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Joseph Kim:
Welcome to Clinical Research Confidential. On this show, we highlight and demystify the inner workings of this greatly misunderstood activity called clinical research. Now, why is clinical research important? Well, it’s the basis for nearly every modern remedy for sickness and a growing method to build trust and solutions meant to optimize health. But it’s not for the faint of heart. And so, on this show, you’ll hear what it really takes to succeed in the clinical research game. I’m your host, Joseph Kim, and I’ve spent over 23 years in the clinical research industry, now serving as the Chief Strategy Officer for ProofPilot. Get ready for some adventures as we look into the underbelly of clinical research.

Joseph Kim:
So today, I’m here with the great Kate Wolin, who I met at a conference in West Chester, Pennsylvania, of all things, talking about innovation in healthcare and research. So Kate is the Principal at Circea, which is a very cool behavior science lab, I’ll call it, but you correct me later. Kate, it’s great to have you on the show. Thanks for joining us.

Kate Wolin:
Thanks for having me. I’m excited to talk about behavioral science.

Joseph Kim:
So before we get into behavioral science and how it extends to things like healthcare and clinical research, tell us a little bit about your background, because behavior science is a big, wide world of things, and how does one actually get into it? And, like, what do you study to be an expert?

Kate Wolin:
Yeah, so I got my doctorate at the Harvard School of Public Health. So a lot of population health actually involves behavioral science. And I focused my studies at the intersection of health, psychology, epidemiology, and biostats. So when I was training, we called what I do behavioral medicine, so the application of behavioral science to health and medicine. And I think for a lot of folks that this is something new, but the Society of Behavioral Medicine, that’s like the academic, my nerd home, where we all hang out, have been around for decades. And obviously, for a professional society to have been founded, people had to have been doing that work for a while before they said, Hey, we should get together and share our science in the same place. It’s something that really has been around for quite some time. I have a dear colleague who works in the motivation of exercise and physical activity, who likes to remind me that like the earliest paper published in that space is actually from 1898. So we’ve been studying like behavior change in health and health behaviors for a long, long time.

Joseph Kim:
Most people might think about behavior change modification, beginning with Pavlov’s dog, right? So tell us where Pavlov fits in this whole continuum of of expertise here.

Kate Wolin:
I love talking about Pavlov’s dog because one of the things I love to remind people of in behavior change is the great thing about that experiment is the dog got feedback right away. So like when the dog did the thing, like Pavlov didn’t wait a week to give the dog a treat, you’re giving the dog and anyone who’s housebroken a puppy knows that would be an unsuccessful housebreaking endeavor if you waited a long time to give feedback. But a lot of the way our healthcare system is orchestrated is very episodic, and we don’t actually give feedback in anywhere close to a meaningful time period. So like, you think about you go in, and you get your annual physical, and your doctor says like, oh, hey, Kate, your cholesterol is creeping up. Like, you know, I’d like you to think about making these dietary changes and changes to your exercise plan. And then I’m like, left on my own, right? And I get no feedback on what if I’m doing is correct or not until I go back in a year and we check my cholesterol again.

Joseph Kim:
Yeah, there’s no palpable consequence. There’s no feedback for doing the thing right the next day, the next month, or whatever.

Kate Wolin:
Right.

Joseph Kim:
So this old principle of immediate feedback, Candy Crush gives it to you, but not your doctor.

Kate Wolin:
Right, exactly. And I think the healthcare system has changed over time, right? Like for, maybe not, I’ll say my age generation, right? Like that was how it worked. But for my grandparents, their primary care doctor was the town doctor that they saw like on the regular. So when they went to the fish fry on Friday night, you were going to see the doctor, and the doctor was going to, it was a different structure, and I think the, we took a lot of the humanity out of healthcare over the years. And the exciting thing for me is that we can actually build connection using technology when we do it well these days, and there’s enormous opportunity in that. And like you mentioned, Candy Crush, we can learn from these other fields, and how, like how do video game designers create community and connection with people who may live halfway across the globe from each other, right? And they can, and they do, and we don’t have to be face to face in order to give feedback and create connection and put humanity back into healthcare, but we have to be thoughtful about how we do it and leverage what we know about motivation and behavior change technique and data collection and analytics and all of those things. And I guess as someone who’s super curious and nerdy, I love that where we are in the field right now really requires a lot of disciplines to come together and that that’s both like creative and stimulating and I think a really exciting thing.

Joseph Kim:
Yeah, because there’s so much technology, it’s hard to do. Well, it’s not hard, but why not take advantage of a multitude of disciplines that involve technology and human design and feedback and blah, blah, blah to create a holistic way to change behavior? So let’s start with the basics then. Like what do you call, how would you define just behavior change?

Kate Wolin:
So I think the first is defining what we’re talking about with a behavior. There’s a lot of things that we do that relate to behaviors but aren’t behaviors. So are we clear on what the behavior is that we want to impact or change? So my weight is not a behavior, but what I eat, when I eat, like all of those things play into it, and that’s part of it. And then, when we get to the change part, it’s, are we starting a new behavior? Are we stopping? Are we increasing something? Are we doing it once? Are we doing it for a while? Are we doing it forever? And so there’s a lot of elements that go into what we mean by change, right? Like when my doctor writes me a prescription for an antibiotic, it’s okay, take this twice a day for the next 14 days, and then I’m done. And so that’s really different than, hey, Kate, you have high cholesterol, or hey, Kate, you have celiac disease, don’t eat gluten ever again, right? They’re both like talking about behavior change. But those are really, really different things, right? Like, you want me to do something for a period of time? You want me to stop doing something forever.

Joseph Kim:
I love that. So there’s two main categories, which is the dimensions of the behavior and then the dimensions of the change. And under those, there’s all these different like factors and variables to think about.

Kate Wolin:
Yeah.

Joseph Kim:
Wow.

Kate Wolin:
Yeah.

Joseph Kim:
And so you’ve laid out a few frameworks for me. One that always has resonated with me is this notion of competency, autonomy, and community or some version of that. Can you break down that framework as it pertains to behavior change?

Kate Wolin:
Yeah. So it’s called self-determination theory. And as a native of upstate New York, I love that one of the scientists behind it is University of Rochester. So that’s not why, that’s not why it’s a fave, but it’s always something that makes me get a little warm, fuzzy as an upstate New York native. And the thing that I think is awesome about it is it’s not just relevant to health, right? You can apply it to video game design, you can apply it to a lot of different things, but there’s a ton of research that applies that framework to health. There are also a bunch of others. And so that’s the other thing I like to remind people of is, depending on the behavior and the context that you’re working in, a different framework or behavior change theory may be more appropriate. I come out of a public health background, so we spend a lot of time talking about context and the context that we live in work in, and people are pretty familiar with that these days because we talk a lot about social determinants of health, but so that, even though self-determination theory doesn’t explicitly name context as part of it, it’s certainly something that comes into play there. And some situations, you may want to emphasize that more than the other, but when it comes to self-determination theory, what I really like about it is the recognition that we put it in like layman’s terms, right? Neither my child nor my father likes for me to tell them what to do all the time. Like they want to have a sense of autonomy and choice. And so when you think about it in that context, like it really resonates, and no one likes to suck at everything, right? Like in colloquial terms, right? So we want to feel both a sense of accomplishment, but when we start tasks, we also want to have a sense that we’re going to be successful, right? It’s very hard to feel intrinsically motivated to something that you think you’re going to fail at, and it’s hard, particularly in the space that I work in, of chronic diseases and lifestyle behaviors. These are things that we’re going to want people to do for an extended period of time. And so really, like, if I think I’m going to, like, this is never going to work, it’s really hard to get going, and it’s really hard to stay engaged. And so I like that component of competence and getting, like, how do we feel like we’ve accomplished something and mastered something and achieved a goal? And those things come in. But it’s also as humans, like we are meant to be connected to other people, and in behavior change techniques, that comes into things like social support and having doing things as a group or how do you feel connected to people around you. And so that that sense of I don’t actually have to be in a support group with you to feel a sense of connection, there are other ways of doing it, but there is this human motivation and need to be related and connected to people. And so that can come into play in a number of different ways. So when you think about, I started my career doing work in smoking cessation, and I’m old enough that at the time I went to college, you could smoke in bars and restaurants, and you would, you know, right? Then at some point the laws changed, and you couldn’t smoke in bars and restaurants, right? And so to be the person smoking when no one else is smoking, right, to be the person who leaves the bar or restaurant to go smoke a cigarette because you’re addicted, right, you became not connected to other people. There was a stigma and like a social isolation that came with it. And so that wasn’t that driver, in addition to the fact that we raised taxes enormously on cigarettes, like those changing of social norms did far more than any of the individual and group coaching interventions that I had been working on, right? Like we literally changed the context and the norms around smoking behavior through policy, and that, to me, brings to life how that element can play into health behavior change.

Joseph Kim:
Yeah, it’s a subtle thing that happened, but it might have been the most powerful thing because you raise the taxes, and people just still spend the money, but you force them outdoors, and they get off their ostracizing themselves, and that actually is a more of a turn, at least a reduction, if not cessation.

Kate Wolin:
And the other part of it is, right, like the number of people who would be like, I don’t smoke except when I’m in a bar, and everyone else around me and the smell hits, and then I’m tempted. And so when you took that out of the equation, they just weren’t tempted as much, right? So like the casual smoker who might then become addicted, you just arrested a lot of behavior, like habits and norms and prompts that pushed people to do this versus that changed.

Joseph Kim:
Yeah, and it’s probably the reason they started, right? Their friends were doing it. There’s some sort of peer pressure, so there’s a community influence that made them start, because it’s certainly not easy to get as an underage person, and it’s expensive, and you have to go hide, so there’s not a lot of autonomy there.

Kate Wolin:
Your high school must have been different than mine. They, everyone just stood outside like it was just crowds of people like ten feet from the door to the school smoking every day.

Joseph Kim:
No, we always had to go hide. So yeah, there was lack of autonomy and competence, because it wasn’t easy to do. Anyway, so this is a fun conversation. So let’s move to clinical research. As you alluded to, changing your behavior for healthcare can be hard. Changing it to do research can be doubly hard or exponentially harder because, so I have glaucoma, and what I have to do is go to my doctor twice a month, twice a year, and I take drops every day, not that hard. But I did enter a glaucoma study once where I had to wear these pressurized goggles every night for six hours, for, it was really hard. And that behavior change was, I couldn’t actually do it for a bunch of reasons. But I have to imagine clinical research is, for anyone is somewhat the same where you’re doing something lightweight, maybe, but then you go into research, and now you’re doing something like every day, every week, right? So yeah.

Kate Wolin:
You highlighted a number of things, right? Which is like our intention, right? As humans, we have wonderful intentions, most of us, we hope to do things all the time. And then it’s a different thing to have an action plan, which is the big part of behavior change, and behavior change theories is, what’s your action plan to take that intention or motivation and actually see it through? And I think that’s hard to do for a lot of people in clinical trials because even though it’s like somewhere in that informed consent, what you’re going to be asked to do, we don’t always think about really what that means in terms of, you signed the consent. You know, you were supposed to wear the goggles for six hours every day, right? Like you’re fully intellectually aware. But what does that mean in terms of my comfort level? And oh, now I’m going on a trip, and I have to pack the goggles when I go with me, and that takes up room in my suitcase. And there are all these things that happen in life, and the more burdensome the thing is, the longer the trial goes on, right? Like you don’t necessarily have a support system around you to continue to execute on that behavior. And like when you get stuck, what do you do? When you miss a night, does that mean like, I’m done, the trial’s over, and I should just quit? Or does it mean, get back on the horse tomorrow and just keep going? And we often don’t talk about those things with people. And I think there’s this element, too, of we talked about the competency, I messed up, I left the study down, and people don’t want to admit it, and they like there’s shame associated with it, right? There’s something like negative emotions. And I think that’s a really fine line for a researcher between normalizing that this might happen and actually giving people a sense like you expect it to happen, and therefore they don’t, right? Like it’s a very fine line of like, hey, Joe, this might happen. And then you can be like, oh, they don’t really care if I do it every day. No, no, no, we really care if you do it every day. And we recognize that sometime in the next six months that you’re doing this, you might miss a day. And when that happens, just get back on and do it the next night, right? Like, it’s an interesting thing about how do you build connection with your study participants so that you have trust and you have sharing in those sorts of situations. There’s just a lot of elements that come into that that starts with, who are the people that opt into trials? Like they are well-intentioned. They are, right? But they’re are people who they want to do good, right? Thank goodness for all of these people who are willing to do it. And because many clinical trials, the participant will not benefit from participation, it’ll be future patients who are benefiting from your participation in the trial, and that intention to do good and give back is a lovely thing. But it is a different, people who are in the product space or marketing space, right, it’s a different persona.

Joseph Kim:
And in terms of influencing behavior, now I’m remembering some things, which is like when the goggle lost its pressure, and this is at night, mind you, I’d get an alarm on in the middle of the night. So there was a lot of negative sort of reinforcement. I never got like a positive one where it was like, hey, you nailed it tonight. You got six hours in, right?

Kate Wolin:
Or like you, you’ve worn it for six days in a row, like gamification. Coming into that around, I’m always fascinated by there’s interesting science around streaks, and streaks can be motivating for people, but it can also be the sense like, when you break the streak, like people just give up on the behavior altogether because, like, I’ve lost the streak, why bother now?

Joseph Kim:
Yeah.

Kate Wolin:
So I think it’s interesting now you start to see like layering of streaks in some of these apps, right? Where it’s like, oh, I can have a number of days streak, I can have a week streak, right? Like, so there’s always some streak that potentially you still have going even if you break one, right? Some other one is going, and I think that layering of techniques is part of what we do in designing behavior change programs is to think about not that there are, basically, more or less like a hundred different behavior change techniques that have been scientifically identified. Like, why would you just pick reminders? Like, lovely thing, but like, why would you stick to just one when you could do many?

Joseph Kim:
Yeah, even five. It would be more like. So where do researchers mostly get this wrong? Is it that they don’t value, they don’t think about streakiness, and they don’t think about acknowledgment, and they don’t all the above? Like, what are they not doing that? And maybe this is more of a mindset than a tactical behavior. What are they not thinking about when they want to support a patient in their journey of participation?

Kate Wolin:
So I’m going to reframe it and assume positive intent. And one of the challenges is like, if I start doing all of these things to give you feedback on the goggles, that becomes part of the intervention. Is the active ingredient the goggles, or is it that like I was giving you all this feedback every day about your glaucoma, and you just became better at managing your condition overall? Part of I think the challenge is how do we do these things around keeping people engaged in the trial that we don’t then create disparity between intervention arms. So you can do that in, say, a double-blind placebo drug trial where you’re giving all kinds of medication adherence feedback to both arms because they’re both taking a pill.

Joseph Kim:
Yeah.

Kate Wolin:
That becomes a little more complicated if you want to start managing the side effects that might lead someone, right? Like drugs have known side effects, right? So this is going to make me constipated, right? Are you giving both arms feedback and coaching on how to manage constipation? Because now you might be cluing the placebo arm, but isn’t experiencing any of that into the fact that they’re on the placebo, right? So I think very well-intentioned. This can get pretty complicated pretty quickly, which is really different than out in the real world where you might be wanting to drive in a real-world evidence trial or sort of post-market doing that. When we do interventions straight up of a behavior change program, when I started in the field, it was like intervention versus usual care. One of the best-known behavior change programs out there is something called the Diabetes Prevention Program. It’s a lifestyle coaching program for people who were pre-diabetic around diet and activity with a goal of having them lose weight and therefore, decrease the risk of progressing from prediabetes to diabetes. And the comparison in studies like that is just usual care, which is like your doctor telling you you should lose weight and not getting any support around that. And now what we are seeing is a lot more complexity in the study designs where we’re doing micro randomization within the trial. So based on like branching logic, people get randomized over and over again to different intervention components, and that allows you to test different components and separate them, and they’re, the studies are powered differently, accordingly. We see optimization trials like similarly. So based on how I’m responding, like I’m doing these things, am I losing weight? If not, we’re going to change the intervention, and that’s actually built into the protocol, and the power calculation, and the study design.

Joseph Kim:
Wow.

Kate Wolin:
I’ll be transparent. I have, I’m not aware of that kind of trial going in front of the FDA, which I could imagine could it can make the studies need to be larger, therefore, more expensive, right? There’s complication in doing that, and I think it really, but I think the reality is, recruiting people for clinical trial participation is hard, and it’s expensive. And I think we may see people I hope we see people rethinking that investment, because if it allows us to keep people in the trial because they have a better trial experience, then that may be worth doing and thinking about, not just what is the thing, the drug, the device, whatever it might be, but what is the clinical trial experience for both arms?

Joseph Kim:
Yeah, and I think part of what makes it hard, and this probably ties into both competency and autonomy, is like setting an expectation, right? Whether it’s for the trial or for the home kit I have to do today or for visit three. I think pharma companies and research sponsors notoriously do a bad job of just setting expectations, which I think is in a safe space without ruining the science, like as you alluded to earlier, like certain things can ruin it, ruin the science. But talk to me about expectation setting and where that fits in a behavior change.

Kate Wolin:
It’s a key part of that, right, is, am I going to experience side effects?

Joseph Kim:
But how long will this thing take?

Kate Wolin:
How long will it take? Like that’s … informed consent, but also, like you might miss a dose, here’s what to do. And we do that in medication adherence, it’s actually an important part of medication adherence behavioral science, is helping people navigate a setback, which could be a missed dose. That’s part of your expectation management being like talking about side effects, right? And talking about those side effects may mean, I don’t sign up for the trial, but that’s better than you spending all of this money to do visit one and having me drop out before visit two.

Joseph Kim:
That’s true.

Kate Wolin:
Right? I mean in my mind, I think it’s thinking about all of that. We do it on the sort of outside of the trial setting is like, you know, you might not feel better until you’ve been on this drug, right? And I think about the behavioral health space, right? It can take a while to find the right medication and the right dose. And so the expectation is not, your doctor is going to write you a prescription for this behavioral health medication, and you’re going to feel better tomorrow, right? That’s true with other, we have an infection, right? It’s not necessarily the infection is not going to go away tomorrow. And it’s that same understanding of people might have a different mental model or expectation for how this is going to go. And it’s action planning, too, right? Because when I have the expectation, I can do the action planning. And so you think about that, like if this is a medication, it’s really important to take with food or at night, right? And I work a night shift or something like I’m supposed to take in the morning, and I don’t with food, and I don’t eat breakfast. Like, okay, let’s talk through what that means. Do I have to eat breakfast now? Do I have to take it in the morning, right?

Joseph Kim:
Yeah. Can it be a glass of oat milk or something? As simple as that, if it’s not breakfast, but, you know, like oat milk. I don’t like oat milk.

Kate Wolin:
Do people just, like, straight up drink a glass of oat milk?

Speaker3:
I think they do.

Kate Wolin:
Really? I’m fascinated by this.

Joseph Kim:
Because my son.

Kate Wolin:
There’s no cookies? Like.

Joseph Kim:
No, he’s just glug glug glug.

Kate Wolin:
Amazing.

Joseph Kim:
Yeah, yeah, but I like what you said about expectation setting. It’s not just telling them what to expect when things go right, it’s also telling them to expect when things go wrong and giving them a plan B or some sort of remediation to do that sort of thing. And you talked, you touched on the informed consent, but here’s where I might have a problem with the informed consent also, and I think you might too. Sometimes, the use of language, the English language, is unclear. For example, I’ve always had a problem with this, which is, here are the common side effects. Now, to the layperson, common is like it will probably happen, but informed consent, common may be as little as 5%, which is different. What’s going on here? Should we stop saying common? We try and use simple words, but common is the wrong word.

Kate Wolin:
Right? I mean, and there’s two layers to it, which is my frustration when we talk about like risk, right? Is like absolute versus relative risk. Yes, doing this thing might increase my relative risk, but on the whole, my absolute risk of that thing happening is incredibly rare, right? I think it’s the same thing around side effects, right? Like, in the grand scheme, this side effect, like side effects are rare. When a side effect happens, these are the more common ones, right? Like that’s very different than saying to me like, this side effect is common and without any quantification of it, right? And the hard part, if you try to quantify it, is people’s quantitative skills, like numeracy skills of the general population, is not high. Like even among healthcare providers, it’s not always that high, right? I think it’s like, I’m curious, right? You have something where it’s like a chemotherapy regimen, right? Like the common side effects may be nausea, right? Like everyone who’s known someone who’s undergone, had a cancer diagnosis, and undergoes treatment, has this expectation of cancer treatment leads to nausea, right? So it’s one of those things, like you said, like, oh, I’m clearly going to experience this, but to your point, it could be a very small segment of the population that experiences it. And there’s also like degrees of magnitude, right? Like in terms of something like headache or nausea, right? Like, am I going to be missing work because it’s so bad, or is it like, take a couple Tylenol and carry on my merry way headache?

Joseph Kim:
Yeah, yeah. Is my nausea like a random Wednesday, or is it something like after a night of partying? Like those are two different kinds of nausea, for sure. Tell us a little bit more about your approach at Circea and what you do to help digital health, healthcare, and clinical research just get better at what they’re trying to, how they’re trying to support patients.

Kate Wolin:
Yeah, so I think there’s not one way, but like, an example of how that might work is to say a company has a product, right? And they’re not getting the adoption or the engagement that they were hoping for, or they’re going to be working with a new type of customer, and they want to be prepared. Is sort of, like kind of like where we started, like, what are the behaviors that we’re trying to touch on? What kind of change are we looking to drive? And then I like to do something super nerdy that I call Bayesian product development, which is go to the science and use the known priors in Bayesian secret, like what does the scientific literature say is effective in this situation? And I use that as a means of then sort of de-risking the choices we make about features and functionality to build. Because there’s 100 behavior change techniques, there’s a whole plethora of ways that those could be implemented within different products at different time points for different customers. A lot of the companies that I work with are doing personalization on top of all of this. So it’s not a one-size-fits-all, experience. It, and how do you make choices about what to build next and how to go about building it? And part of behavioral science is also like measuring what we’re doing. So what is the expected outcome here? And is it, are we ultimately trying to change, like ultimately, theoretically, we’re trying to change some health outcome, but in a lot of situations, that health outcome can be pretty distal in terms of impact or timeframe. So thinking about what are the process measures that are going to indicate that we’re having the desired effect or likely having the desired effect, because most of what we do, particularly in digital health and digital experiences, is we have the ability to test and learn, and you can’t test and learn if you don’t have a hypothesis and you don’t have something that you’re measuring, and so, thinking about what are those techniques to bring into it. And there’s a behavioral science component to it. It pulls on user-centered design and classic product management, and those things kind of all come together. And for most of those companies, it’s also a question of, what does this mean for my operating cost, right? Like, is this something that is part of my base product, and I’m not going to be able to charge more for it? Or is this creating something new, and to charge more for it, I have to be clear that I’m delivering a new outcome? And so wrapped around all of it is the business model implication.

Joseph Kim:
Yeah, and it’s a real art. You have to look at it from so many different angles that are economic, technological, human. Do you, have you seen a pattern arise in some of these, maybe younger companies or even mature companies who are trying to do this? Have they framed the question wrong in terms of the behavior or the change? What do you see as like the more common missteps or mistakes?

Kate Wolin:
I think the most common misstep comes from, I love that people have discovered behavioral science. It’s great, right? It’s great that people are looking at wanting to use it. I think there are also some voices out in the field that have made it seem pretty simple to do, right? Like A plus B equals C, and it’s complicated. And so, I think when it doesn’t, when it doesn’t go according to A plus B equals C, like they might dismiss that behavioral science is worth doing, or it loses traction within the endeavor, and I think that does a disservice to everyone. It is a science, that means you’re doing experiments. It does not mean I’m going to walk in and give you a formula, and it’s going to go according to plan, like we’re talking about human behavior here, and so I think that’s the part of it. I think the other, related to that is this, I read a book about a hammer, and now everything’s a nail. So it’s just easy to pick on nudges because it’s the one that comes up a lot. It’s a lovely behavior change technique. It’s one behavior change technique in a whole library of them, and so to just pick one behavior change technique is bananas to me. The other is that, again, it gets oversimplified by people who are like, oh, well, take a reminder. Like, I’m going to send a reminder. Well, what’s the reminder going to say? Is it going to say, Joe, take your pill, or is it going to have something more interesting and appealing to you in the content of that message, right? Like, how is the reminder being delivered? When is the reminder being delivered? Is it in the morning? Is it in the evening? As an example, like, I’ve made mistakes too, right? Like when we launched our weight management company, we sent reminders for, the goal of people should weigh daily on a cloud-connected scale, and if we didn’t get a weight from someone, we would send a reminder. Now, if you’re like, if you’ve ever met someone who’s trying to lose weight and they’re weighing themselves, no one ever weighs themselves dressed in the middle of the day, right? You weigh yourself first thing in the morning after the morning …, not wearing a lot of clothes. Got to keep that number down. So for me to send a reminder to you at noon, like no one’s getting on the scale at that point. In fact, they’re annoyed. Like you, I’m like, I’m at work. And so it was the realization that if the reminder didn’t come in a pretty timely fashion to when that person was getting up and going out the door, we weren’t getting away from them that day.

Joseph Kim:
Right.

Kate Wolin:
But if I know you get up at six, and I don’t get away from you at six. 6:15, I send you a note, maybe I get weight from you. Until you go on vacation with your family to Disney World, and I wake you up at 6:15 in the morning with that reminder to step on the scale, and you’re like, I hate you, you just woke me up, right? Like your glasses, like waking you up. Like, now I’ve annoyed you, right? So even something like that, like a reminder, there’s a lot of nuance in understanding human behavior, understanding motivation, and like, some of that is just like, user-centered design, right? And doing that well is hard.

Joseph Kim:
Yeah, I’m just spitballing here, but with the, is it better for that reminder to come at night and say, hey, you didn’t get to the scale today, don’t forget in the morning. Is that?

Kate Wolin:
So that’s right, again, it’s like, what does the reminder say? So that’s one way to do it, is to do it at the end of the day and say, we missed your weight today. Let’s have an action plan for tomorrow, right? Another way to do it is to say that, and then, if maybe you get the reminder the first day of Disney World, but you can pause reminders for a period of time while you’re on vacation because I don’t want you to turn them off and then not turn them back on, right? So there’s a lot of subtlety, and there’s not one right way to design it, but like, exactly the spitballing, right? It’s like thinking about what are the pros and cons of each, and then maybe we experiment, right? Maybe half the people get the evening reminder, half the people get the 6:15 reminder, and we go from there.

Joseph Kim:
Yeah, see what works. Kate, this has been a truly enlightening conversation. I could talk to you all day because I’ve plenty of behaviors I want to change. Certainly, for our company, we’d love to engage you more in that fashion in terms of how do folks find you on the Internet to work with you and use your expertise.

Kate Wolin:
I’m at DrKateWolin.com. I’m sometimes @DrKateWolin on Twitter although I’m trying to, it’s one of my behaviors I’m trying to change is to be on social media less, so yeah, but I’m on LinkedIn, I’m on my website, and folks can find me, always find me there.

Joseph Kim:
Yeah, and Circea is C I R C E A.com. Yeah, great, okay. Kate the great, thank you for joining us. It’s been a lot of fun. Have a great rest of the day. I know you’re in Chicago and we’re wrapping up here, but thanks for spending time with us. This was a lot of fun.

Kate Wolin:
I appreciate it, it’s fun. Me too, thank you.

Joseph Kim:
Thank you for tuning in to Research Confidential. We hope you enjoyed today’s episode. For more information about us, show notes, transcripts, and resources, please visit ProofPilot.com. If you’d like to debunk a clinical research myth, share some war stories, or maybe just show our audience what kind of heroics it takes to pull off gold-standard research, send us your thoughts, episode ideas, and more to Help@ProofPilot.com. This show is presented by ProofPilot and is powered by Outcomes Rocket.

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