Today in the UK, people's overall health is determined less by clinical interventions than by the behaviours they adopt and sustain. Government research shows that across different types of cancer, there are common risk factors: smoking, alcohol consumption, low levels of physical activity, poor diet and overweight or obesity. The same lifestyle factors drive cardiovascular disease, diabetes, and other significant conditions that account for over 60% of ill health and early death in England. Yet these are the very behaviours that are notoriously difficult to change, because they're deeply embedded in our daily routines, social environments, and our general sense of well-being.
This is where digital tools, architected sensibly and responsibly, can make a significant difference. They can encourage healthier routines, support treatment adherence, and provide help on a larger scale. Designed with anything but the user's health at heart, though, and they run the risk of alienating or hurting users at the exact moment people most need help, burdening public health services too.
As the NHS App evolves to become a 'doctor in your pocket', providing digital tools that encourage better health behaviours becomes essential to preventing illness rather than simply treating it. Behavioural science offers frameworks for guidance. We've long leveraged an adapted COM-B model at ustwo, building upon it with practical, design-led methods. Below are our key mechanisms:
1. Celebrate the joy to be had in the jobs to be done
Change is hard, even when someone desperately wants or needs things to be different. We work with users to uncover their intrinsic motivations for change, enabling us to design experiences that offer delight in both the process and the outcome. When we built a product in the Health and Fitness space, we baked in the ability to cater to individual constraints. For example, our upcoming wellness app for new mothers encourages them to carve out just 15 minutes of self-care amid the demands of caring for a baby.
2. Embrace perpetual progress
Change doesn't happen overnight, so being present and enabling people whilst they're on the journey is essential. We use feedback loops that show the impact of behaviour in real-time, tracking medication adherence patterns or stress reduction over weeks rather than days, combined with reward structures that are motivating without veering into manipulation. Drawing on our playthinking ethos, we seek ways to make reinforcement essential and personal, rather than relying solely on rewards, so that people are motivated to create change for themselves.
3. Turn complex data into behavioural insights
In public healthcare, we’re awash with health data, yet without the proper context, it’s hard to know what to act upon. This is why we design for clarity: transforming raw health data into simple, actionable insights that help people take the next step. For instance, rather than burdening users with multiple health metrics, we might surface just one key insight that draws from multiple data points per day—"Your sleep improves by 15% on days you exercise"—with a clear suggestion for the next small step forward, and contextual learning.
4. Leverage social support
Health is rarely an individual journey. Many of our most entrenched behaviours —diet, smoking, and how we move our bodies —are shaped by our families, friends, and environment. Where appropriate, we design tools that facilitate safe and supportive connections. Within the NHS App ecosystem, social features might allow users to share progress anonymously with others managing similar health challenges, or enable family members to encourage medication routines—always with robust privacy safeguards and user control.
5. Solve for personalisation and inclusion
No two people experience health in the same way, and in a public health setting, we must design for all people. Inclusive design involves considering language, accessibility, cultural attitudes, and socioeconomic barriers from the outset, and incorporating people with diverse lived experiences into user research and co-creation efforts. What will motivate one person may alienate another, so personalisation must be done transparently and respectfully to ensure tools feel relevant and empowering rather than prescriptive or judgmental.
Conscientious care
Of course, designing for healthcare carries responsibilities. The matter of behaviour change is complex, and the correct considerations guide responsible design practice, ultimately creating more impactful products that encourage healthier choices without compromising engagement and trust.
Over-nudging and judgment
There's a fine line between support and shaming. Gentle prompts designed to encourage healthier choices without restricting options can become overly direct nudges. If they come across as patronising—or worse, coercive—they may ultimately drive disengagement and increase the likelihood of users deleting the app. In healthcare, this is especially ironic: users are already bombarded with apps competing for their attention through gamified nudges and manipulation tactics, which is hardly conducive to wellbeing. For example, while a reminder to take medication can be helpful, constant notifications about missed doses or judgmental language about "failing" to exercise can be more likely to shame than motivate. Digital health products must lead with empathy and direct users to appropriate care when they cannot provide direct assistance.
Privacy concerns
Behavioural interventions often rely on collecting sensitive data about habits and health, raising questions about how that data flows through interconnected health systems. As NHS digital architecture evolves to connect GP records, hospital systems, and community services, robust privacy frameworks become essential. We advocate for privacy-by-design principles, including transparent data use, clear opt-ins, and robust safeguards that work seamlessly across the interoperable ecosystem, making prevention possible.
Sustaining change
Healthcare apps are no strangers to 'app fatigue'. Research shows that health and fitness apps had a 3% retention rate by day 30 in 2023, though systematic behaviour change often takes far longer than that, and recognisable results may take even longer. Designing for sustained engagement means prioritising genuine usefulness and actionable guidance built on intrinsic motivations, and embedding behaviours into routines in ways that can last.
Getting better, together
Public health is only effective if everyone can access and benefit from it. When leveraging digital apps, that means tackling the digital divide: ensuring experiences work on low-cost devices or offline when necessary, and in multiple languages; designing for older adults and people with low digital literacy; and addressing broader barriers to technology and app adoption.At ustwo, we believe the promise of digital healthcare lies not just in technology, but in making healthier choices easier, more joyful, and more equitable. Behaviour change is never simple, but when we design with evidence, empathy, and inclusion at the core, we can create tools that truly help people live better, healthier lives.
The vision of a 'doctor in your pocket' becomes reality when the pocket understands the person carrying it. That's where thoughtful behaviour change design transforms architectural possibility into sustained health improvement, one person, one choice, one better day at a time.