Behavioral Research: Commitment Devices Tie Results to Risk and Reward

Understanding the motivations and mechanisms for changing behaviors—and making new behaviors stick—is truly fascinating. At DarioHealth, we’re always looking for ways we can harness behavioral science concepts for the benefit of people with chronic conditions like diabetes, high blood pressure, obesity, and pain.

As champions of behavior change, we’re trying to push the envelope as much as possible in digital health care. One thing I’ve been thinking about lately is the power of commitment devices to inspire changes in behavior that yield lasting results.

Commitment devices, or commitment contracts, are used to establish a system of risk and reward when it comes to achieving goals. Here are just a few examples:

• Setting aside money you can only access if you achieve a stated goal
• Taking disulfiram, a nausea-inducing drug, to avoid consuming alcohol
• Watching TV only after—or during—an exercise session

By definition, commitment devices are voluntary and include clearly defined parameters. The consequences, however, can be mutable or immutable. If you decide you want to set aside some money for use after you reach a goal, for example, you can either keep control over the money during the process and decide to access it even if you don’t achieve your goal, or you can give it to a third party with instructions to withhold the funds from you if you’re unsuccessful.

While it all comes down to each individual’s unique combination of resources and risk tolerance, it’s clear that commitment devices shouldn’t be too easy or too onerous if they’re going to be successful.

The trick, in most cases, is finding the smallest possible lever to motivate people to change their behaviors. Jane, for example, might not bet her house that she’ll lose 10 pounds in the next six weeks, but she might be willing to risk $100 and be able to achieve her goal. Jason, on the other hand, might need to up the ante to $500 or $1,000 in order to get sufficiently motivated to change his behavior.

Commitment Devices at Scale

Here at Dario, commitment devices come into play in several aspects of our digital therapeutic solution. Through gamification, for example, users are rewarded for taking actions that improve their health. Although there’s no money involved, the systems of badges, points, affirmations we’ve developed are enough to motivate certain users to stay engaged when deployed in a personalized fashion.

Our coaching program can also be considered a form of commitment device. Instead of financial consequences for missing actions there are social ones: not wanting to let someone down and the desire to keep commitments to an accountability partner have proven to be powerful motivators for another distinct portion of our user base.

We’re continually innovating when it comes to presenting commitment devices to users in personalized ways. Users who prefer evidence-based tips, for example, receive practical information on commitment devices they can try themselves, such as portion control, buying a gym membership, and ordering groceries online to avoid impulse buying.

Recent research supports this type of personalized approach. In “Commitment Devices: Using Initiatives to Change Behavior,” a 2014 opinion piece in the Journal of the American Medical Association, the authors present a compelling case that “expanding the use of commitment devices to facilitate health maintenance will likely require novel strategies for maintaining people’s engagement and attention at key moments when drop-off or discontinuation is a risk.”

Behavioral science tools are top-of-mind here at Dario, and we’re continually expanding these across the six domains of personalization we deploy to maximize user engagement.