Psychologists and the Future of Technology-Based Behavior Change

Psychologists should prepare themselves to play a major role in the development of new tools and technologies to promote behavior change.

Richard Bedrosian, PhD
rbedrosi@its.jnj.com
Wellness & Prevention, Inc.

Amy Bucher, PhD
abucher1@its.jnj.com
Wellness & Prevention, Inc.

A growing portion of the economic burden of healthcare is being driven by such modifiable health risks as obesity.  The role of psychology in mitigating these risks is increasing, as behavioral factors such as exercise habits, food choices, and medication adherence come into greater focus.

At the same time, more and more citizens of the planet are becoming “wired,” tethered electronically to one another every waking moment.  In our daily lives, we leave behind us an increasingly rich trail of electronic breadcrumbs, documenting lifestyles, health habits, and relationships.  Moreover, the world around us is increasingly able to take note of our behaviors as we pass through “smart” cities, dwellings, hospital rooms, and so on.  Traditional diagnostic methods, ranging from psychological tests for depression to heart monitoring, are gradually being supplanted by tools that can be used remotely, wirelessly, non-invasively, and for better or worse, unobtrusively.

All these sources of data can and will be used to identify health risk, triage individuals to services, tailor interventions, and measure and predict outcomes.  These functions rely on skills psychologists have in abundance.  Consequently, psychologists will continue to play a critical role in the design, dissemination, and evaluation of the full spectrum of technology-enabled behavior change interventions: telehealth and telemedicine, digital health coaching, ecological momentary assessments, sensor-enabled diagnostics, tailored messaging, and so on.

Following are some thoughts on the emerging role of psychology in these enterprises:

Early career development should be encouraged.  While there are many innovators and early adopters of these technology-enabled opportunities within the membership of Division 46, we’d like to see more colleagues join us on the path.  It’s important to get graduate students and recent degree recipients thinking about and pursuing these opportunities early on, giving them exposure to other disciplines (e.g., human computer interactions, informatics) that can inform their work going forward.

The scientist-practitioner model will continue to be very relevant.   A flashy new technology may have intrinsic appeal, but someone still needs to answer the question: Does it truly help to change behavior?  Testing for efficacy will require psychologists to have a working knowledge of outcome research design and methods for assessing usefulness and efficacy.  In a similar vein, as new applications and fads enter the picture, psychologists have a responsibility to help end users and stakeholders such as health plans and government agencies to go beyond “sizzle,” and make well-informed judgments regarding the clinical appropriateness and efficacy of technology-based tools.

An understanding of the economics of innovation will be invaluable.  Even a startup based in someone’s garage requires funding.  Innovators will need an understanding of how to secure necessary capital, whether it involves crowdsourcing, applying for Small Business Innovative Research grants from the government, joining a start-up incubator such as Healthbox or Rock Health, or courting venture capitalists.  Innovators also need to have an endgame in mind — a vision of the next steps beyond designing an effective application.

Innovators need access to a wide range of technical and business expertise.  Most psychologists will need help with writing code, engineering devices, and designing user interfaces, but many more skills will likely be required to be successful.  It will be vital to get expert help in other diverse areas such as forming a corporation, structuring partnerships, and protecting intellectual property.  For psychologists working in an academic setting, university tech transfer offices may provide a starting point.

Psychological assessments will increasingly move beyond the traditional question-and-answer format, but psychologists will still have a critical role to play in validating them.  Facial recognition and vocal analytic technologies are already being used to diagnose psychiatric and neurological disorders, but that is only the beginning.  Assessment will also increasingly utilize passive data and unstructured data, as is already seen in Ginger.io’s mobile intervention which won Sanofi Aventis’ 2011 Data Design Diabetes innovation challenge.  To provide a behavioral health example, risk of depression may be indicated in the elderly if sensors in assisted living indicate a drop in physical movement or a reduction in the frequency of outbound phone calls or e-mails.  While these new methods differ in form from traditional assessment, they still need to be validated using the same concepts and criteria (e.g., convergent and discriminant validity) as other psychological measures.  Psychologists with backgrounds in assessment theory and test validation are uniquely qualified to bring scientific rigor to these new tools to ensure that they have real value as predictors of behavior.

Multicultural competence will be invaluable. Psychology has fostered a deep understanding of cross-cultural differences in attitudes and behaviors related to health. Psychologists with such knowledge will make an important contribution to future behavior change technologies.  Not only is the US becoming more multi-cultural and multi-lingual, the health trends manifesting themselves in this country are being replicated throughout the world.  In order for new applications to become truly successful in modifying population health, translation and cultural adaptation need to be factored in from the outset.

Mental health presents a unique opportunity – and a special responsibility – for psychologists.  We believe psychologists, especially those with clinical training, have a particular obligation to develop technology-based solutions that can provide screening, information, and evidence-based self-management strategies to large populations.  There is evidence that by disseminating applications that can be used privately and confidentially to large populations, it is possible to reach people who might otherwise not receive any other help.  For example, over 250,000 people have now used the Wellness & Prevention, Inc., behavioral health digital coaching programs.  Over 75% of them were receiving no other treatment when they participated.

Integration of data sources and refinement of predictive modeling will be vital to the successful utilization of “big data.” As the data available on any given individual increases, it becomes daunting to parse it meaningfully.  Psychologists with strong data skills will have a unique opportunity to help identify meaningfully predictive variables, to enable early and effective intervention.

Finally, we encourage psychologists of all backgrounds who have a passion for technology-based behavior change to pursue those interests as far as they can.  We believe there will be many exciting opportunities ahead to use our skills to improve people’s health throughout the world.

Richard Bedrosian received the 2013 Distinguished Lifetime Contribution Award from APA Society for Media Psychology and Technology.

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