Technology and Behavior Change at the 2011 Connected Health Symposium

Over the next several weeks, I will be authoring a series of posts on some of the keynote speakers slated to present at the 2011 Connected Health Symposium. This year, the Symposium is unparalleled and we’re trying a multimedia approach to get the word out, stimulate dialogue and debate and prepare people to take in the amazing content that will be available.

First up, psychology and connected health.

We are delighted that Cliff Nass, author of “The Man Who Lied To His Laptop is speaking at the Symposium. At first glance, you might wonder what the connection is between a psychologist who uses computers to tease out the basics of psychology and connected health.

I was first attracted to Cliff’s book about a year ago.  I’ve been very interested in the role that computers can play in substituting for humans in providing the emotional aspects of care.  This can be an off-putting concept to some, but we are at a cross roads with respect to the demand for medical services and the supply of providers.  We don’t have enough healthcare providers to go around, especially if we continue to demand that a face-to-face encounter between patient and provider is required to move a treatment plan forward.  So when I saw this book title and the review in The New York Times, I was intrigued.

The book is both entertaining and informative.  It reads like a guide to success with such pearls of advice such as:

Praise others (but not yourself) freely, frequently, and at any time, regardless of accuracy.


Clear personalities are better than ambiguous personalities, even if they do not match that of the person with whom you are interacting.


Traditional team-building exercises don’t build teams because they support neither identification nor interdependence.


Your persuasiveness comes down to whether people perceive you as expert (are you worth listening to?) and trustworthy (should you be listened to?).


Being labeled an “expert” or a “specialist” grants you all the persuasive power that actual experts have.

All of these and many other truths are convincingly laid out using a common experimental framework.  Namely, Nass and his students use computers as emotional agents, but ones that are absolutely controllable (in a scientific sense) so they can tease out the psychological variables that lead to the conclusions above.

This all makes for great reading. But once again, you may ask, what is the relevance to connected health?

To me the relevance is in the part of the story that Nass tells early on and then dismisses.

Have you heard the story of the border guard who watches a young man with a bicycle cross the border day after day?  Each day the guard stops the boy and searches him because he is suspicious that the boy is smuggling.  After years of this charade, the guard, in frustration, finally asks the boy, “Alright, I can’t stand it…what ARE you smuggling?” to which the boy smugly answers, “bicycles.”

The relevance to connected health is right under our nose.

It is amazing that Nass and his colleagues can draw study subjects into innumerable scenarios using computers as agents of behavior change.  Here is a brief excerpt describing some of them:


 “I’ve had to put participants in my experiments through many struggles and travails: answering difficult math problems amid the pressure of stereotypically superior competitors (in the form of avatars), dealing with a nagging passenger and frustrating roads on a drive (in a driving simulator that talks), enduring false praise and criticism (from a game-playing computer)….”

Study subjects found all of these gimmicks convincing, or at least their behavior was altered.  This is the hidden gem.

So, here is the connection to connected health. What Nass’ experiments show is that the applications for using computers to bond with our patients and alter their behaviors are enormous.

I look forward to Cliff’s keynote and hope he will spend some time on this connection.

A related presentation will come from keynoter Tim Bickmore whose relational agents have repeatedly been shown to be a potent tool for behavior change.  Among the experiments I’m sure Tim will talk about is our collaboration using Karen the Virtual Coach.  Patients who had a virtual ‘meeting’ with Karen three times per week did significantly better in achieving their activity goals than controls. Likewise, Tim has some impressive data showing that using a relational agent for hospital discharge is preferred to having discharge planning done by a human.

These presentations create a theme around how we can use technology to provide care to our patients, make them feel cared for, and allocate our human resources to serve more patients at any given time, attacking that supply and demand mismatch.  There will also be some debate and commentary on this area and my own talk, “Quantification as a Tool for Behavior Change”.  All in all, the topic of computers as agents of behavior change will be well covered.