We frequently aspire to improve our lives, and cultivating new, beneficial habits is fundamental to achieving this. On New Year’s Eve, millions of us make resolutions like “Next year I’ll go to the gym every weekday.” Or, following a scary discussion with their doctor, many will vow: “I’ll take my hypertension meds regularly.” However, life unfolds, and the Doer within us subtly undermines the grand plans arranged by the Planner.

Picking up a new activity requires considerable energy at first, especially for something that may not be enjoyable in the moment but offers great future benefits. Sticking with behaviors can turn them into habits, and activities like meditating right after you wake up become easy and automatic. You’ll probably begin to feel something is wrong with your day if circumstances force you to skip these activities. 

This is the power of habit: formerly deliberate tasks evolve into automatic components of your life. Even in moments of absent-mindedness, a habit remains your go-to choice. With the right tools, we can influence people to form new, beneficial habits for their health and well-being. In this chapter, we will show you a powerful framework to do this.

Advancing behavioral science and digitalization creates a real opportunity to build powerful habit-building tools

Studies by neurobiologists and cognitive psychologists indicate that at least 40 percent of everyday human behavior falls into the habitual category. While habits have an enormous impact on people’s physical and mental health, and most medical interventions require patients to modify their routines, habits are also notoriously hard to change because they are so deeply rooted in our everyday lives.

Digital applications, particularly mobile apps, and wearables, offer growing potential to influence health-related behaviors and habits. Developments over the past decade underscore this trend from two angles: advancements in behavioral science and the pervasiveness of digital technology.

Behavioral scientists continually refine theoretical models of habit formation. This, in combination with our expanding scientific knowledge of Behavior Change Techniques (BCTs), offers practical methods to assist individuals in developing more effective health-related habits. The tech industry has already begun capitalizing on these findings by employing these techniques and tapping into the underlying science.

This is particularly evident in social networks, where robust digital behavioral engines can now link users to specific products and sway behavior on a massive scale. In fact, their influence is so profound that managing their impact on individuals and society has become a global social challenge, igniting intense political debate.

How can health tech companies leverage digital technology to assist patients in developing positive health-related habits? In the following, we present a practical model supported by science to create a self-reinforcing habit-building cycle.

Every behavior starts with a trigger. Without a trigger — whether it’s an internal feeling, such as hunger, or a cue coming from the environment, like a notification on your phone — the habit simply wouldn’t take place. So, the first step in creating or changing any health-related habit is to identify the trigger that will be associated with it.

• Use contextual triggers: find or create triggers in the environment. Most digital apps apply contextual prompts to trigger the expected behavior. These can be artificially designed events like a push notification reminding you to take your medication at a certain time of the day. They can also be physical cues in your environment, such as keeping medication on the kitchen counter where you’ll see it during breakfast.

• Competing with the digital noise requires creative solutions. Artificial prompts like push notifications are straightforward tools apps can use to stimulate behavior. However, effectively delivering notifications is increasingly difficult in a world filled with virtual events that compete for our attention. Even when accurately timed and placed (using geo-location and machine learning for targeting), their impact is limited to the initial stages of habit formation. Over time, these prompts lose their potency, rapidly blending into the distracting digital noise we all aim to minimize.
  
  
• Use anchor habits: linking new behaviors to existing routines. For enduring habit change, we need dependable, long-term triggers deeply embedded in a person's life. Ideal triggers are pre-existing habits that can be used as foundations for building new habits. For instance, the new habit of flossing can be effectively linked to brushing your teeth, a habit most of us already practice. The trick is to identify an existing anchor habit that aligns with the frequency and location of the new habit and establish an association between the two behaviors.
  Digital apps can assist users in identifying suitable anchor habits (established routines), and then foster and strengthen the connection with the new, desired behavior. For instance, instead of sending medication reminders at the same time each morning, encourage users to store their pills on the kitchen counter and take them with their morning coffee. 

Triggers are prerequisites, but on their own, they aren’t sufficient to launch us into action. The two other necessary components are motivation and the ability to carry out the behavior. Being reminded to wash your hands before eating is insufficient if there is no soap or disinfectant you can use (missing ability) or you simply believe that “some dirt just makes you stronger anyway” (missing motivation). The key for digital apps is to recognize the inverse relationship between motivation and the effort required, as described by the Fogg Behavior Model.

The Fogg Behavior Model in practice

Fogg's model provides a practical lens for predicting and influencing human behavior. Consider the following two examples:

When minimal effort is required, a small amount of motivation is enough. If it takes only a few seconds to scan and automatically upload your blood pressure data via an app, you're more likely to keep track of it than if you had to meticulously record each result in a notebook for your doctor.

Strong motivation will spur action, even when considerable effort is needed. For instance, learning about a friend's severe illness and becoming frightened might prompt you to go the extra mile to schedule a comprehensive medical examination, despite the considerable effort involved.

Keep in mind products and features demanding excessive effort from users without strong motivation almost never achieve their objectives.

The strategy is clear: increase motivation and decrease the effort necessary to carry out the behavior (or vice versa, if the goal is to put an end to a bad habit). In reality, when designing habit-forming digital products, making beneficial behaviors easier is more achievable than trying to influence the motivation to act. To a degree, it’s possible to increase and maintain motivation through education and emotional design, but without initial buy-in from the customer, habit-building is unlikely to happen.

We will look into how to decrease the required effort, but first let’s examine how motivation fuels habits, and what techniques digital health apps can apply to boost it.

Motivation isn't constant: apply different strategies for peaks and valleys.

A crucial aspect to consider when it comes to motivation is that it oscillates. You experience natural surges of motivation when you’re eager to change: you switch to a healthier diet, start exercising, or meditate every evening. In those periods (usually at the beginning of the year or after an important life event) you might even invest in a pair of new running shoes and go for a run a couple of times.

However, these peaks of motivation will inevitably be followed by valleys of motivational lapses. Different strategies are needed, depending on whether the user is currently at the peak of a motivational wave or has slid down to a valley.

• Motivational peaks are the best time to make users put in the hard work that will help them stick with the habit in the future. Get them to structure their future behavior, and create plans, goals, and commitments to keep the new habit running. Facilitate investments to mitigate any obstacles that might hinder their behavior in the future when motivation will be a scarce resource.
• When motivation dips, focus on following existing structures, take baby steps, go for the small wins that will keep the habit alive. Users’ current motivational level can be assessed directly via quick survey questions within the app, or indirectly by analyzing app usage.

As a general pattern, expect short periods of motivational peaks to be followed by longer motivational valleys.

Behavior change techniques to boost motivation

There are several Behavior Change Techniques (BCTs) designed to affect motivation within the habit loop. These systematic procedures can be directly employed by digital apps to regulate a user’s motivation level. As always, there is no panacea that works for everyone, and these techniques should be tested and blended to best suit your product’s context and your users’ unique needs and characteristics

• Make goals explicit and progress tangible
  Motivation is mainly fueled by future results, and not seeing tangible progress can quickly deflate users’ motivation. Ask users to clearly define goals and enable them to visually track progress with regular reminders of the reward at the journey’s end. Along with long-term goals, it’s useful to offer mini-challenges to keep habits running through small victories.
  
  
• Adjust difficulty to keep the journey challenging
  Help users gain confidence and skill by incrementally increasing the complexity of their tasks. Journeys should unfold as a series of victories earned through effort and resourcefulness, all in step with users’ evolving abilities. Achieving this balance isn't simple; user testing and behavioral data-based optimization are recommended to fine-tune the challenges.
  
  
• Show the downside and activate loss-aversion
  Remind users of the negative consequences of unwanted behaviors (such as neglecting to take their medication) or the possible loss it could lead to. Take care in how this is communicated; a light touch can work great and you don’t want to introduce anxiety.
  
  
• Motivate users to chase streaks
  Congratulate users on consecutive successful behaviors and use loss aversion to discourage them from breaking a positive streak. Streaks offer simple yet effective challenges that tap into multiple psychological mechanisms.
  
  
• Build enticing bundles
  Connect the desired behavior to a pleasant activity to make it more attractive. For example, “Listen to a new podcast episode while doing your daily exercise.
  
  
• Create anticipation with rewards
  The benefits of a positive habit often lie in the future. But you can sweeten the deal in the present too if you include an immediate reward. Offer tangible, emotional, or social incentives when a user performs a behavior or makes progress in habit formation - such as points, discounts, or peer endorsements.. To sustain interest over time, make sure the rewards fluctuate unpredictably in value. According to behavioral science, variable rewards are the most effective, which explains why gambling can be so enticing to many.
  
  
• Boost users' pride in emerging habits with achievements and badges
  Name and visualize various achievements users have accomplished. Use identity association by portraying positive behavior as an integral part of the user's identity, such as 'I'm a vegan' or 'I'm a non-smoker'.

Behavior change techniques that tap into our social nature

• Establish a network of social support
  Connect users with friends and acquaintances to provide praise or emotional support for achieving their goals. Arrange a “buddy” who they can turn to when they lose motivation or they feel tempted to revert to negative behaviors.
  
  
• Ignite motivation with social comparison and competition
  Build on the natural competitiveness of your users. Gamify the habit-forming process by making it a fun competition between friends who are working on developing the same habit.
  
  
• Enhance persistence with social commitments
  Ask users to make explicit commitments in front of their social network and provide ways of accountability.

If there is one thing UX-driven digital technology truly excels in, it’s simplifying complicated tasks for users. When you scan a barcode at a grocery store and receive tailored advice on how the food integrates into your diet, adhering to a recommended nutritional plan becomes significantly less challenging than independently investigating ingredients and calculating their values.

The inverse relationship between motivation and ability (the effort needed to do something) shows that reducing difficulty has strategic importance when users lack motivation to perform the desired behavior. Influencing people's motivation proves more challenging than improving their ability to do something, which is why the golden rule of behavior design is to start with fixing ability first, making the desired action as simple as possible.

What makes a behavior difficult (or simple)?

The factors that make an action easy to perform are well-established. While there are countless ways that simplicity can manifest itself in a product, they all derive from a combination of certain fundamental elements.

• Time: how long it takes to complete the desired behavior. Or, to be precise, how long a person feels it will take. Ultimately, it’s the user’s perception that matters.

• Physical effort: all the physical activities involved in carrying out a behavior. Do I need to travel to see my doctor in person or can I share medical data from an app and book a video appointment? Do I need to keep track of my blood pressure by noting the readings in my notebook every day, or can I scan my readings with my phone and have them memorized by an app?
  
  
• Mental effort: The amount of cognitive load required to perform a behavior. Adopting new, healthier habits demands greater mental effort than following a simple treatment plan, which itself can pose challenges. Patients often encounter the difficulty of limited guidance from busy doctors regarding integrating essential lifestyle changes into their daily routines. As a result, they may have to navigate the process independently or seek information from less reliable sources. These challenges can be categorized into four interconnected areas:
  
  
• Formulate a plan: A portion of the cognitive load comes from having to plan and reschedule daily activities.
  
  
• Remember: Another challenge lies in remembering to consistently complete the desired behavior, such as taking medication.
  
  
• Restock supplies: Keeping track of necessary supplies is the next possible point of failure (for example, my pills are running out, I need to get a new prescription). 
  
  
• Learn what is relevant: With the advance of the internet, access to information is no longer an obstacle, but having to filter out relevant and trustworthy data and translate it to personal context still adds to the mental load.
  
  
• Deviation from existing routines: the more a new behavior disrupts existing habits, the harder it is to implement. Introducing a new habit often forces us to reorganize a large number of related habits deeply ingrained in our daily lives. Transforming a diet, starting to exercise regularly, and creating a healthier bedtime routine might interfere with dozens of existing routines that are difficult to modify all at once or even over the span of a few weeks or months. Unfortunately, many apps fail to effectively support the implementation of new routines as they demand excessive changes far too quickly. People are simply unable and unwilling to keep up.
  
  For instance, transitioning to a vegan diet involves altering how one shops at the grocery store, prepares food for oneself and others, orders meals, dines out, and celebrates special occasions with friends and family. All of these changes confront the resistance of long-standing routines that might have been in place for decades. 

Two strategies to support habit changes

1. We recommend initiating habits with tiny first steps
   
   
2. Attach new habits to existing routines

1) Once the seed has been planted we can gradually increase the challenge difficulty and the extent of change needed in users' routines. Instead of trying to get someone to do yoga twice a week for 30 minutes, start with two-minute stretches that can be done after waking up, without necessitating an overhaul of their entire morning routine. Two minutes of stretching? There’s no excuse to skip that.

Perform just one downward dog pose after climbing out of bed, then proceed to relish a deserved cup of coffee, with the warm feeling of having completed your daily goal. The seed of the habit has been planted, and perhaps next week, you could extend its duration by a few more minutes. Because you progress gradually, you have the time and capacity to adjust other habits around it: start waking up earlier, or prepare your breakfast the day before to leave more time for your expanding practice, for example.

2) We discussed the concept of anchor habits serving as effective triggers for new routines. Linking new habits to established ones can also significantly decrease the necessary effort. Creating a random mid-day flossing routine is more challenging than ensuring it's done before brushing your teeth in the evening, when you're already standing before the mirror.

It's crucial to trigger positive emotions either during or immediately after completing a desired behavior. 

What truly affirms and solidifies a behavior is the sensation of success, pride in progress made, feelings of competency, productivity, and receiving admiration and appreciation from others. One crucial rule to remember is that for these emotions to be associated with the behavior, users need to experience them during or directly after the task completion.

Imagine you decide to brave the elements and go for a run in the park, bringing along your favorite fitness tracking app. Upon finishing your typical 5K, you discover that you've beaten your previous record and also hit the 100 km milestone for the year. As you cross the finish line, Roger Federer's voice from the app commends your performance. You feel proud and elated – you have reached a significant milestone. So you return home feeling satisfied and positive, ready for the next run later in the week. Would you feel the same if the app hadn’t congratulated you immediately? Would the same data, if provided as part of your end-of-month performance report, incite the same emotion? When designing rewards to elicit positive emotions, it's absolutely essential to deliver them immediately following the behavior for successful habit formation.

Reinforcement tactics for your product: evoke positive feelings by celebrating success

Even though triggers for positive feelings undoubtedly depend on individual factors, celebrating users’ success is an effective approach that you can safely build on. You don’t need a glass of champagne to celebrate. Tiny positive affirmations included in the app can trigger users to feel successful on the way to developing a new habit. 

There are a number of emotional design tools you can apply in an app to create rewarding positive affirmations:

• Visualize progress: Progress bars or checkmarks on top of a daily to-do list will make user progress more tangible and help them appreciate even small wins like taking a pill or drinking a glass of water.
  
  
• Quantify results: Displaying the total calories burned, miles run, or hours spent meditating aids in translating abstract progress into concrete, measurable results that can be valued and shared with others. Progress that isn't quantified remains unseen. Ensure that the results displayed are meaningful to your users. If they don't understand what 100 calories signifies in their personal context, it's necessary to either convert the information into a more relatable measure (like fruits) or incorporate some educational elements.
  
  
• Celebrate milestones: Breaking hard-to-achieve, long-term goals down into smaller milestones will provide more opportunities for celebration and allows users to experience success more frequently.
  
  
• Promotions and badges: Moving up to a higher level or tier in an app, or getting a badge that recognizes your hard work, can make your progress feel real and valued. It also serves as a constant reminder of past achievements each time users open the app.
  
  
• Social reinforcement: There's a reason why over 1 billion images are shared on Instagram daily: the satisfying feeling induced by social reinforcement. Likes, comments, and reactions from friends can feel incredibly rewarding. A word of caution: ensure that the context of your app and the information users provide is something they would feel comfortable sharing about themselves.