Case Study: Helping Asthmatics With Habit-Forming Product Design.

If you’re an asthmatic, taking your inhaler can mean the difference between life and death. Yet it’s easy to forget to take your medication in the morning. In this case study, we’ll learn how behavioral economics and product design combined to help asthmatics never miss a dose.

In this case study, you’ll discover:

  • How a team lead by Nir Eyal was able to ‘hack’ the habit-forming process to better help the lives of asthma sufferers;
  • the 25 cent solution that encouraged asthma sufferers to take their medication when a 7 figure app didn’t; and
  • A method of research that you can use to make your products and services become a habit.
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Problem: Asthma sufferers forget to take their medication.

Asthma is a life-changing condition that affects millions worldwide and so when a pharmaceutical company created a preventive asthma medication in the form of an inhaler, it was essential that their patients used it correctly to fully realize its benefits. The problem was that people kept forgetting to take it twice a day. And so, the pharmaceutical company spent a small fortune trying to encourage people to take their medication. Even spending a small fortune to design and create an app. Yet, it didn’t work. That’s when the company (whose details we can’t reveal) came to habit-forming product specialist Nir Eyal to solve the problem.

To prevent Asthma, it was essential that patients used the inhaler twice a day without forgetting to take it.

Why People Forget To Take Their Medication

You would be forgiven for thinking that this shouldn’t be a problem. After all, if you have a condition that requires medication, it should be the easiest thing in the world to remember to take that medication.

Yet studies have shown that 20 to 30 percent of medication prescriptions are never filled and that approximately 50 percent of medications for chronic disease are not taken as prescribed. And when you consider that according to the WHO 262 million people in 2019 were physically affected by asthma, it shows the sheer scale of the problem. So, why does this happen? Why are people forgetting to take this important medication? It’s because of something called the ‘wanting-doing gap’.

As humans, we want to do a lot. We want to go to the gym, we want to lose weight, we want to spend more time with our family, we want to take more trips, and of course, we want to take our medication. But when it comes to the ‘doing’ aspect things can get in the way, be it a phone ringing, a notification, someone speaking to us, or a news story on the TV that gets our attention. And of course, old habits can be fighting for our attention too. The result is that we often don’t do what we set out to do, whether through distraction or forgetfulness. The question is, how do you change a product so it becomes a habit?

How to Turn Using a Product Into a Habit

With so many asthmatics not using their inhaler correctly, Nir Eyal’s team was drafted in to find a solution. One of the fastest ways to change a habit is to find a behavior that you can latch onto. And this happens in the form of finding a trigger.

One of the fastest ways to change a habit is to find a behavior that you can latch onto. And this happens in the form of finding a trigger.

There are 2 core types of triggers when it comes to habits: internal and external. Internal triggers manifest in the mind of the product user. For example, a person might become bored, so they head over to their phone and open up a social media app that’s designed to provide content to relieve that boredom. 

An external trigger is different as it is outside of the mind of the user. For example, it could be that the Peloton bike sitting in your bedroom that you’re paying for each month serves as the trigger for you to exercise. But how do you know what kind of trigger you can latch onto when it comes to a product? Well, that’s where Nir’s team took it up a level, with observational studies.

The Importance of Observational Studies to Uncover the Truth

It was David Ogilvy that said: "People don't think what they feel, don't say what they think and don't do what they say."

"People don't think what they feel, don't say what they think and don't do what they say."

And this is the problem when you ask people why they aren’t undertaking a certain behavior. They tell you what they think you want to hear, not the actual reason. So the best route forward is to observe people actually using the product and undergoing their daily routines. This might mean going to a place of business, a city or town, and yes, even into people’s homes. And that’s exactly what the team did. They observed people carrying out their morning activities to see if there was a behavior that they could latch onto. And there was. It turns out that brushing their teeth offered the perfect opportunity.

The 25 Cents Stand that Turned Taking medication Into a Habit

When Nir’s team observed that people all brushed their teeth as part of the morning routine, it was easy to come up with a solution that fitted in. And that solution came in the form of a plastic stand that cost around 25 cents to make. The stand was provided together with the inhaler and instructions were given to use the inhaler as part of their normal daily routine, such as brushing their teeth.

The stand was provided together with the inhaler and instructions were given to use the inhaler as part of their normal daily routine, such as brushing their teeth.

When you latch one habit onto another in this way it’s called habit stacking. And the team looked for habits that were done twice daily, just like the inhaler needed to be used. Once the habit was identified through observational studies, the next part was to test the hypothesis. They did this with a small sample group and the results were as expected, people used the inhaler as desired. 

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Why Product Design Must Consider Behaviours

Luckily, the fix to the inhaler issue was a cost-effective solution. But it isn’t always going to be that way. As product designers, if the user isn’t using the product or taking the desired action, it’s never the user’s fault. It’s the design of the product that is at fault.

Good product design helps the user to fully utilise the product and gain its benefits. And this will help a business to retain customers for longer, receive higher-quality reviews and also reduce the customer churn rate. So, before you create a product or service you must consider how people will use the product and invest time before you roll out your product or service. This might sound like an unnecessary cost, but if you don’t undertake these studies before launch, you’ll end up paying more to fix problems further down the line.

Before you create a product or service you must consider how people will use the product and invest time before you roll out your product or service.

How You Can Leverage Habit Stacking For Your Business

You might be wondering how you can use the strategies above to enhance your product or service. Here are some ideas.

Observational Studies

Head into the environment where your product or service is used. If you make beer, visit pubs and bars to see who is drinking and how the beer is being consumed. You might run a car rental service, head out and observe the cars being rented. Use tracking studies to see how people interact with the website and visit pick up locations to see what the service and experience are like for a customer. The key here is to observe what is going on.

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Habit Stacking

We all know that there is a reason that bars like to give out free nuts to customers. Because nuts make you thirsty. But is there a habit that you can ‘latch onto?’ The world-famous ad campaigns for the chocolate bar ‘Kit Kat’ and Diet Coke both latched onto workplace breaks with the slogan ‘Have a break have a Kit Kat’ and Coke went even further by calling it a ‘Diet Coke Break’. 

These triggers were of course hammered home with huge advertisement budgets. But can you think of a better way? For example, consider what your customers do, where they look and how they behave when in a product usage setting. Even consider how long they spend undertaking a certain task and what they do before and after they use your product. Once you find a habit to focus on, then it’s time to see how your product or service can be stacked on top.

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Product and Service Design

If you find a habit to stack your product or service on, the next aspect is to design it for ease of use/ inclusion in that habit. For the asthma inhaler, it was the morning routine and a stand that was created to sit next to your toothbrush. For a restaurant owner, it might be adding ‘wine pairing’ options onto a menu, after all, once you choose your food, it makes sense to choose the right wine. 

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Key Takeaways:

  • Feedback is rarely an accurate reflection of behaviour, so make sure that you undertake observational studies of your product or service in use. And if required visit the actual setting it is used in.
  • Look for existing habits and behaviours and create a new habit by stacking onto an existing one. The inhalers used the morning routine of brushing your teeth - what activity could you utilise?
  • Design your products and services with the user in mind. The inhaler was given a stand to promote use at the desired time. And remember if the product isn’t being used as intended it’s the fault of the design and not the user. 


Introduction of an expert
  • Case study by
  • Nir Eyal
  • Author, Public Speaker, Investor, Consultant