Examples of evidence-based impacts in the literature

Research into human behaviour has demonstrated that individuals are relatively open to change on occasions characterised by dramatic events, such as natural catastrophes, the death or the birth of a family member, the loss of a spouse by divorce or death, physical movement, i.e., relocation to a new home, change of employer, etc. (Thaler and Sunstein, 2008; Phil et al., 2010). Besides this, the presence of a reward factor, and the way in which it is introduced, is critical. Rewards will increase in importance with reduction of the time elapsed between action and reward received (Bealer et al., 2007). The role of different kinds of rewards can further be structured based on insights what matters most for different people and at different points in time (Deval et al., 2005).

There is recent clear-cut evidence that mobile interventions can work effectively to enact changes in behaviour, especially when introduced in a way that complements other critical factors (Hawkins, 2010; Lyles, 2011). The potential implications for the health care industry, for instance, globally as well as in the GCC countries and Kuwait, are far-reaching (Kazem and Beales, 2010).

At the same time, the LearnforLife programme goes beyond what has been attempted in earlier work. It brings together several components, each of which have proven effective in the past. The precise magnitude of the benefits of the programme depends on the scope of the effort to determine and gradually sharpen the most cost-effective mix of interventions to promote favourable activity. Fine-tuning the package results in higher precision and gradually enhanced impacts, cf. past inducements to increase the physical activity of patients (Cobiac et. al, 2009).

Programmes applying ICT

The advancing information and communications technology (ICT) offers new scope for creating a constructive interface between individuals/citizens/patients and information suppliers on how best to prevent or counter serious societal challenges. In particular, with the diffusion of mobile telephony it has become possible to reach out to millions or even billions of people within minutes, and over extended period of time. The potential importance of this aspect is partly associated with changed means and strategies for how knowledge is created and used, and also how individuals search information and educate themselves (Wagner et al., 2004; Andersson, 2011).

So far, however, ICT tools have largely been applied for entertainment and pleasure, catering far less for cultural and societal perspectives and issues. Scant attention has been paid to the potential for applying ICT for productive exchange of experience and learning, within as well as across societies, on how to counter the most pressing and destructive issues of our time.

Applying Internet-based services and mobile telephony, the PCS is developing the means for user empowerment in a number of areas, through inspiration and the constructive interface between technology and human behaviour. Special emphasis is placed on designing incentive structures and tools for training and monitoring that can be applied effectively in the context of specific cultures and in response to specific acts of mismanagement, weather it comes to safety, health disorders, or environmental degradation. The key is for individuals to gain the insight and ability to pursue small but important adjustments in everyday life. Part of the challenge is to motivate and enable people to turn from ignorance to awareness, from reaction to pro-action, from uncertainty to confidence, within their particular societal context.

On this basis, the LearnforLife programme has developed a multi-risk-factor intervention methodology, with applications using mobile technology as a core element, tailored to addressing the complex interactions between lifestyle , behaviours and psychosocial factors. The approach has been fine-tuned over the past five years through collaboration between researchers and practitioners, in Europe, Asia and the Middle East. Several organisations have contributed to the development of the scheme, including the methodology and content provider PCS Ltd., Ericsson Ltd., which has developed the technical platform, IKED as a non-profit organisation and think-tank that has worked with several governments on ICT and innovation policy, and research teams at Karolinska Institute in Stockholm and Kings College in London, in preparation of the evaluation and research agenda to follow the implementation.

Socio-economic benefits

With a focus on the health agenda, we here discuss briefly aspects of socio-economic payoff. Other areas also offer examples where benefits may be obtained, such as road safety.

Current trends point to an ongoing escalation of already very high societal costs from lifestyle induced disease, notably related to diabetes and obesity. It is estimated some 285 million people suffered from diabetes worldwide in 2010, which corresponds to 6.4% of the world population (Farag and Gaballa, 2011). Projections for 2030 estimate this will rise to about 440 million, or 7.7% of world population at that point. According to these sources, the estimated societal cost of diabetes is currently estimated at $376 billion, and is expected to reach $490 billion in 2030. Diabetes and obesity are estimated to consume 14 and 5.7% respectively of total health expenditure in the United States. When costs associated with overweight are added, the upper limit of obesity expenditure rises above 9 % of total US healthcare expenditure. The relatively highest expenditure on diabetes alone in any country is found in Saudi Arabia, where it reaches 21% of total health expenditure, with no data available on the cost of obesity.

Against this backdrop, the potential social and economic benefits of prevention are evident. The costs of treating patients for diabetes and related disease run into tens of thousands of USD per year per individual requiring dialysis. These costs are gradually escalating as the conditions of patients worsen. As the population falls prey to such disease as increasingly young age, the present situation is set to gradually worsen, given that present trends continue. The costs keep increasing as patients enter serious stages of the disease early in life and will survive to endure it for a longer period, and because their working period in life shortens, as does their lifespan. Costs rise due to the long-term diabetic complications, reduction in health-related functioning, reduction in the quality of life, and reduced overall life expectancy. Long-term complications include myocardial infarction, cerebrovascular stroke, and end-stage renal disease. There is also a documented association with chronic stress, depression and sleeping troubles.

A range of additional benefits observed in previous studies will, at the same time, be accessible through the LearnforLife Programme, although their precise magnitude cannot be quantified as of this stage. Among these, there is the documented synergy between the IT-induced behaviour change model and the payoff of other treatments, including medication. The behavioural change methodology is, in other words, capable of leveraging the positive impact of other kinds of treatment.

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