You’ve probably seen the statistic: 42% of patients with chronic conditions don’t stick to their treatment.

But have you noticed that this figure has barely changed in twenty years?

And it’s certainly not for lack of trying.

We’ve built an entire arsenal of digital tools to tackle the problem:

• Appointment booking apps.

• Notifications and reminders.

• “Patient engagement” dashboards, collecting both self-reported and automatically tracked data.

• Real-time monitoring.

At this point, perhaps the question is no longer “How can we improve treatment adherence?”

But rather:

Why, despite all this technology, has so little actually changed?

The promise of a brighter future was built on a beautifully simple assumption:

“If we provide better information and better reminders, patients will follow through.”

And yet, all the user delight in the world doesn’t seem to have moved the needle.

What technology actually changes

Let’s not throw digital health out with the bathwater. It’s not useless.

It’s just often solving the wrong part of the problem.

Today, technology allows us to:

• Measure actual patient behaviors.

• Intervene between consultations to monitor and inform.

• Deliver personalized support at scale.

The catch?

Technology doesn’t create behavior. It amplifies what’s already there, while adding another layer of interaction.

And that’s how something designed to make life easier can become:

• An additional cognitive burden. (Hello, endless notifications and digital illiteracy.)

• A dependency on technology. (Hello, having to replace your perfectly functional phone because the latest app update no longer supports it.)

So now we’ve introduced a second problem:

Getting patients to engage with the app itself.

And when we look at the issue from this perspective, something becomes clear. The real challenge lies elsewhere.

We need to change the conditions under which decisions are made.

Because what we’re dealing with is a human decision, repeated over time, under real-life constraints.

In other words:

This is a behavioral psychology problem, not an interface problem.

Let’s unpack that.

The classic product trap

Many digital health products make the same mistake: they focus on improving adherence and engagement.

But the questions we should really be asking are:

“At what exact moment does the user decide to disengage?”

And, more importantly:

“How can we design the experience so that disengaging doesn’t even become a question?”

I’ve got good news and bad news.

The bad news?

It means focusing on very specific moments in the user journey, many of which happen outside your product.

And over which you have very little control.

The good news?

Those moments can be designed for.

Designing for the right stage of behavior change

You don’t know it yet, but this diagram is incredibly sexy.

The Health Action Process Approach (HAPA) is a model rooted in behavioral change psychology.

It offers a relatively simple (but remarkably useful) framework for understanding what happens between intention and action.

HAPA is built around five particularly interesting principles.

1. Behavior change happens in two distinct phases

First comes motivation: the process of developing an intention to change.

Then comes volition: turning that intention into action and maintaining the behavior over time.

These are two different psychological processes.

And they require different kinds of support.

2. Not everyone is at the same stage

People can be in very different psychological states:

• Those who haven’t yet formed an intention to act.

• Those who intend to act but haven’t started.

• Those who are already taking action.

Product translation: you can’t design the same experience for everyone.

A user who hasn’t decided to change doesn’t need the same support as someone struggling to maintain a new habit.

Yet we routinely design as though they do.

3. Intention isn’t enough

Some people are motivated.

Convinced.

Absolutely fired up.

And still…

Nothing happens.

Because motivation alone doesn’t guarantee action.

There’s a crucial missing step:

Planning.

4. Planning is the bridge between wanting and doing

Planning transforms an abstract intention into something actionable.

It involves two complementary mechanisms:

Action planning: When, where, and how am I going to act?

Coping planning: What will I do when things don’t go according to plan?

You know.

The famous Plan B for when life decides to throw everything out the window.

This is what helps transform an intention into actual behavior.

And it’s precisely the step that most digital health products tend to overlook.

5. Self-efficacy is essential

Helping users believe in their ability to succeed isn’t optional.

It’s fundamental.

And that confidence needs to be supported differently at every stage of the process.

Someone who hasn’t started needs reassurance that change is possible.

Someone taking their first steps needs to feel capable of acting.

Someone facing setbacks needs to believe they can recover and keep going.

Your product should guide and reinforce users according to the specific challenges they’re experiencing.

Because ultimately, everything starts with one simple belief:

“I can do this.”

And here’s the problem.

Most digital health products are designed around motivation, while the real challenge often lies in volition.

So what does this mean for product design?

You don’t change behavior simply by providing information.

You change behavior by designing an experience that makes action possible.

An experience built around:

• Support: Helping users navigate difficulties instead of simply reminding them what they should do.

• Personalization: Adapting the experience to their actual stage of behavioral change.

• Continuity: Supporting people beyond isolated interactions and consultations.

• Simplification: Reducing the effort required to turn intentions into actions.

Because the goal isn’t to create another app that patients have to remember to use.

It’s to create the conditions that help them do what they’ve already decided to do.

Pure product thinking, really.