Sugar Streak: Seeking the holy grail of behavior modification and patient motivation

Presenter: David Ahn, UCLA Endocrinology @AnhCall

My clinical career and the iPhone were very intertwined, and I’ve been very interested in the use of mobile technology in medicine.

Medicine versus Business

  • They’re very different; polar opposites in many ways (both have their pros and cons).
  • Business-led ideas in medical hardware are often not what they’re promised to be (over promise & under deliver), i.e. Scanadu, Theranos: Hubris in disruption.
  • Medicine-led ideas: clinical utility over the user experience (“everything but the sink” approach), no clear business model: hubris in being a domain expert.

Achilles Heel of Digital Health: Engagement

  • Poor user engagement
  • Preaching to the choir
  • What happens after 30 days?
  • Do they actually lead to behavior change
  • Passive measurement alone is not the solution

How Do We Engage & Motivate Users?

  • Habit-forming psychology
  • Variable rewards, i.e. slot machines
  • Loss of reward > Hope of earning reward; expiring offers

Apps that Do a Good Job with Engagement

  • GymPact: “get paid to work out,” commitment-based, negative & positive reinforcement, effort-dependent, not result-dependent
  • Prevent by Omada Health: 16 week online course structured around the DPP (I think this one is based on solid medial principles); health coach via phone, text, private message; social motivation (teamed with 12-18 random people); technology tools provided include a wireless scale and pedometer.

Hipster / Hacker / Hustler

  • UX, Engineer/dev, marketing/business
  • In health startups you also need the healer!


  • 29.1 million in US have it
  • Hundreds of millions are spent on it
  • Managing it: monitoring glucose, diet, physical activity, exercise

Blood Sugar

  • “What gets measured gets managed”
  • Regularly checking sugar is proven to help improve diabetes control
  • Traditional: use glucose logbooks (a vital tool)
  • Every device has it’s own proprietary plug/cable

Patient’s Perspective

  • Information overload
  • I don’t want to feel bad
  • Forgetfulness
  • Inconvenience
  • I don’t gain anything from it
  • Insurance restrictions

How to Change Perspective?

  • Scare tactics
  • Education
  • Gamification
  • Rewards/Incentives
  • Punishments
  • Social pressure

What Works for Me

  • “Pact App for Diabetes?
  • Commitment based
  • Negative and positive reinforcement
  • Effort-dependent, not result-dependent

Streak-Based System

This approach helps to build a healthy habit

  1. Commit
  2. Build streaks
  3. Learn and earn

Trends and habits are reflected via graphs



App has been successful so far!

v1.8 New for “Code for the Mission”

  • Dashboard for viewing/sharing glucose reports
  • Viewable on an y mobile or desktop browser
  • Notes field

How are we doing on User Engagement?

  • 10% log in every day
  • Longest user streak: 164 days
  • Thousands of users have logged 50k sugar readings

David then gave a demo of the app

Education Technology

Chorus: Visually creating mobile web, SMS, and interactive voice apps

Presenter: Armen Arevian, UCLA (Telemedicine specialist, among other things)

Personal note: Chorus looks a bit like IFTTT to me

Disparities in Technology Development

  • Technical sophistication
  • Financial Resources
  • Creating tech that’s actually used and has impact
  • Sustainability of projects/maintenance

…results in several limitations

  • Created by a select few
  • Smaller subset sustains them
  • Limited types of people that can be directly involved in creating technologies
  • Time delays to create technologies
  • Limited customization/tailoring of technologies that can be created

Traditional Development

  • Development process = Expert + IT + User feedback

“Participatory Technology Development”

  • Stakeholders as equal co-partners
  • Community-based participatory research


  • Visually create apps yourself in real-time
  • HIPAA compliant
  • Vetted by UCLA OIT security & Semel IT
  • Approved for use in research
  • Provides basic interaction building blocks, but users create their own story about what makes sense
  • Reads & writes to the web app

Armen then gaveĀ a demonstration of Chorus…very impressive!

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