"To encourage behavioural change we need persuasive and ethical applications"
 Manuel Armayones

Manuel Armayones is one of Spain's leading specialists in persuasive design in digital health (Photo: UOC)

Teresa Bau
Manuel Armayones is the director of the Behavior Design Lab of the Psychology, Health and Network (PSINET) research group at the UOC's eHealth Center and also co-director of the UOC-COCEMFE Chair in Personal Autonomy and Digital Health


The World Health Organization (WHO) recently highlighted the importance of behavioural sciences in addressing the problems of today's world. Manuel Armayones, a psychologist and researcher at the Universitat Oberta de Catalunya (UOC), is one of Spain's leading specialists in persuasive design in digital health and the director of the Behavior Design Lab of the Psychology, Health and Network (PSINET) research group at the UOC's eHealth Center. He is also co-director of the UOC-COCEMFE Chair in Personal Autonomy and Digital Health, which has just celebrated its first anniversary.

It's been a year since the creation of the UOC-COCEMFE Chair. What are some of the key milestones and challenges you have encountered?

The work carried out so far has been very positive. Among other milestones, we have advanced in the study of the relationship between loneliness and disability, through a joint project with the Barcelona Municipal Institute for People with Disabilities. We have carried out a systematic review of the scientific literature, the grey literature (reports, theses, administration documents) and the main databases, and we've seen how addressing the issue of loneliness is complex and, what's more, not being measured systematically. If we include the disability variable, we find that in the group of people with disabilities the perception of loneliness is greater than in the general population.

What motivated you to push for the creation of this chair?

The concept of personal autonomy is commonly used in the movement of people with disabilities, but we realized that it could cover any area: the elderly, vulnerable groups, etc. All sectors of the population aspire to be as autonomous as possible in their lives. The concept permeates all sectors: housing, health care, habits, work, decisions about our lives; in other words, everything to do with being members of society. Narrowing down this concept is the main challenge that led to the creation of the UOC chair together with COCEMFE (Spanish Confederation of People with Disabilities). It's a research tool to help answer questions such as: Is there a single dimension to personal autonomy? Does technology help us to be more autonomous? Or should we be more critical of it, since often its only aim is to reduce costs? A good example of this is when bank branches are closed and the elderly are forced to use cash machines and told that's its "modernizing", but without giving real answers to those who, for whatever reason, find it more difficult to use technology.

Of the six initiatives you proposed when creating the chair, in which have you made most progress?

I would highlight two in particular: first, the study on loneliness and disability, which this year has focused on evidence gathering, and second, the work done on fostering healthy habits in people with disabilities. Mention should also be made of the collaboration with the UOC's Faculty of Economics and Business in areas such as accessibility and accessible tourism, with the aim of promoting universal accessibility to improve personal autonomy. 

Can technology offer a solution to society's loneliness problem? 

Technology in and of itself does not solve or worsen anything; it’s all about how we use it. With Beni Gómez Zúñiga and Modesta Pousada, who are both members of the Faculty of Psychology and Educational Sciences, we have already shown that studying loneliness and the role of technology is far from easy. Naively we might think that we could solve it by generating more social interaction, but this does not apply to everyone. In fact, it doesn't even seem as though there is a direct relationship. Technology is just a tool. It's the people themselves who feel lonely; this subjective feeling cannot be addressed simplistically. Alleviating loneliness with technology requires a very broad view of the phenomenon and the ability to generate scenarios that allow everyone to use the resources that are useful to them.

What has been the impact, so far, on improving people's autonomy with digital technologies? 

I'm not impressed by technology if it fails to make life easier for people and increase their personal autonomy. A good example of useful technology is the project by Mònica Cerdán from the Faculty of Economics and Business, who points out that, in the field of accessibility to public transport, the use of mobile applications such as NaviLens. It's been developed by the Mobile Vision Research Laboratory at the University of Alacant in collaboration with the start-up company NaviLens, and has been adopted on public transport in cities such as Barcelona. It's a great example of a technological initiative that promotes the personal autonomy of blind people.

Your Behavior Design Lab is extremely active. How would you explain the interest in this type of research in today's society? 

There is growing certainty that if behavioural sciences, and specifically psychology, are not taken into account, then it will be really difficult to address societal challenges that require changes in behaviour. The Secretary-General of the United Nations, António Guterres, last year published a guidance note on behavioural science, in which he indicated its enormous potential to meet the seventeen 2030 Agenda Sustainable Development Goals (SDGs) and urged institutions and governments to invest in it to overcome barriers and facilitate change in society. We believe in this potential, and focus on applied research, especially in the field of health.

Which of the Behavior Design Lab's projects is closest to being used in clinical practice and actually benefiting patients?

We are currently collaborating with Barcelona's Hospital Clínic and the University of Twente on a project to understand how technology allows patients with chronic illnesses take care of their health. We're also collaborating with the Hospital Clínic's Patient Experience Unit on the Clí-Nit project, which is based on behavioural design techniques with the goal of helping patients sleep well during their hospital stay. Being able to rest properly when admitted to hospital has obvious effects on patients' quality of life.

We are also participating in a research project with DKV Salut that studies how to achieve therapeutic adherence to diet and exercise in overweight or obese people.

What types of technological interventions are most useful for changing people's behaviour and improving their health? 

We are becoming increasingly aware that to encourage behavioural change we need persuasive applications, in other words, applications that are able to influence attitudes and motivations and foster this change. And to do so from an ethical and respectful perspective. An ideal mobile application should combine elements of behaviour-oriented design – user experience (UX), gamification, etc. – keeping in mind that a good user experience is a required but insufficient condition for promoting lasting change. In the case of health promotion and healthy habits apps, users should be able to understand that there are people behind the app who want to help them and that technology is just another tool, but it's not always the core of the intervention.

What kind of mobile apps and interventions have you developed so far? 

Here at the Behavior Design Lab we've carried out an intervention to acquire healthy habits through a Telegram channel, which came about as part of the UOC Health Week in 2020. The intervention, based on the Fogg behaviour model, was a great success, with a hundred people telling us that they had managed to adopt new healthy habits. We are also carrying out a project to create healthy habits among people with disabilities, specifically with COCEMFE Catalunya, which is now up and running.

What do you think about the actions taken by public organizations with technological tools to influence citizens?

I believe that tackling a pandemic like the one we are currently experiencing has given administrations the opportunity to gather a lot of information, which we hope will gradually be transformed into knowledge. There've been cases of applications that we thought would play a central role and it turned out not to be the case – I'm thinking specifically of Radar COVID-19 – and, in contrast, others that have been very successful, for example the application to request a vaccination appointment. I'd also like to highlight the use that many professionals make of instant messaging apps like WhatsApp and Instagram in terms of training and accessing information.  We end up using the tools that meet our needs, tools that add value.

The rapid evolution of the pandemic makes it difficult to conduct experiments that provide information on, for example, the effect that certain social media campaigns have on the behaviour of their target audience. We should follow the example of countries that have developed specific working groups to conduct research on social issues related to the pandemic, such as the relationship between individual and collective behaviour in protection from Covid-19 – the famous "hands, face, space" – to see what barriers and facilitators people face and thus be able to offer scientific support to decision-makers.

I always cite the example of the Behavioural, Environmental, Social and Systems Interventions (for pandemic preparedness) or BESSI, an international working group that generates evidence to improve governments' ability to react to the non-medical aspects of a pandemic, which undoubtedly also play a central role in finding solutions to the crisis.

If one day someone manages to discover the keys to clearly influencing people's behaviour, it will be a momentous milestone. Are we close? 

There are more and more theoretical models, groups, and researchers working on behavioural design, persuasive technology, and, in general, how to influence the behaviour of others. But we must act carefully and, above all, comply with the codes of ethics of each profession and academic research. The situation is very different for multinational corporations, which know perfectly well how to change the behaviour of millions of people, and this is widely known among the general public. When millions of people use apps like WhatsApp, Instagram or Twitter every day, you would have to be very innocent to think that there isn't a persuasive technology team behind it.

The world of research is very different. However, we're interested in dissecting what principles these companies use and in trying to apply them to issues such as therapeutic adherence, smoking, vaccination and, in general, healthy behaviours, always taking into account ethics and scientific standards. We're fortunate that there are PhD students doing research with us in this area from a number of different theoretical approaches.

Now that it's been a few months, what is your assessment of the We're scientists, get us out of here! project, in which you are participating to promote scientific careers among young people? 

It's always a good opportunity to see how scientists are seen by secondary school students, some of whom will be the scientists of the future. Being invited by prestigious organizations like the Spanish Foundation for Science and Technology (FECYT) to speak openly and honestly with students was a great experience. I was impressed by their knowledge of certain aspects and, likewise, by their lack of knowledge of others. There were those who thought that researchers are like rich and famous YouTubers who sign autographs, while others believed that it's not possible to carry out research and make a decent living at the same time. All this suggests that, if left unchecked, many research-focused careers could be lost. This cannot be allowed in any country, so an activity like We're scientists is very welcome, as it gives a boost to young people who want a career in research.

In addition to being a researcher, you are a great science communicator and popularizer. What would you say to scientists who aren't interested in science communication?

I believe that explaining to the public – who, after all, pay for our research through their taxes – what we do in the simplest way possible is the method we should adopt. Sometimes, when you communicate your work and contrast your findings with people who live with the issues you're researching, they teach you things you can't find in scientific articles and make you change your mind, as well as teaching you things that cannot be found in the literature. More than once it's proven to be a useful reminder of the importance of humility.

Finally, what would you ask for in 2022 as a researcher in the field of digital health?

Let's take advantage of the pandemic to strengthen research in all fields, because perhaps for the first time in history, scientists from all disciplines and from all over the world have come together to do research on the same subject, and all have made important contributions. Here's an example. It would be useless to develop a vaccine if, from the perspective of social and behavioural science, we are not able to understand why some people decide not to get vaccinated. The efforts made to work together from different disciplines is impressive. I would like us to be better researchers, more open, transdisciplinary and aware that we can all contribute knowledge to avoid suffering as a result of this pandemic.