Behaviour design should be lynchpin of digital health strategy, says Roche executive

Developers of digital health tools designed to improve adherence to medicines need to make behavioural science the cornerstone of their strategy if they are to keep patients engaged and motivated, according to Paul Upham, Head of Smart Devices at Roche/Genentech.

He defined behavioural design as taking cognitive neuroscience behavioural economics and proven experiments and marrying that with design thinking “to really understand what is likely to overcome some of the cognitive biases that patients and all humans have.”

“Many pharm apps, when trying to improve medication adherence, focus on having the patient track everything that they’re doing, and doing lots of logging,” he said. “Accurate logging of medication adherence is great for clinicians and risk holders but it’s terrible for patients because they get less than zero value from it because they have to do work.”

He said chronic disease patients who self-manage their conditions and self-administer their medications become “burdened and disengaged when they’re handed these apps that require a lot of logging and tracking” because the system “doesn’t match up with how our brains work and how you drive motivation and engagement.”

Upham said the tech industry had succeeded quite well in applying behaviour design, with many top companies employing behavioural scientists “almost at the C-level” to run departments with the remit of applying cognitive neuroscience principles to user interface design to keep users addicted to their platforms.

“We’re thinking very carefully about how to take these same principles and what we understand about how the brain works, not to make patients addicted to our pharma apps but really to support patients and improve self-management that will hopefully lead to improved outcomes,” Upham said.

Two landmark studies published in the peer review literature in the last two years have debunked some of the marketing hype around connected healthcare devices.

Both a Heartstrong clinical trial of 1,500 patients – which Upham described as one of the largest ever studies looking specifically at an array of digital tools -- and a REMIND trial of 53,000 patients using digitally-enabled solutions found no improvement in medication adherence.

Upham warned that a connected device cannot be the focal point of digital strategy: “A connected device is one thin slice in a broader digital strategy that a team might be bringing to their clinical trial or to market.”

He added that Roche/Genentech has criteria for working with its therapeutic area and brand teams to better understand their digital strategy and the digital ecosystem their connected devices exist in.