Change is hard. And changing to healthy habits is one of the greatest personal challenges for all of us. Our research and work for the smartphone-based Fittle+ system aims to help (and literally) change all of that.
Fittle+ has the potential to be a major advance in what has become known as Ecological Momentary Intervention (EMI) in the medical research world. EMI is a framework for behavior change characterized by the delivery of interventions as people go about their daily lives.
These interventions may range from unstructured SMS text messages providing recommendations such as Text4baby, to smartphone notifications to comply with some agreed-upon action like taking a 15-minute daily walk. The key components are interventions integrated into everyday life and provided at specified moments to maximize impact.
EMI contrasts with the standard clinical practice in which therapists, counselors, dietitians, or fitness trainers meet with individuals or groups on a weekly basis for a short time (e.g., 1-2 hours) during which assessments are made, feedback is provided, and clients are encouraged to set positive goals, practice skills, participate in activities, and complete “assignments” between meetings. EMI aims to help people during the other 166 hours of the week.
We also see Fittle+ as a potential disruptive innovation in evidence-based intervention (EBI) in health(1). Disruptive EBIs integrate robust features of EBI, such as our expert-designed health challenges, personalized coaching, and group support, but in a manner that is simpler, less expensive, and meets the essential needs of consumers in ways that are more accessible, scalable, replicable, and sustainable.
Smartphone-based systems like Fittle+ provide an obvious platform for projecting successful behavior-change support into the ecology of everyday life. Current successful programs are limited by the fact that good counselors are in limited supply, and each counselor has limits in the number of people to whom they can give quality support. To add more people to the program requires adding more counselors. In other words, the current best practices have what is known as poor economies of scale: Their costs per end-consumer do not really diminish as more end-users are serviced. This contrasts with Fittle+, where there are upfront costs to development, but once the system is deployed new users can be added at diminishing costs per user.
Often, people forget that one of the key original observations about disruptive technologies was not that they arrived on the market with a bang, but that they started out simple and gained in quality and functionality until they overcame the dominant paradigm.
Our research on Fittle+ is founded on the expectation that as more people use Fittle+, more insights and innovations will be discovered about what works, how it works, and for whom it works. Increasing the number of users not only drives down costs (the economies of scale argument), but also increases the rate at which the system improves and the diversity of individuals and issues that can be addressed.
So the bet is not only that existing evidence-based interventions can be more effectively disseminated and supported, but that truly new ways of individualized support can be discovered. For this to happen, we are always looking for partners and collaborators. If interested, please visit fittle.org or email us at firstname.lastname@example.org.
(1) Rotheram-Borus, M.J., and Swendeman, D., and Chorpita, B.F. Disruptive innovations for designing and diffusing evidence-based interventions. American Psychologist 67, 6, (2012), 463-476.
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