Evangelos Karapanos, Madeira Interactive Technologies Institute

Sustaining
User
Engagement
with
BehaviorChange Tools
Insights
Despite the uptake of
wearable activity trackers,
they fail to sustain user
engagement and impact
users behaviors.
Most products rely on
self-monitoring. Once
self-monitoring stops,
individuals quickly relapse
to old behaviors.
Three strategies for
sustaining user engagement
with behavior change are:
creating checking habits,
social translucence, and
supporting action.
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Technologies for behavior change

have immense potential. Consider,
for instance, the case of physicalactivity trackers. Our healthcare
systems are facing unprecedented
challenges. Western lifestyles, now
spreading throughout the world, have
had a direct impact on the increase of
chronic diseases, which today account
for nearly 40 percent of mortality cases
and 75 percent of healthcare costs, and
are predicted to increase in frequency
by 42 percent by 2023. Obesity alone
has been estimated to account for 12
percent of the health-spending growth
in the U.S. It is thus no surprise that
policy makers and political figures are

increasingly calling for a healthcare

model that stresses patient-driven
prevention rather than cures, such
as Hillary Clintons call for a health
initiative that focuses on wellness, not
sickness and Gordon Browns call for
an NHS [National Health Service] of
the future [being] one of patient power,
with patients engaged and taking
control over their own health and
healthcare.
In this new landscape of healthcare,
physical-activity trackers have
become a focus in both research and
practice, as they can provide many
benefits, ranging from empowerment
and people taking responsibility for
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their own health to opportunistic

engagement in desired behaviors
[1]. The market for wearable activity
trackers such as Fitbit, Jawbone Up,
and Nike+ Fuelband has seen rapid
growth, estimated to have grossed
$1.15 billion in 2014.

SUSTAINING USER
ENGAGEMENT IS
CHALLENGING

D
Figure 2. Habito uses constantly
updating textual messages to sustain
user engagement.

Despite significant recent advances,

one could argue that research
and practice in behavior-change
technologies are still in their infancy.
The industry is currently following a
technology push paradigm, appealing
to the users interest in experimenting
with self-quantification. In research,
our efforts are continually expanding
to different sensor technologies and
different uses of them, as if we have
actually been successful in developing
behavior-change strategies that work.
The reality of behavior-change
technologies, however, is somewhat
disappointing. A recent survey
found that over a third of owners of
commercial physical-activity trackers
discarded them within six months [2].
The reality is even worse for activitytracking mobile apps, where adoption
is often more exploratory, and for
researchers who typically deal with
exploratory ideas and prototypes that
are necessarily less developed than
commercial products. For instance,
in our own work we found that out of
the 86 users who installed a physicalactivity tracker that we deployed on
Google Play, only 21 percent of them
used it for more than two weeks [3].
Ensuring long-term engagement
with behavior-change tools is
important for a number of reasons.
The majority of todays behaviorchange technologies rely largely on the
principle of self-monitoringthe idea
that monitoring our behaviors makes
us more likely to engage with behavior

The reality of behavior-change

technologies is somewhat disappointing.
A recent survey found that over a
third of owners of commercial
physical-activity trackers discarded
them within six months.
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change, be it walking the extra steps,

reducing our energy consumption,
or other changes. Research has
repeatedly shown, however, that
individuals quickly relapse into their
old habits once self-monitoring ceases.
Martin Siegel and Jordan Beck [4]
argue for technologies that support
slow changeones that promise
less and involve users more. They
argue that todays technologies pose
unrealistic expectations about the
ease and pace of behavior change. We
agree. In fact, in our study we found
the adoption rate of the tracker to
be as low as 7 percent among users
in the precontemplation stage (who
had no defined plan about exercising
more) and as high as 50 percent in
the contemplation, or preparation,
stage of behavior change [3]. Effective
behavior change involves significant
involvement from the user
technologies should not lie about that.
But how we designers can assist users
in keeping them engaged is a question
with a less clear answer.
Ensuring engagement over the long
term is not just a question for research;
it is highly relevant for industry as
well. While the current market is
largely dominated by the aesthetics
of wearable devices and their user
interfaces, and not many structural
differences exist among the products
from a behavior-change perspective,
it is very likely that with the
increasing saturation of the market,
companies will be required to prove
the effectiveness of their products
in supporting behavior change.
Moreover, this increased saturation is
likely to reduce the cost of acquiring
a wearable device and companies will
seek other streams of revenue, such
as selling behavior-change services.
This implies a shift from an emphasis
on the initial purchase to sustained
engagement with the service [5].

STRATEGIES FOR SUSTAINING

USER ENGAGEMENT

The question we pose in our research

is how to sustain user engagement with
behavior-change technologies (and the
behavior-change process per se) over
a prolonged period of time. We now
describe some of the different paths we
have explored so far.
Creating checking habits. The
question we are asking here is: How
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can we design behavior-change

technologies that entice users to keep
checking their data?
Recent work has highlighted the
capacity of smartphones to create
strong checking habits brief,
repetitive inspection[s] of dynamic
content quickly accessible on the
device [6]. Powered by instant
information rewards found most
commonly in social media updates
and incoming emails, these brief
interactions, lasting fewer than 15
seconds, have been found to account
for as much as 40 percent of our usage
sessions with smartphones.
On one hand, the potential for
checking habits to transform into
addictive behaviors is alarming. On the
other hand, checking habits can also
serve a good purposefor instance, if
they sustain user engagement with an
application that helps them to exercise
more.
In the design of Habito (Figure
2), a prototype developed by Sergio
Barros for his masters thesis, we
explored the capacity of behaviorchange applications to create checking
habits. Motivated by the success of
the computer-gaming and airline
industries, who regularly update their
content to sustain user interest in
the game or the safety instructions
respectively, we asked: What if the
feedback provided by an activity
tracker constantly updated? We would
then sustain the informational reward
people attain from checking the app,
which is assumed to be the primary
cause of the formation of checking
habits.
Habito does this through the
use of textual feedback. We created
a total of 91 messages, which are
displayed to users over time and
when certain conditions are satisfied.
Some of these messages aim to
support further inferences about the
activities performed. For instance,
when the system has sensed high
physical activity at a given location,
it colors this entry as green, and the
text below may provide further detail,
for example: M-ITI has been your
most active location of the week.
On average, 400m more than other
locations and In your breaks at
M-ITI, you walked an average of 50
meters. Others provide mere facts,
such as Only 13% of children walk
to school nowadays compared with
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Figure 3. Social Toothbrush. Social translucence as a means to behavior change: Making our
behaviors visible to others makes us more likely to adhere to healthy ones.

66% in 1970 or Keep active. Simple

movements such as fidgeting, which
includes knee shaking or pen tapping,
can burn up to 3,600 calories per
day. Others provide just-in-time
recommendations such as You have
been sitting for 45 minutes. Try taking
a break every 30 minutes, when the
system has sensed extended sedentary
activity, or If you have time, park
your car further away and walk the
remaining distance! when the system
has sensed commuting by car. Others
try to create a sense of community,
for example, OCalhau is the 2nd
most physically active community in
Funchal. Just 300 meters below the
first (M-ITI).
Our hypothesis was supported. We
found that users take less time to come
back to Habito following an interaction
with a novel message compared
with a message they had seen before.
Furthermore, interacting with
persuasive messages as opposed to
merely informational messages would
make them take a walk in a shorter
period of time.
Social translucence. The second
strategy suggests: If persuasive
technologies are not successful in
the long run, what if we push the
responsibility to families and other
strong social ties? This implies a
change in perspective. Rather than
thinking of such technologies as
persuasive, we think of them as socially
translucent, where the goal is to raise
awareness of one anothers behaviors.

Behavior change in this sense is

expected to happen not as a result of
the technology, but rather because of
the often-ingenious forms of nudging
families employ (e.g., a mother putting
some tape over the light switch so her
children dont use it every time they
come into the room).
While social influence is one of the
most common approaches employed
both by research prototypes and
commercial products, it is often
reduced to simplistic techniques (such
as competition) that are mediated
only through the technology. In our
work we attempt to reduce the role
of technology in the behavior-change
process to two important attributes:
visibilityallowing information about
the individuals behaviors to be seen
by othersand mutual awareness
raising the individuals awareness
that this information is visible to
others (I know that you know). The
combination of these two attributes
is expected to lead to compliance and
feelings of accountability regarding
ones behaviors [7]. Most important,
technologys role is reduced to one of
mediation; it is the communication and
coordination practices that families
establish that define the path to
behavior change.
Consider for instance Social
Toothbrush, a prototype developed
by Ana Caraban as part of her
masters thesis (Figure 3). The
prototype senses the frequency,
duration, and performance of the
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users tooth-brushing practices and

provides information both in real
time and during subsequent use, as
does any other personal informatics
tool. More important, a minimalistic
glanceable display (in the form of a
colored light in the lower part of the
prototype) allows a person entering
the bathroom to know whether the
toothbrush has been used during
the past couple of hours. Similarly,
Donovan Costa in his masters thesis
developed Hydroscale, a prototype
that senses the users water-intake
practices in the workplace and
reminds them when its time to have
another sip. The fact that the display
is visible to everyone in the vicinity
plants the seeds for playful nudging
and discussion over the users water
intake. One may as well choose to
adhere to recommended waterintake practices to avoid this form
of nudging. This strategy certainly
poses significant ethical questions:
Is it likely to raise conf licts within
families or between individuals,
or is it the first step to the creation
of norms and adherence to them,
eventually even leading to a possible
reduction in conf licts?
Supporting action. While todays
physical-activity trackers and
behavior-change technologies all
inform users about their levels of
physical activity, they do little to
assist them in implementing new
habits. CrowdWalk tries to combat
this by proposing walking activities
one can do from the current location.
Activities are produced by users and
can be tied to breaks (e.g., walk
around the campusit will take you
15 minutes) to commuting (e.g.,
walk downtown rather than taking
the bus) or to practices that involve
walking (e.g., try to maximize the
distance walked while shopping in the
supermarket). While CrowdWalk
proposes walking activities to users,
it doesnt nudge them to carry out
these activities (see [8] for a different
approach). While this avoids
reactance, it suffers from possible
attrition as individuals forget or lose
interest in the proposed activities.
How to assist users in transforming
these walking activities into
daily habits is a key question for
such tools.

W
LOOKING FORWARD

We proposed three directions, but

also considerations, for the design of
behavior-change technologies that
sustain users engagement.
The first direction implies that
behavior-change technologies have
to fight for users attention. In a life
of constantly fragmented attention
filled with distractions and changing
priorities, how do we design
technologies that do not overwhelm
the user, and yet do not disappear in
the muddle of daily life?
The second direction implies
that social relationships may be more
effective in inducing behavior change
than human-technology ones. The
question posed to us designers is how
to integrate humans and technologies
in supporting the behavior change
process in a way that is ethical,
effective, and socially acceptable.
The third direction implies that
assisting behavior change is not only
about reminding people, but also about
telling them how. Keeping to a healthy
diet is far easier when a clear, step-bystep process is available. As designers,
we should ask, does the technology
suggest clear actionable goals that
are tailored to the user? Does the
technology have the agency to stress
the implications of these goals?
Last but not least, we suggest that
engagement is key to behavior change.
In fact, the majority of early studies
on behavior-change technologies
overlooked users engagement,
focusing directly on the final outcome:
whether behavior change took place
or not. We argue that understanding
how people engage with behavioral
feedback is an important gateway
to the invention of more effective
behavior-change strategies. For
instance, in a recent study we found
that contrary to conventional wisdom
that portrays behavior change as the
result of deep knowledge about ones
own behaviors, users truly lack the
interest to reflect on past behaviors.
Instead, more than 70 percent of
the long-term usage of our tracker
related to glancesbrief, five-second
sessions where users called the app
to check their current activity levels,
with no further interaction [3].
Consequently, we should question the
current paradigm of deep reflection

underlying most of todays technology.

Instead, we should ask: How can we
maximize the impact of these glances
on individuals behaviors, and how
can we leverage these glances to act as
proxies for deeper engagement with
the feedback?

ACKNOWLEDGMENTS

This work would not be possible

without the dedication and passion of a
wonderful team of graduate students:
Ruben Gouveia, Ana Caraban, Sergio
Barros, and Donovan Costa. This work
was supported by the Carnegie Mellon
Portugal project Studying the longterm acceptance of personal health
informatics tools project (CMUPEPB/TIC/0063/2013).
ENDNOTES
1. Karapanos, E., Gouveia, R., Hassenzahl,
M., and Forlizzi, J. Its not that hard to
walk more: Peoples experiences with
wearable activity trackers. In press.
2. Ledger, D. and McCaffrey, D. How the
science of human behavior change offers
the secret to long-term engagement.
2014; Retrieved online from http://
endeavourpartners.net/white-papers/
3. Gouveia, R., Karapanos, E., and
Hassenzahl, M. Activity trackers in the
wild: Design strategies and their impact on
engagement and physical activity in daily
life. M-ITI Technical Report. 2015.
4. Siegel, M.A. and Beck, J. Slow change
interaction design. Interactions 21, 1
(2014), 2835.
5. Karapanos, E., Zimmerman, J., Forlizzi,
J., and Martens, J.B. User experience over
time: An initial framework. Proc. of the
SIGCHI Conference on Human Factors in
Computing Systems. ACM, 2009, 729738.
6. Oulasvirta, A., Rattenbury, T., Ma, L.,
and Raita, E. Habits make smartphone use
more pervasive. Personal and Ubiquitous
Computing 16, 1 (2012), 105114.
7. Erickson, T. and Kellogg, W.A. Social
translucence: an approach to designing
systems that support social processes.
ACM Trans. on Computer-Human
Interaction 7, 1 (2000), 5983.
8. Hassenzahl, M. and Laschke, M.
Pleasurable troublemakers. In The Gameful
World. S. Walz and S. Deterding, eds. MIT
Press, 2015.

Evangelos Karapanos is an
assistant professor with Madeira
Interactive Technologies Institute (http://
experiencedesign.m-iti.org), where he leads
the experience design lab and acts as the head
of the scientific council. His interests lie in
human-computer interaction, user experience,
and ubiquitous computing.
e.karapanos@m-iti.org

DOI: 10.1145/2775388 2015 ACM 1072-5520/15/07 $15.00

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