By Aline Holzwarth
Did you sign a lease to rent housing, or sign a deed to buy your house? Did you have to sign your marriage certificate to solidify your nuptials? What about the last time you executed a business contract? Or when you took out a loan from the bank? Did you sign your tax return?
You probably answered yes to at least one of these questions, and that shouldn’t be a surprise to you. There are all sorts of things we have to sign in our lives, and this simple act of writing our name on a document — the only time we leverage our cursive skills until the next document we sign — is more than a legal obligation to stick to our promises. In fact, when we sign our names we are also reminding ourselves to follow through on those promises. The signature is hard evidence of the seriousness of our commitment, and it stays in our mind as a symbol representing that dedication.
Signing Seals the Deal
Behavioral science research supports this notion that a signature can make commitments more resolute. In a series of studies looking at honesty in reporting, researchers found that participants were less likely to lie when they signed a commitment to be honest before filling out their report. The act of signing brought thoughts of ethics into their minds, serving as a reminder of their desire to be honorable. (Shu, Mazar, Gino, Ariely & Bazerman, 2012). Despite the fact that people had an incentive to lie on the report (they would pay less if they fudged their numbers), the simple act of signing their names to commit to honesty at the beginning of the report (before they had a chance to be dishonest) prompted participants to engage in more honest behavior than those who signed at the end, after it was too late.
Even without the signature, precommitment can dramatically improve behavior. In a study by Professors Ariely and Wertenbroch (2002), the researchers asked some of their students to set deadlines for a series of assignments. They found that the students who precommitted to assignment deadlines were more likely to turn in their assignments on time and to perform better on the assignment.
We Rarely Precommit to Our Health
If you think back to the scenarios where you’ve signed a precommitment (a rental lease, deed for a house, marriage certificate, business contracts, bank loans, tax returns), you might notice that none of these fall into the health domain. Think about the precommitments you’ve made for your health. If you’re like most people, then you haven’t made many at all. This might lead you to believe that people don’t care very much about their health, that it simply isn’t all that important to them.
We Do Care About our Health, We Just Don’t Act Like It
However, people do care about their health. And quite a bit. According to a Gallup survey, 90% of the people that were polled claimed that health was very important or extremely important to them (46% and 40%, respectively) — much more so than the importance they assigned to work, friends and money.
And yet, we don’t commit to our health in the way we do our non-health undertakings. Why not show that same dedication to our health goals?
Pattern Health uses Precommitment to Help Patients Commit to their Care Plans
Patients using Pattern are given the opportunity to precommit to their health. How so? Once they have converged on the best care plan for them through discussions with their physician or care manager (for example, which medications to take, how often to check blood pressure, how much to exercise, and so on), they review their personalized care plan (which we call their “pattern”) and commit to it. They commit by signing their name in the app (just like the example in the image below).
The review-and-commit process has numerous benefits. First, reviewing the elements of their care plan helps patients better understand what they need to do to manage their health. Having everything laid out in one place reduces the inherent complexity of many clinical care plans, transferring the cognitive burden from patients to the app. Because it can feel overwhelming to try to hold all of their health tasks in their minds at once, patients appreciate having the ability to offload this responsibility.
Second, the simple act of signing to commit to the plan should lead to higher adherence, and it’s not merely because it feels like a more formal process (and is more likely to be taken seriously, as we do with our taxes). In addition to the implied formality of a signature, the act of signing has a self-signalling effect, where people’s actions serve as feedback, sending the message that adhering to their care plan is important to them. And then they are more likely to follow suit.
So if you are among the 90% of people who believe their health is very important or extremely important, then perhaps you should start acting like it. And perhaps we should all find more ways to precommit to our health.
P.S. We are very much interested in how you are using behavioral science for your health. If you’ve made your own health precommitment, send us a tweet @ptrnhealth to let us know what it is.
Shu, L., Mazar, N., Gino, F., Ariely, D., & Bazerman, M. H. (2012). Signing at the beginning makes ethics salient and decreases dishonest self-reports in comparison to signing at the end. Proceedings of the National Academy of Sciences, 109(38), 15197-15200.
Ariely, D., & Wertenbroch, K. (2002). Procrastination, deadlines, and performance: Self-control by precommitment. Psychological Science, 13(3), 219-224.
About the author
Aline HolzwarthHead of Behavioral Science
Aline Holzwarth is an applied behavioral scientist, primarily focusing on digital health research and scientifically informed product design. She is Head of Behavioral Science at Pattern Health, an evidence-based connected care platform that leverages behavioral science to help patients stick to their care plans. She also co-founded the Behavior Shop, a behavioral science advisory company, and holds an appointment as Principal of the Center for Advanced Hindsight at Duke University, an applied behavioral science lab that helps people be happier, healthier and wealthier, at home and abroad.