heart-attack-cafeWill fitness tracking take off in middle and rural America? The larger question is whether people really, truly want to engage in health and, if so, how?

My colleague and friend Dr. Carol Torgan, who curates the most extensive wearable tech Pinterest board and writes extensively about the subject in her blog Kinetics: From Lab Bench to Park Bench, was struck by my recent blog post, Health, Wearables and the IoT in the Windy City. That weekend I was in Chicago, Carol was visiting a rural region in the state of Virginia and spent time at a county fair.

The quintessential county fair is packed with regional fun, games, food, and local culture. At this fair were rides, agricultural competitions, Ferris wheels, and of course, country fair fare — fried food on sticks, cotton candy, funnel cakes, and the like.

Carol DM’d me on Twitter to let me know she had quite the opposite experience that I did that weekend — that where I saw health “everywhere” on my walk on Michigan Avenue, she saw pre-diabetes, obesity, and heart disease in the making.

Carol spoke with a woman, who looked lonely as she was staffing a health fair booth ready to take peoples’ blood pressure. Carol asked her how was “business,” and the woman woefully told her that “people don’t want to know their numbers.” She further observed to Carol that people “don’t believe free is free,” and that in stopping to get their blood pressure read at the fair, the consumer would somehow be beholden to the woman or her organization for follow-up, information sharing, whatever.

Furthermore, the health fair staffer told Carol that (and I paraphrase here), “If you tell them they have high blood pressure, most of them don’t have doctors for follow up or medications.”  The staffer said that many of the fair attendees had other more pressing issues to worry about than their health – such as simply putting food on the table.  They avoid the booth because they don’t want to risk having anything else to worry about, such as bad numbers.

Health Populi’s Hot Points:  For people managing chronic conditions, it’s not country-fair fun to take care of oneself. A study in the August 2015 Journal of Medical Internet Research by Dr. Jessica Ancker and colleagues is titled, “You Get Reminded You’re a Sick Person: Personal Data Tracking and Patients with Multiple Chronic Conditions.”

The researchers found that patients/people really don’t like to do “illness work” — that is, management tasks that deal with multiple chronic conditions simultaneously. They observed: “Developers of consumer health information technologies for data tracking (such as diet and exercise apps or blood glucose logs) often assume patients have unlimited enthusiasm for tracking their own health data via technology.” 

Au contraire. Carol and I discussed our yin-and-yang perspectives, and developed a list of issues to ponder:

Health engagement is in the eye of the beholder. Something we know we know is that every individual (rightfully) defines health and wellness through their own lens, set of values, and cultural bent. We cannot assume, with arrogant public health hats, that one behavior change strategy in health will be attractive, motivational, inspiring, or sustainable for all people.

“Illness work” must be made simple. The researcher of the JMIR study point out that new digital health technologies aimed at patients will be successful only if they reduce patient inconvenience and burden, and helping people accomplish “illness work” more efficiently and effectively.

User-centered design is a sine qua non of working in health care. That is, if you want to be effective in inspiring and bolstering behavior change. Deep understanding, in an anthropological, sociological sense, is a key to creating programs that go direct-to-health-consumer. We’re in the era of post-demographic consumerism where just segmenting on the basis of age, gender, or income just doesn’t work. The folks at TrendWatching have taught me this, and they’re spot-on. There are millions of older people who Skype with grandkids, and Millennials who despise the idea of wearable fitness tracking. Do the required homework.

Food is a central way to get to people and their health.  I’ve learned over the past several years the growing and central role that food plays as medicine for people. More people are looking to the grocery store for cures, or at least risk-mitigation for health conditions. Witness the growth of the gluten-free aisle and homeopathic remedies at your chain grocer, along with the pharmacy as a key component of the store. Would a salad sell at a country fair? Does that matter? All good things in moderation has an evidence base which demonstrates that when people go cold-turkey on their favorite things, they end up less well than if they allow themselves bites of good things along their health journey.

What we know: the shiny new things along Michigan Avenue won’t work for everyone passing by the pretty windows, and not everyone attending the Virginia county fair is health-disengaged. But when we’re talking about behavior change, we must keep that N of 1 — the individual health consumer, patient, shopper, fair-attendee, and caregiver — central in our R&D, product development, marketing, sales channel strategies, and after-care service programs. The value of getting to know those “N’s” cannot be underestimated.