We Know More About Health Than Ever Before. So Why Is Change Still So Difficult?

Most people understand the fundamentals of good health.

  • They know physical activity is beneficial.
  • They know sleep matters.
  • They know stress has consequences.
  • They know that maintaining physical and mental wellbeing is important.

Yet knowledge alone rarely produces lasting change.

This creates one of the most persistent challenges in healthcare, workplace wellbeing and prevention.

If information is widely available, why do so many people struggle to maintain healthy behaviours?

The answer appears repeatedly throughout the research literature.

Behaviour change is not primarily an information problem.

It is an engagement problem.

Understanding this distinction has become increasingly important as healthcare systems, employers and insurers invest in digital wellbeing solutions.

Technology has made support more accessible than ever before. However, access alone does not guarantee participation.

People must remain engaged long enough for healthier behaviours to become habits.

This insight has influenced a significant body of research over the past decade and has played an important role in shaping the Trigo platform.

Most people have experienced the gap between intention and action.

A person may intend to become more physically active, improve sleep habits or follow a rehabilitation programme.

The challenge is not deciding to start.

The challenge is continuing.

Researchers have studied this phenomenon extensively.

Across health promotion, rehabilitation and workplace wellbeing programmes, one finding appears consistently:

People are more likely to achieve positive outcomes when they remain engaged with the intervention.

This may sound obvious, but it represents an important shift in thinking.

Historically, many programmes focused on delivering information.

Increasingly, researchers are asking a different question:

“How do we help people stay involved long enough for meaningful change to occur?”

The answer lies in understanding engagement.

What the Research Tells Us About Engagement

One of the most useful reviews in this area was conducted by Milne-Ives and colleagues (2023), who examined behaviour change techniques associated with engagement in mobile health applications.

The review identified several techniques that repeatedly appeared in successful interventions.

These included:

  • Goal setting.
  • Self-monitoring.
  • Progress tracking.
  • Feedback.
  • Social support.
  • Behavioural prompts.

The significance of these findings extends beyond mobile applications.

They suggest that engagement can be deliberately designed.

People are more likely to remain involved when they can see progress, understand their goals and receive feedback on their actions.

This is an important distinction.

Engagement should not be viewed as a marketing metric.

It is increasingly recognised as a mechanism that helps individuals translate intention into action.

For organisations investing in wellbeing programmes, this observation has profound implications.

The quality of an intervention matters.

However, participation may matter just as much.

Why Information Alone Is Not Enough

Many traditional health programmes operate on a relatively simple assumption.

  • Provide information.
  • People will make better decisions.

Unfortunately, human behaviour is rarely that straightforward.

Most people already possess a reasonable understanding of what constitutes healthy behaviour.

The challenge lies in maintaining motivation over time.

Researchers often refer to this as the intention-behaviour gap.

  • People intend to change.
  • They intend to exercise.
  • They intend to complete rehabilitation programmes.
  • They intend to prioritise wellbeing.

Yet competing demands, busy schedules and everyday distractions frequently disrupt these intentions.

This is where engagement mechanisms become important.

  • They help keep health goals visible.
  • They provide reminders.
  • They reinforce progress.

Most importantly, they help maintain momentum.

Without these mechanisms, even well-designed interventions can struggle to sustain participation.

The Role of Gamification: More Than Points and Badges

Few concepts in digital wellbeing have generated as much misunderstanding as gamification.

For some, the term evokes images of games, competitions and superficial reward systems.

The academic literature presents a very different picture.

Edwards and colleagues (2016) reviewed gamification within health applications and found that many successful interventions incorporated recognised behaviour change techniques.

These included:

  • Achievement systems.
  • Progress indicators.
  • Feedback loops.
  • Goal attainment.
  • Recognition.

The important point is that these mechanisms are not valuable because they are entertaining.

They are valuable because they influence motivation.

They help individuals recognise progress and sustain effort.

More recent evidence reinforces this perspective.

Alzghoul and colleagues (2024) conducted a systematic review and meta-analysis examining the effectiveness of gamification in health and wellbeing programmes.

The review found evidence that gamification can positively influence:

  • Engagement.
  • Participation.
  • Motivation.
  • Physical activity.

However, the strongest outcomes occurred when gamification was integrated into broader behaviour change programmes.

This is an important nuance.

The evidence does not suggest that points and badges alone improve health.

Instead, it suggests that carefully designed engagement mechanisms can support participation when combined with meaningful goals and structured support.

Why Engagement Matters for Employers

The implications of engagement extend far beyond individual health.

Employers increasingly invest in wellbeing programmes because workforce health influences organisational outcomes.

Research by Howarth et al. (2018) and Sevic et al. (2023) suggests that digital workplace health interventions can positively influence employee health behaviours.

However, both reviews identify engagement as a critical determinant of success.

A wellbeing programme cannot influence behaviour if employees do not participate.

This creates an important challenge for organisations.

The objective is not simply to provide services.

The objective is to create conditions that encourage ongoing participation.

The distinction may seem subtle, but it changes how programmes are designed, implemented and evaluated.

Participation becomes more than an activity metric.

It becomes a leading indicator of programme effectiveness.

Why Human Support Still Matters

As digital health technologies become more sophisticated, it is tempting to assume that technology alone can drive behaviour change.

The evidence suggests otherwise.

Many successful interventions combine digital tools with human support.

Across multiple studies, engagement improves when individuals have access to guidance, coaching or professional input.

This finding is consistent with observations from workplace wellbeing, rehabilitation and self-management programmes.

  • Technology can improve accessibility.
  • Technology can improve consistency.
  • Technology can improve scalability.

However, human support often provides accountability, reassurance and context.

The most effective systems frequently combine both.

This observation has significantly influenced the evolution of Trigo.

How the Evidence Influenced Trigo

When we began developing Trigo, we were interested in a simple question:

How can we help people remain engaged with their health?

The evidence did not point towards a single solution.

Instead, it identified several recurring principles.

People engage more effectively when they:

  • Understand their goals.
  • Can monitor progress.
  • Receive feedback.
  • Experience recognition.
  • Have access to support.

These principles influenced many aspects of the platform.

  • Activity tracking provides visibility.
  • Goal-setting tools create structure.
  • Progress indicators reinforce momentum.
  • Communication features support connection.
  • Professional guidance remains available when additional support is needed.

Importantly, these features were not introduced because they are fashionable digital trends.

They reflect mechanisms repeatedly identified within the evidence base as supporting participation and behaviour change.

The objective is not to maximise platform usage.

The objective is to help people remain engaged with healthier behaviours over time.

Engagement as Infrastructure

One of the most important lessons emerging from the research is that engagement should not be treated as an optional enhancement.

It is foundational.

  • Without engagement, prevention programmes struggle.
  • Without engagement, self-management becomes difficult.
  • Without engagement, workplace wellbeing initiatives often fail to achieve their potential.

This is why we increasingly view engagement as infrastructure.

Just as healthcare systems require clinical pathways and professional expertise, digital wellbeing systems require mechanisms that help people remain involved.

The evidence suggests that engagement is not accidental.

  • It can be supported.
  • It can be encouraged.
  • It can be designed.

Looking Forward

The future of wellbeing will depend on more than technology.

It will depend on understanding how people behave.

The research reviewed by Milne-Ives et al. (2023), Edwards et al. (2016), Alzghoul et al. (2024), Howarth et al. (2018) and Sevic et al. (2023) paints a remarkably consistent picture.

People are more likely to achieve positive outcomes when they remain engaged.

Engagement improves when interventions provide structure, feedback, visibility and support.

Technology can help.

Professional guidance remains important.

The strongest approaches combine both.

At Trigo, these findings have shaped the way we think about prevention, supported self-care and workforce wellbeing.

Because ultimately, meaningful change does not begin when information is delivered.

It begins when people remain engaged long enough to act on it.

References

  1. Milne-Ives, M., et al. (2023). Potential Associations Between Behaviour Change Techniques and Engagement With Mobile Health Apps.
  2. Edwards, E. A., Lumsden, J., Rivas, C., et al. (2016). Gamification for Health Promotion: Systematic Review of Behaviour Change Techniques in Smartphone Apps. BMJ Open.
  3. Alzghoul, A., Alkhazaleh, Z., Alkhawaldeh, M., et al. (2024). The Effectiveness of Gamification in Health and Wellbeing: A Systematic Review and Meta-Analysis. The Open Public Health Journal.
  4. Howarth, A., Quesada, J., Silva, J., Judycki, S., Mills, P. R., & Schiavo, J. H. (2018). The Impact of Digital Health Interventions on Health-Related Outcomes in the Workplace: A Systematic Review. Digital Health, 4.
  5. Sevic, S., Müssig, M., Bredemeier, J., et al. (2023). Effectiveness of eHealth Interventions Targeting Employee Health Behaviors: Systematic Review. Journal of Medical Internet Research, 25:e38307.