The Affinial Digital Health Platform – The Role of Dynamic Nudges in Therapy Adherence

September 19, 2023 Sean Gill

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The Affinial Digital Health Platform – The Role of Dynamic Nudges in Therapy Adherence

In our previous article, we discussed the importance of patient engagement, and involving patients in their health and well-being journey to improve outcomes. When creating a digital health solution, it’s important to remember it will be used independently by the patient. So, to secure engagement, there needs to be an understanding of how patients manage their health, the environmental context in which they use the digital health solution, and how their treatment fits into their lifestyle.

Many solutions provide nudges to patients to remind them to perform an action, such as taking an injection or recording symptoms. However, repetitive reminders and notifications are seen as nuisances by patients and are soon ignored or disabled completely. To address this issue, the nudges must be dynamic, timely to ensure that patients only receive prompts they require at the precise moment, and actionable so that they can be acted on.

As part of our plans to continuously evolve our Affinial digital health platform, we are in the process of developing a behavior engine on the platform, that will enable customizable patient support, providing nudges to patients based on data collected on what they are most receptive to.

Please note this article makes forward-looking statements and is intended to outline our product direction in general. It is intended only for information purposes, Any unreleased features or functionality referenced that are not currently available are subject to change at our discretion.


Tailored nudges are key to securing adoption and persistence with therapy

When speaking to pharma companies, an overarching problem for many digital health solutions is that the nudges delivered to patients are often universal and not tailored to the unique patient. As a result of the static nature of nudges, many solutions don’t engage customers effectively and therefore do not support adherence to treatment plans. There are 4 main challenges that need to be addressed.

  1. The need to sustain engagement beyond the initial period, to consistently support patients throughout the therapy journey, and to tailor the user experience to patients' needs and life context.

  2. The ability to monitor and modify patients’ care plans to match their therapy stage in order to sustain therapy adherence over time and do so in a way that ensures the care team can retain clinical governance at all times.

  3. The need to dynamically tailor nudges for each patient, adapting them iteratively based on their unique needs by recommending relevant nudges at the right time and in a manner that resonates best with each individual.

  4. The need to proactively anticipate and address potential obstacles patients may encounter over time, by providing dynamic support tailored to their changing requirements, and to assist patients in overcoming setbacks and finding effective strategies that align with their individual preferences and circumstances.


Affinial’s behavior engine

We are developing a proprietary behavior engagement engine on the Affinial platform to intelligently predict each patient's most suitable features and content, precisely timing when these interventions should be presented. These personalized nudges are dynamically tailored to the individual's unique engagement profile and their specific stage within the care pathway.

Before recommending any pathway, the engine considers the patient's personal motivations and ability to engage, considering their physical and social environment. Every action or inaction is carefully tracked and categorized based on the underlying driver of behavior change. Engagement occurs only when the presented content addresses the specific barriers hindering the patient from taking action. These insights are rooted in findings from behavioral sciences, forming the foundation of their engagement profile at that particular moment in time.

Continuously adapting to the patient's engagement profile and context, the nudges constantly evolve over time. This iterative process enables the engagement engine to learn what approaches work best for each unique patient. Adaptive feedback loops play a crucial role in improving the timing of future nudges and determining the level of personalization necessary to effectively engage the individual.


Sylvie's psoriasis journey with Affinial’s behavior engine

To understand how the behavior engine works and what different nudge loops can look like, let’s take a therapy area such as psoriasis and outline a typical patient experience.​

  • Sylvie is an active 25-year-old woman who has psoriasis and has been recently prescribed a new treatment by her dermatologist, which consists of a monthly biologic injection.​
  • She’s engaged in managing her health and wants to reduce the negative impact psoriasis is having on her life.


To build good habits around taking her injections right from the start of her treatment journey, Affinial’s behavior engine helps Sylvie to create an injection routine and encourages her to pair her injections with a fun and enjoyable activity such as watching her favorite Netflix show, with her injection in order to create a ritual.


To help Sylvie learn how to inject correctly, she is provided with a simple checklist of actions to complete and short interactive in-the-moment video walkthroughs that demonstrate how to complete each step successfully.


When it’s time for Sylvie’s second monthly injection, she is sent a nudge to complete her injection ritual. If Sylvie ignores this prompt, the engine will assess a better time to engage her and nudge her again at a more appropriate time within the acceptable window of time available to inject safely.


The engine then gathers feedback on why the injection was missed; was this simply not a good time on this particular day, or does the ritual Sylvie created need to be tweaked to better fit into her lifestyle? As time goes on the behavior engine continuously monitors how well Sylvie is adhering to her planned routines and automatically recommends adjustments whenever necessary.


It also is constantly leveraging real-time data from connected devices and third-party apps, such as Sylvie’s injection pen, so that it always knows exactly how Sylvie is doing and personalizes her experience with tailored content.


Let’s revisit Sylvie a year into her therapy. Affinial’s behavior engine knows Sylvie is engaging with her therapy but notes she has now stopped responding to nudges and has missed some recent injections. Given her behavior to date, it assumes that Sylvie has intentionally missed her dose as opposed to just forgetting, and so focuses on uncovering the reason why. With psoriasis, there are three main reasons Sylvie may have stopped taking injections:


  • She feels good and thinks that there is no longer a need to inject each month: The behavior engine shows Sylvie what sort of progress she should expect to see at this stage in her therapy journey and how a lack of visible progress doesn’t mean that the treatment isn’t working. This reassures Sylvie that it’s worth continuing her monthly injection routine and makes her aware of the negative consequences of just stopping therapy completely.​
  • She is experiencing symptoms or side effects: The behavior engine helps her to automatically track them over time so she can better understand them and how they are developing. It can also provide Sylvie with the ability to share her symptom trends and insights with her care team so that they have a complete picture of her progress when making decisions about her care pathway.

  • Sensitivity at the injection site from the previous month: The behavior engine nudges Sylvie to address her injection hesitancy concerns, explains to her how changing injection location on her body regularly can help to prevent the discomfort she experienced before and provides her with an easy to follow step-by-step process to choose a new injection site.




But what if Sylvie becomes totally disengaged with the nudges the solution is providing to her and continues to miss her injections? The behavior engine can escalate her situation to her PSP care team who can reach out to her directly to understand what’s going on and to explore her personal motivations. It’s important to remember that psoriasis is just one aspect of Sylvie’s complex life and managing it needs to fit in somewhere between family, work, friends, hobbies, etc. Leveraging Affinial, the care team can share a personalized self-management program with her that will help her to better manage her condition and help her to do more of what she wants to do in life.​


In this learning series on Affinial, we are taking a deeper look at several features of the platform including:

How Affinial provides the building blocks for creating customized, regulated solutions

The Return on Investment (ROI) for pharma of using Affinial to create digital health solutions

How Affinial helps ensure compliance with ever-evolving cybersecurity requirements and keeps patient data safe

Empowering personalized patient engagement in digital health solutions

If you would like to learn more about how Affinial helps pharma companies create customizable digital health solutions, request a demo of the platform with one of our digital health experts here.