Yeah, I I would love to find out those answers as well. It's it's interesting as well because I would like an extension of that type of experiment. What I would be really curious to understand and and see how it plays out is the study of abstinence violation effect.
When it comes to usually that's looked at when it comes to like something like drinking related maybe addiction or some form of thing where someone is trying to abstain from from doing some form of thing and they're having some social support in trying to abstain from this but then they failed to abstain. Like they they have they go to you know alcohol anonymous and they have some sponsor but then they end up drinking.
Will they tell that person or will they kind of feel really embarrassed because they've kind of let someone down and then kind of spiraling the wrong way And and that's sadly something that can obviously happen in many cases. And and sometimes you know it's been the case with some interventions that I've been doing where it's it's maybe a little bit less steaks in terms of maybe it has to do with their eating behavior. But it still hurts when you're
supposed to you know, less. An app tells you that today it's it's good if you have this salad and then you end up having a pizza. Going into that app, admitting to that that actually I had a pizza instead, and seeing the calories just go through the roof. Or whatever it's. Painful to admit. It's painful to admit. It's true, I But people are much more honest with their sort of anonymous devices than they are with people. Right?
So. So I think that that you you would see less a less a lower likelihood of someone lying to their nutrition app than they would to a friend.
Yeah, but that's where I wanted to test experiment as well where you know if you have 3 scenarios like either they they they have committed to some form of like app that's bring them or they have this this circle of fellow patients or fellow people that are going through similar journey but are more kind of further from the social circle or they have that family of nominated or like group of nominated people, which one would be more likely to kind of suffer the abstinence violation
effect from. So that's just a caveat to that experiment. If if anyone ever runs it again, let let me know. No. Awesome. Do we have anything more to say about about social before we move on to personalization? No, I think we should, we should finish off and talk about personalized and we've kind of planted some seeds here. We'll talk about some of these things along the way in terms of why it's important, how it could be done.
But yeah, given that you fought to have this as its own thing, like tell me more, replace, replace, replace. Timely, sorry, behavioral insights. I feel like I need to, like, send an apology. I'm sorry I've butchered your framework. Yeah. I mean, no, you're right. I there are threads of personalization through every one of the other categories and in many ways, you know, everything must be personalized. But yeah, I I think like one
major area. It just goes back to the number of pills, the complexity of the medication regimen. You know, what is your schedule like? Can you use a pill bottle or do you need a pill box? Do you need, you know, how much organization do you actually need in terms of compartments? If you have a a ton of pills on a simple schedule, you know, that's fine.
You take them all at one time, but as soon as you have, you know, before breakfast, after breakfast, lunch, dinner, before you know before bed and so on gets really complicated in terms of separating things and or you know you have this. This one can be taken every four hours and this one can be taken every six hours. This one has to be taken with water. It can get really complicated
really easily. And so yeah, for for a situation like that, you have to design AA much different solution than for the person who's who's taking one thing right. Yeah, so complexity is the enemy in many ways here, like understanding how how we solve for that. Do you have any ideas or how we can can manage that somehow? I mean, there are definitely some solutions out there on the market. So when we were talking to Arthy, we were joking that that the pill bottle she created was,
you know, $100 pill bottle. I've actually found a much more expensive, actually. It's this massive smart dispenser and it looks kind of like a coffee machine that you essentially program your very complicated schedule into. You dump all your pills into it and you know it just it. It dispenses exactly what you need when you need it. But it is bulky. It is expensive. It's something like 30 or $50.00 a month and you know you can't take it anywhere you have. You can only take your
medications at home. It's just like a very it's personalized for complexity, but it's not personalized for something like you know someone who must travel or like someone who needs to to take their medications on the go. If you think of the the there are some some larger pill boxes that still have a removable compartment.
So if you you can you can have your massive organization at home, but then you can still, you know, take out your, you know, you know your lunch and dinner meds and bring them with you if you need to, which seems like maybe a better compromise. If you can't, if your if your complexity is not so high that you need this massive smart dispenser, then I think a basic pill box can be, you know, just an adequate solution.
Yeah. This reminds me of like how how used everything we do when we kind of basically get out of our confinement of our home reduces risk of our habits sticking. Like it's just we do we introduce so much mess when especially when we travel in terms of, I think that's an interesting part of, you know, of course people travel for work maybe, but you know what if they have to go for what what if they have to sadly go for a very nice vacation. That can still be an issue in terms of you can't.
Go on vacation. Yeah. But it it's, it is tricky in terms of kind of mitigating for that. Yeah. Or personalizing for that more unpredictable pattern that some people might be inclined for. And and there you're kind of have to figure out the best of worst set up. Like it's obviously the one you illustrated like the the hero whatever machine. It's hard to beat that.
But then you're stuck at home, you can't leave at home and so on. And so yeah, it seems like whatever other personalized solution might be deficient in some ways and that like, OK, if you bring it with you in the car, you might forget about it in the car or you might. There's a lot of those challenges that I think it's it's interesting to consider and I guess context will differ in terms of what's needed. Context matters. There are upsides and downsides to every solution.
And yeah, I suppose we don't have all the answers, other than there's an infinite number of ways to to personalize, and that should be done in some way. Yeah. In the past, if we had now like a very clear understanding of what the medication was, what the audience was and so on, I guess it would be easier to kind of approach this. This one doesn't mean that it's you know again not important,
it's super important. But I think it's it's especially a good example where even you and I right now we we are a little bit limited in terms of not really having a defined thing to personalize for. It's true, but we do have a pretty good starting point. I think we have some some nice rules of thumb that that you can start from in order to design if you did have more information about the situation. Yeah. Now honestly, this has been really great. I think this is one of the more
fun for details in many ways. And you know, it's always fun whenever I say something, you kind of having another ace up your sleeves to say like, yeah, I did, I did that research. That's always. What if we did that? I did do that. Yeah, so that I think this has been awesome. Any closing thoughts about pill boxes? Yeah, I think that that our easy, attractive, social and personalized framework works.
It really served us pretty well here and and I think we could we could recycle it in the future as well. Yeah, yeah. We'll see if BIT forgives us for making. I know we're going to get sued. But yeah, hope everyone enjoyed this as well. If you have any further ideas, just reach out podcast@haveaweekly.com Thank you so much for listening, supporting everything we do. This was the final product deep dive of this season but hopefully more more to come next
season. And again all of your messages is really I think welcome. It's it's always, I don't know, Len, do you agree that like there's few things that makes you feel as happy as when someone compliments? I completely agree. Nothing brings me more joy. Yeah. So thanks for that and thanks for listening. Hope you have a great day and take your pills. Time to wrap up another episode of the Behavioral Design Podcast. We hope you enjoyed the show. Oh, and I am an AI.
Yeah, welcome to Uncanny Valley. Sam and Elaine told me. This is going to be an awesome season, so make sure to subscribe and help spread the word. Maybe share the podcast with a colleague or friend, and if you want to show us some extra love, head over to Habit Weekly. Come and join our community Pro members, get access to a wealth of resources and the chance to interact with leading practitioners. It's a great way to support the podcast and deepen your understanding of behavioral
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