How to ‘up the ante’ on your Fitbit goals!

Ashley Kilgore:

We’re just about halfway through the summer, and with many days of warm weather still ahead, most of us are planning fun outdoor activities or family adventures, or maybe just working towards our summertime fitness goals. But for some, okay, many of us, staying active can be a real struggle. Not only to reach our fitness goals, but to stick to our good exercise habits in the long run. The use of wearable health devices, such as a Fitbit, can serve as a valuable tool not just for tracking progress, but for setting goals and helping motivate users to meet them. However, new research shows that there are ways to enhance the effectiveness of these tools for even longer term benefits through a process called gain-loss incentives.

Ashley Kilgore:

I’m pleased to introduce Idris Adjerid from Virginia Tech to discuss the findings of his study, Gain-Loss Incentives and Physical Activity: The Role of Choice and Wearable Health Tools, which will be published in the INFORMS Journal Management Science.

Ashley Kilgore:

Idris, it’s such a pleasure to speak with you. Thanks so much for joining me.

Idris Adjerid:

Thank you for having me, Ashley. It’s a pleasure to be here.

Ashley Kilgore:

I know from my own personal experience with a wearable health device, in my case it was a Fitbit, I had both daily and long-term goals set for myself. I was training for a road race at the time and the device definitely helped. But what really pushed me to achieve my goals was the added incentive of another friend who I would compete against to get more steps in each day. Is that kind of along the lines what we’re talking about here?

Idris Adjerid:

That’s definitely an interesting and important way that people motivate themselves via these devices. In fact, we have another paper forthcoming in Management Science that looks at the effect of things like leaderboards, where people compete against one another. In this paper, we’re focusing on economic incentives and how they can help with the benefits from Fitbit devices.

Ashley Kilgore:

It sounds like I was close, but not quite. In that case, can you share, what are gain-loss incentives?

Idris Adjerid:

Yes, absolutely. I think to understand what they are we have to add a little bit of context, a little bit of background. Economists have been studying the effect of economic incentives, which is a fancy way of saying the effect of paying people to do things. And they’ve studied them in the context of health, so can we pay individuals to be healthier, to be more physically active, to eat healthier, to eat less.

Idris Adjerid:

And they found effectively that these incentives do impact behavior. But one major challenge is that, once you stop paying people, and this is probably pretty obvious to the average person, once you stop paying people, the behavior stops. So there’s been this push in the literature, try to understand or design economic incentives that are more effective, particularly in the longer term. Can they motivate behavior that persist even after the economic incentives have ended?And one of the ways that the literature has thought about this is basically having incentives that are a little more aggressive. If you achieve the goal, you get some economic payout. But if you fail to achieve the goal, for instance, there’s some penalty.

Idris Adjerid:

Gain-loss incentives is a variant of that type of incentives, where we offer, again, some high payout if you achieve some health goal, in this case physical activity. But then there’s also a loss if you miss the goal, if you fail to achieve it. So you have both motivation on both sides of the incentive, as opposed to just a reward for meeting the goal. Now one of the additional nuances that’s important for our study is that despite the efficacy of these kinds of incentives, people very rarely choose them. I you have a choice between the standard incentive, where you can get paid but there’s no penalty, versus one that has a penalty as well, people will rarely choose them.

Idris Adjerid:

What we study by gain-loss incentives, are not only do you have a penalty associated with the incentive that you’re being provided, but also whether you have a choice. So we manipulate both. We manipulate the type of incentive you get and whether you have a choice in the matter. And we try to understand what is the effect of this combination of factors on physical activity.

Ashley Kilgore:

Now how can these incentives be leveraged in conjunction with Fitbits and similar devices?

Idris Adjerid:

Yeah, that’s a really interesting question. I think one of the things that is useful about this paper is that it brings in two relatively separate literatures, but that have a lot of potential benefits from joining them. One is the incentives research, which we just talked about. And the second is these health platforms, health wearable devices.

Idris Adjerid:

Where the Fitbit and the incentives have a lot of complementarities is in this intersection of the incentive can give you that initial motivation or burst to engage in good behavior. And that the Fitbit devices as these low cost, digital interventions can help you sustain that high activity after the economic incentives end. And so it’s that same kind of issue is how do we get sustained behavior, sustained positive behavior, even when we stop paying individuals.

Ashley Kilgore:

Now I’d love to dive in and explore the structure of your study and how you evaluated the impacts of these types of incentives.

Idris Adjerid:

We studied this in a large scale experiment conducted at the University of Notre Dame. And in this experiment we effectively had students that were part of a long-standing study on campus that gave them Fitbit devices as part of the study. And as part of that study they were also having their steps measured and all these other kinds of things that were being measured as a part of being in that study.

Idris Adjerid:

So we took this existing sample and we effectively ran an experiment on them. And the main part of the experiment was a one-week step challenge. We announced to this group of individuals, students, that we are having a one-week step challenge and as a function of … If they chose to participate in that challenge, they could get some additional economic rewards, they could get some payouts as a function of being in that challenge. And then each of them were effectively given a new step goal that they were trying to meet for that week. And then, depending on the condition you were in, you may or may not have been given some additional economic incentive to meet that goal. And then you may or may not have been spurred to also use some of the features of Fitbit device.

Idris Adjerid:

That’s where the random assignment comes in. In particular, we’re interested in the goal-setting feature of Fitbit device, so leaderboards and competition are one aspect of these platforms. But another aspect that I think everybody uses is just whether you set that goal, the step goal, on your device, and to the extent to which you use that to motivate yourself. Some random subset of participants were also asked to adjust their step goal in line with the new one that we were providing them.

Idris Adjerid:

That’s the initial part of the experiment. But what was equally important was that we continued to track their behavior, even after the one-week step challenge ended, consistent with what I mentioned earlier about trying to understand which of these individuals would sustain or persist in that positive behavior that they did when they were actually getting paid.

Ashley Kilgore:

Was there anything within your study findings that surprised you? Anything that was unexpected based on previous knowledge or studies?

Idris Adjerid:

I think the thing that probably surprised us the most initially, was that giving people a choice is really ineffective. It’s a difficult finding, because what happens is, if you offer individuals a choice between some fairly aggressive incentives, even if they can make more on average using them, and a standard incentive where there’s, in our case, no chance for penalty, a lot of the individuals would opt into the standard safe incentive.

Idris Adjerid:

And so very few individuals opted into the more aggressive incentives. And those that did opt in were the people who needed them least. So it was the people who were very confident they could meet the goals, the people who were already very physically active and fit, that opted into the more aggressive incentives. And it’s this kind of phenomena where the people who need the incentives least are the ones picking them, and vice versa. The people who really need that motivation were very unlikely to pick them.

Idris Adjerid:

That left us with a conundrum, because often it’s not feasible to superimpose aggressive incentive schemes on individuals, so that was an interesting finding. And I think the other piece, honestly, is just how sustained the effects could be when they were coupled with the Fitbit devices. Maybe we’ll talk about that a little bit later, but I think there’s some interesting things that we didn’t really expect.

Ashley Kilgore:

Now you just mentioned long-term impact. Does activity levels start to decrease once these incentives are no longer an option, or do they stay pretty consistent?

Idris Adjerid:

By and large, the effects faded within the first month for the participants. In the first week there were large effects of all the incentives. So whether you had standard or more aggressive incentives, the gain-loss incentives, you had some effect. Maybe unsurprisingly, the individuals that we assigned to the gain-loss incentives had larger effects initially, because there’s obviously a penalty that motivates people to try to avoid that. But in terms of long-term, most individuals, their behavior reverted back to the baseline within the first month, so not very persistent.

Idris Adjerid:

The group that really stood out was this group that was forced into the gain-loss incentives. It’s the individuals who, if they had been given a choice, they would’ve picked the safer incentives. But because we took that choice away and forced them into the gain-loss incentives, they’re the ones that did the best in the short-term. And if you also told them to use the Fitbit device, they maintained that physical activity, or at least some amount of it, for six months after the end of the week.

Idris Adjerid:

That was a pretty impressive result we thought, given the relatively short duration of the experiment and how long the effects persisted if they also used the decision aids that were part of the Fitbit device.

Ashley Kilgore:

As I mentioned earlier, I’m a Fitbit user. What are the biggest takeaways for me and similar listeners? What actions can we take to leverage your insights?

Idris Adjerid:

Well, I think there’s a few different takeaways. Some are for individual users, some are maybe for app developers, some for even employers. As a user, you mentioned that you had competed with a friend. And you might up the ante a little bit and put some dollars at stake between you, where you would have to pay them or they would have to pay you. That element of loss is also very motivational. The element of trying to get obviously some economic payout is motivational, but avoiding a loss can be even more motivational. Avoiding having to pay your friend may be more motivational than the hopes of getting funds from them. I think putting a little skin in the game might help in terms of long-term motivation.

Idris Adjerid:

But I think, honestly, some of the bigger takeaways might be to employers. Employers who have a pretty strong economic incentive to kind of encourage healthier behavior from their employees. And they often have incentive programs in place to try to motivate employees to be healthier. Whether it’s a discount at the gym or a discount on a health wearable device sometimes, an Apple watch, whatever it might be. They might want to think about how to design some of those programs in ways that really generate longer term effects.

Idris Adjerid:

It might also be useful, for example, for app developers, there are a lot of health apps that introduce different kinds of incentives. They might give you a Starbucks gift card for meeting a step goal and so on for that day. So the results here could also play into how Fitbit designs their interface and how they try to motivate their users for instance. I think there’s hopefully different takeaways for different types of entities and people involved in trying to motivate healthier behavior.

Ashley Kilgore:

Idris, thanks again so much for joining me. I really enjoyed learning how I can up the ante on my Fitbit use. And for our listeners, visit resoundinglyhuman.com for this episode’s show notes to learn more about Idris’s study. We also have a couple of fun, new features, including recommended episodes and related content so be sure to check those out as well.