Mobile Technology

“Personal Purpose” Engagement App Tests Work-Life Boundaries

Engagement app promises to help you fulfill your purpose in life.

Engagement app promises to help you fulfill your personal purpose in life.

Your employer sends out an email saying they want to make sure you’re getting enough sleep and physical activity, are eating well and feeling creative and, finally, have a sense of “mindfulness.” So they’re providing a free app designed to facilitate finding your “anchoring purpose in life.”

Sound like a nice perk? Now add in one more detail.

All the information, albeit with individual data de-identified, goes into a giant database meant to boost productivity and reduce medical costs by improving worker physical and mental health.

Any less excited?

The app, from a start-up called JOOL Health, raises the question of when good engagement can bleed into overtones of Big Brother. The answer is complicated.

JOOL is the brainchild of Victor Strecher, a professor of health behavior and health education at the University of Michigan School of Public Health and a successful entrepreneur. Marketed to third parties rather than direct-to-consumer, the app was pitched at a recent consumer experience conference sponsored by America’s Health Insurance Plans (AHIP) as a way to go “from wellness to engaged wellbeing in the Digital Age.”

JOOL’s promise of a return on investment (ROI) is rooted in research about the impact on resilience of the five positive behaviors mentioned at the start of this article. Resilience, in turn, enables individuals to better manage stress and other difficult experiences in life. The journey from academic insights to app is also a story of heartbreak and hope.

In other venues, Strecher has spoken about the terrible circumstances that led to his championing the centrality of embracing a life purpose. Strecher was painfully pushed to reclaim his after the tragic 2010 death of his daughter, Julia, due to a rare heart condition. JOOL, reflecting Julia’s nickname, is Strecher’s latest effort (he’s also an acclaimed author) to give back to others something positive based on that awful experience.

At AHIP, Streicher presented research summaries showing that having a purpose in life could reduce the risk of stroke, heart attack, diabetes and drug abuse. More intriguingly, each “unit of purpose,” in a study Strecher co-authored, was associated with 17 percent fewer nights in the hospital.

If that clinical and financial return wasn’t enough to seal the deal, there were the “side effects” of a purposeful life, Strecher said: “You have more friends and better sex.”

So how do you get there? The JOOL app helps you set goals and uses machine learning (a form of artificial intelligence) to understand your habits. It then gives you just-in-time information to help you stay the course on, say, maintaining your energy level or eating right. The app also accesses outside data on factors as diverse as the local weather and phases of the moon.

Unlike a typical fitness tracker, JOOL data is designed around self-determination theory to serve as motivational interviewing, with the individual being both the interviewer and interviewee.

For employers, the payoff is a dashboard with individual information anonymized that helps them gauge the wellbeing of the workforce and try to align workers’ purposes with those of the company. The results could be particularly relevant to organizations trying to stoke employee creativity. For health plans and employers alike, the ROI promise also includes the app’s putative preventive health benefits.

It is a fascinating and ambitious use of technology. Nonetheless, leaving aside the limits of Big Data (not everything that counts can be counted) or realistic estimates of an ROI, I have two major concerns.

First, I worry about unwittingly crossing yet one more traditional boundary between work and private life. Even presuming protection of privacy, there’s a difference between my employer paying for a weight-loss class or implementing wellness incentives, where the intent is clear, and purporting to care about my life and dreams in order to boost the bottom line. It’s a matter of trust. Strecher’s background as entrepreneur and academic suggest he’s never watched his salary lag as the CEO’s compensation leaps. When the cappuccino machine is carted away to cut costs, can jettisoning the JOOL Health subscription be far behind?

The second source of uneasiness is more basic. With all due respect, I worry Strecher’s trying to squeeze the biopsychosocial model into an app “mold” that doesn’t quite fit it. Even a quick skimming of the medical literature suggests that resilience depends upon important factors beyond the individual. For example, an examination of “social ecology” discussed the “social contexts and development processes” that shape “better-than-expected health outcomes in the face of adversity.” That social context extends beyond the workplace. My app may prod me to exercise, but it cannot provide me with a non-virtual community.

A best-seller by evangelist Rick Warren is titled The Purpose Driven Life, though that could also be the subtitle of the Bible, Bhagavad-Gita or Koran. If Strecher believes that digitization and data aggregation can offer a path to fulfillment that analog enlightenment cannot, he could start off spreading the good news through groups that gather individuals for a common purpose other than commerce, be they religious institutions, community groups or social ones. Bird watchers rather than bean counters.

No engagement app, no matter how sophisticated and effective, can avoid the implicit questions of “by whom?” and “for what purpose?” If you’re searching for deep meaning rather than deep pockets, the local health insurer or corporate human resources department may not be the best place to start.

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Michael L. Millenson, President, Health Quality Advisors LLC Michael L. Millenson, president of Health Quality Advisors LLC, Highland Park, IL, is a nationally recognized expert on quality of care improvement, patient-centered care and web-based health. He is the author of the critically acclaimed book, Demanding Medical Excellence: Doctors and Accountability in the Information Age, and he is adjunct associate professor of medicine in the Department of Medicine at Northwestern University's Feinberg School of Medicine. National Public Radio called him “in the vanguard of the movement” to measure and improve American medicine. Prior to starting his own firm, Millenson was a principal in the health-care practice of a major human resources consulting firm. Before that, he was a healthcare reporter for the Chicago Tribune, where he was nominated three times for a Pulitzer Prize. He serves on the boards of the American Journal of Medical Quality and Project Patient Care.

Michael L. Millenson, President, Health Quality Advisors has 13 post(s) at EngagingPatients.org

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