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Behavior Change Part I - Autonomy & Intrinsic Motivation

By: Jennifer La Guardia Ph.D., Senior Behavior Scientist

This is Part I of a series focused on behavior change. The first installment focuses on the moment where all behavior change begins: motivation.

People often find themselves feeling overwhelmed by change and don’t know where to start. For participants considering tackling their chronic conditions, the fear becomes even more acute. Why? Change requires getting unstuck from long-standing, ingrained patterns that can sometimes feel like they rule our daily lives. It’s no small feat to shake this up.

Motivation is critical for change. Behavioral scientists have conducted extensive research into why people decide to make changes and the extent to which those reasons for making changes will last long term.

More often than not, when people are first considering making a change they are motivated by rewards: “My HR team says I'll get a Fitbit if I stick with this program for 3 weeks." Alternatively, pressures to change their behaviors: “I have to lose weight so I can impress everyone at my high school reunion.” These are known as “extrinsic” motivators. And while they may work temporarily to move individuals into action, they rarely (if ever) lead to long-term results. When the reward is delivered, or the pressure is off, people revert back to what feels familiar and comforting.

At Omada, we believe that sustainable behavioral change requires intrinsic motivation -- something confirmed by observations from more than 250,000 Omada participants to date. When it comes to weight loss – and changing the patterns that define our lives – the literature shows that the motivation to do something because it is personally rewarding and valuable is both more durable, and leads to longer-lasting results. So wanting to do something because it is directly rewarding (“I want to exercise more because it helps me feel energized”) or because it serves other important goals and values (“I want to have a healthier heart to live a long, healthy life with my family”) can help people keep moving in a healthy direction, even when things feel tough.

People aren’t formulas; they are likely to continue to have both extrinsic and intrinsic motivators for changing their behaviors. But it’s the balance of these motivations that predicts whether a person is more likely to stick with the change over time. Specifically, the greater focus on the intrinsic motivators -- in other words, how autonomous a person is -- the more likely he or she will be to maintain the changes they initiate.

Intrinsic Motivators

Extrinsic Motivators

“I want to be a good role model for my kids and teach them how to eat healthy.”

“I have  to diet and lose weight to keep my insurance costs down.”

“I want to be more fit so I can hike up California Street with my friends.”

“I want to exercise to look better so that people will find me more attractive. ”

“I want to start exercising and eat better so that I have more energy.”

“My doctor is going to be so mad if I don’t hit this goal.”

 

Omada’s entire participant experience incorporates evidence-based approaches that prioritize cultivating autonomy – from account set-up to program features, activities and curriculum.

When participants first create their accounts and profiles, we look for cues as to what is driving their desire to change. We talk to them about how to find value in change, and how it can support their important life goals. We try to shift greater attention to finding meaning and value for healthy behaviors, and give less power to external pressures as a source of motivation. Our coaches focus on intrinsic motivators tied to our participants’ interests, curiosities, and values. We rely less on rewards, social pressures, and nudges to stoke change because behavior changes motivated by personally meaningful issues will lead to more durable results.

Many other digital behavioral health companies fall into the trap of simply screening for participants’ readiness to change via self-reported measures, then accept only those who are deemed “ready”. This approach of exclusion is meant to serve bottom lines, not people. Most people will always have some ambivalence about changing, and struggle with the confidence that they will succeed. 

In contrast, Omada’s screening process is designed to assess the personal importance that change has for our participants and their confidence in carrying out change.  We find that the personal importance of change to our participants is more predictive of early changes in eating and physical activity habits. But even if change is important, people don’t always feel confident they know how to successfully make changes. That’s where Omada’s unique combination of coaches and technology come into play. We meet individuals at their skill level, and focus on small, manageable shifts that help them progress toward their goals.

Other digital health companies focus on devices, wearables, or tech integrations to spark behavior. They neglect an individual’s unique interests and needs in navigating the change process. An effective program goes beyond a simple nudge when a participant gets off track. Omada’s approach to digital care means providing holistic support to help people to take ownership over the reasons they want to change, and supplying the tools to make those changes fit in their lives. The bottom line? Motivation for sustainable behavior change comes from within and is supported by personalized tools to make change happen.

This approach is unique to Omada – and it works. Check out one of our many case studies on how our approach is successful here, as published in the Journal of Medical Internet Research with our study partners at USC and UC Irvine.