Compliance is digital health’s bottleneck

I’ve been working in SF/Silicon Valley digital health startups for the last few years. I have friends in similar companies. For digital products to make a dent on public health, the bottleneck isn’t efficacy. It’s compliance.

For many mental health issues — sleep, anxiety, and depression chief among them —we have a decently effective intervention:  cognitive behavioral therapy (CBT). We can now deliver high quality CBT at scale, for cheap via the web and mobile apps.

So problem solved, right? We just set up the marketing distribution channels and step out of the way? Nope. The hard problem is getting people to actually do the thing.

Imagine a person whose biggest source of suffering in life is insomnia. Imagine that you are willing to give that person a cure for their problem for $20 and a couple hours of effort per week. You might think this person would jump at the chance. But to my surprise, by and large, they don’t. And even when they do, they typically quit after a week or two. So they’ll go on suffering, with the cure sitting right there next to them.

Retention / compliance is the problem. Digital health hasn’t figured it out yet.

The people who are starting to figure out retention are game companies  especially mobile games. Supercell is the one to watch. The tools they’re using are the tools of Skinner and casinos — conditioning and shaping. Digital health will need to learn these skills if it wants to deliver on its promise.


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