Using Behavioral Product Design to Fight a Silent Epidemic

A silent, relatively unknown epidemic in the United States is the sharp rise in Non-Alcoholic Fatty Liver Disease (NAFLD), affecting more than 85 million Americans. NAFLD is characterized by a build-up of fat in the liver, which can lead to permanent liver damage. In fact, NAFLD is the leading cause of chronic liver disease in Americans, and the 12th leading cause of death in the U.S. 

The good news: if this build-up is caught early, patients can reduce the chance of long-lasting damage. But this is where the challenge lies. It’s hard to get patients to take a diagnosis seriously if they haven’t experienced any symptoms yet.

Livvy is a digital therapeutic app created to fight the epidemic of liver disease. Currently in the later stages of development, Livvy is an all-in-one hub to help NAFLD patients understand and manage their condition: users can access educational resources, track their exercise and diet, and find a little extra encouragement when they need it. It’s like your GP, your personal trainer, and your support system all rolled into one.

Livvy’s parent organization, the digital therapeutics company Chronwell, approached TDL for help with giving their product a behavioral boost. Chronwell wanted our help leveraging behavioral insights and user-centered design (UCD) to keep Livvy users engaged, proactive, and feeling empowered to tackle their own health management.

Livvy’s ultimate goal was to nudge users towards healthier behaviors. But before you can even think about behavior change, you have to cultivate an in-depth understanding of who those users are: what motivates them, what challenges they face, and what needs they have that are going unmet. 

With that in mind, our work started with an extensive primary research phase, during which we surveyed around 800 individuals at high risk of or already diagnosed with NAFLD. We asked them about their journeys with liver health, including how much they knew about NAFLD, their current diet and exercise habits, their past successes and failures with making lifestyle changes and so on. 

The data we collected from the community became the foundation for a behavioral framework we developed for understanding the NAFLD experience. The framework identified the key behavioral barriers that prevent NAFLD patients from making key changes, as well as a number of evidence-based behavior change techniques (BCTs) that have been shown to help combat them. 

With a comprehensive framework in hand, we were ready to get started on designing a new-and-improved Livvy.

When generating design recommendations for Livvy, our goal was not to reinvent the wheel. The planned app already had a beautiful interface, and was packed with useful features to help users achieve their goals. Our job was to ideate low-cost, low-friction modifications that would help increase Livvy’s behavioral impact without necessitating too much additional work.

One key example concerned the app’s onboarding process. During our research phase, a sense of insurmountability emerged as a key difficulty for NAFLD patients: the changes that they were being told to make were too big and too overwhelming, and they felt powerless to make them a reality. 

In our design audit of Livvy, we realized that the app’s planned onboarding process was inflaming this pain point. In the original version, new users went through a 20-screen registration and onboarding process, where they were introduced to the app’s many features and functions. Although this gave them a comprehensive overview of everything the app could do, it was also inadvertently confirming users’ anxieties about NAFLD being too big for them to manage. 

To address this, we designed a progressive onboarding that introduced users to the app’s features gradually. The new onboarding flow starts with the most easily achievable goals, and then slowly ramps up the level of user commitment required. This creates an opportunity for users to build their motivation, commitment, and — perhaps most importantly — a sense of self-efficacy. As users achieve small wins early on, research shows that they’re more likely to build their self-confidence and commit to longer-term action. 

We put all of our recommendations together into a behavioral playbook. The playbook also summarized key insights from our surveys and research: 

• Key insights from our survey, as well as relevant insights from existing research 
• Tips on continued development, including strategies for scaling up our BCTs and incorporating more elements of personalization as Livvy matured 
• Peer benchmarking and real-world examples of how other digital therapeutics tools are using our recommended strategies

Our internal UX team incorporated our recommendations into Livvy’s product roadmap, creating wireframes and mockups to visualize how they would slot into the planned interface.

We finished off our engagement with Chronwell by walking the team through applied demonstrations of how our recommendations could work in practice. We specifically focused on 3 high-priority areas that Chronwell had previously identified: the app’s onboarding flow, key diet-related features, and monitoring healthy exercise habits. While these demonstrations were outside our original scope, we wanted to make sure that the team had the tools they would need to amplify Livvy’s impact in these domains.

Thanks to Chronwell’s product design, patients that use Livvy are more likely to stick to their treatment plans, with no additional workload for their healthcare practitioners.

Using behavioral product design to improve social well-being is at the heart of what we do at TDL. We’re proud to have contributed to an app that helps patients to support themselves on their individual health journeys.

1. National Vital Statistics Reports 1999–2013: Centers for Disease Control and Prevention