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2 Design Council RED Health Report 3 Design Council RED Health Report

01Setting the scene

The starting point of an open welfare approachis to look at issues such as health care fromthe perspective and experiences of individualsrather than the structures and imperatives oforganisations. This approach helps to definethe scope and limits of design. The conditionsfor inspiration, opportunity, motivation andsupport can be designed, but not use itself.In effect, co-creating services is not aboutdesigning a system but facilitating emergenceof one – it is about designing a meta-service.As a result the nature of control andownership are redefined.

These principles came to the fore in the Kentproject, which focused on increasing physicalactivity. Obesity and chronic disease, especiallyamongst older people, are emerging as majorhealth challenges in the UK. A key factorunderlying these problems is a trend towardsless physically active lifestyles. Conventionalresponses, ranging from individuals joininggyms to mass campaigns by governments,have so far been relatively ineffective inreversing this trend.

In Kent County Council we had a projectpartner keen to find new ways to promotemore active lifestyles. Kent has been a pilotfor local area agreements between theCounty Council and other public servicebodies, and has been involved in promotingpreventative approaches to fire, accidents andpolicing. Now this same coalition, with theCounty Council in the lead, were consideringwhether they could introduce a programmefor preventative health by, among other things,increasing the level of personal activity.

Kent proposed that we work in a deprivedarea of Maidstone in and around the ParkWood estate.

A design perspective Our focus was on the experience ofindividuals. This is where a design approachcan add most value, and it has led to aradical proposition – a service that does notoffer activity, but rather supports groups ofpeople to organise it for themselves.

The design approach drove our methodology.Designers view problems through the eyes ofthe users. They also work in short intensive,bursts, looking for insights, and ideas thatconnect to people's lives.

Our prototyping took just five weeks. Duringthis time we sketched out a service experience,in the same way a product designer wouldsketch a new phone or model a car interiorin foam and cardboard.

The RED team brought together a diversegroup of designers, from user experiencespecialists to product designers and brandingspecialists. We worked with local stakeholders.At points in the project we also drew on arange of experts including policy analysts,health care professionals, personal trainers,psychologists and others. First and foremost,however, our collaborators were theresidents of Park Wood.

The rhythm of the project was marked bytwo phases of work: – A ‘shallow dive’ involving two days of

intensive research in November 2004 and including a workshop with localstakeholders. Information and ideas fromthe shallow dive were taken back to theRED design studio in London, where theteam developed preliminary concepts.

– A ‘deep dive’ in January and February 2005. In that time, we prototyped a newpreventative health system that standsoutside the existing health service. At thecentre of this system is a platform foractivity that we called ‘Activmobs’.

5 Design Council RED Health Report4 Design Council RED Health Report

The process timeline


02The Shallow Dive

A day at Park Wood was the starting point.The team got a feel for the area and lookedat the background demographic and healthdata. The next stage was to find some residentsto work with. Basing himself in the shoppingparade, our user experience specialistapproached people to ask whether they wouldtake part in our research. We developed ashortlist of potential participants, and visitedsix in their homes over a two-day period.

For the interview, the design team developeda kit of exercises that would provide a moreparticipant-led way of opening up the discussionon activity. One was a day-in-the-life exercise,where we asked our hosts to map out oneday’s activities along a timeline, noting whatthey did and who they were with.

A second was a set of flashcards, eachdepicting a different activity, from walking toswimming to going to the pub. We askedpeople to pick out three categories – thosethey do, those they would like to do, and thosethey would never do. We carried out an 'activityaudit' on our respondents’ homes by askingthem to show us objects such as disusedtennis rackets and bikes, with the aim of gettingat how much activity was really going on.

Finally, at the end of the session, we spentan hour with participants on an activity. Wewanted to understand what walking to theshops or taking the dog out meant in termsof organisation and experience.

From these sessions the team created penportraits – brief sketches of the lives of theparticipants:

Anne and Phil have lived in the area for threeyears. Ill-health means that neither of themare working nor are they getting out as muchas they’d like to. Phil spent his life workingon farms – he’s a fan of the outdoors, a keengardener and conversationalist. He used torun marathons. He still occasionally walks orcycles the three miles to his allotment, butit’s becoming more and more difficult as hewaits for a heart transplant.

Don used to work in a paper mill. He stoppedworking several years ago because of backproblems. Since then he’s had several majoroperations on his back. He receives incapacitybenefit, and has been told he’ll never workagain. That leaves his wife June as the mainbreadwinner for the house. She works for alocal pharmaceutical supplier. A couple ofmonths ago she injured her back too.

John lives above the parade in Park Woodand works freelance as a landscapearchaeologist. His passion for history fills hislife and his home. His living room is piled withthousands of books; the walls are hung withsamurai swords, shields and chain mail. Heorganises walks with his friends, enjoys cookingand has done a cake-decorating course andtried yoga.

To get a full range of profiles of the kinds ofpeople living in Park Wood, the team held aseries of workshops with local stakeholderslike the community support officer, youth clubleaders, a local vicar and an Age Concernworker, and asked them to fill in portraits that were missing.

We also asked the group to brainstorm ideasfor motivating individuals to increase activity.In just 40 minutes we had plastered the wallwith more than 200 Post-it notes, each withan interesting idea.Key themes from the shallow dive

For the ‘shallow dive’ we developed exercises to open up the discussion with our participants on activity and to identify the individual barriers and motivations to beingactive. People knew that exercise was good for them, but making it part of daily life was another issue.

8 Design Council RED Health Report

The shallow dive showed that for Park Woodresidents, being healthy and living an activelife isn’t easy. It seemed difficult for individualsto fit exercise into their busy lives, and toprioritise activity over other commitments

Awareness was not the problem. Peoplewere generally aware that exercise was goodfor them, even if they could not articulate thespecific benefits. Rather, the key challengesappeared to be about increasing themotivation to be active, removing barriersand releasing untapped resources.

Individuals found it difficult to motivatethemselves to start and, in particular, to sustainactivity. For some this stems from a lack ofconfidence or bad experiences at the gym or school. A successful system to encourageactivity would have to address the micro-motivations of individuals, to create thedesire to exercise.

The majority of people we met on Park Woodwere not interested in activity for activity’s sake.Adding something to their lives that was purelyabout fitness was not realistic. However theywere active in an informal sense: gardeningor walking the dog. An effective systemcould build on this to help them keep fit.

It emerged that people felt that they live in anenvironment that is not conducive to activity.They feel it is easier and safer to drive thanto walk. Crime is part of the community imagein Park Wood, although as is frequently thecase, the perception of crime is higher thanthe actual statistics.

Another (perceived) problem was the costand hassle of facility and equipment hire. Thecomplexities of interfacing with anything official,like hiring a sports hall or even using the football

field for a kick around, provide a significantbarrier to activity. There was a distance from,and at times a distrust of institutions and anuncertainty as to who to trust.

Ill health and disability also present barriers.People can perceive that they are too sick orinjured to exercise, when in factthey often standto benefit most from increased activity, providedit is of the right type and at the right level.

The primary driver for activity for John to beactive was his interest in archaeology. ForPhil it was his passion for the outdoors andgardening. Interest and enthusiasm are aresource for motivating other people. Asuccessful system would capitalise on suchpassions and interests, harnessing them as a resource to motivate others.

The RED team found that there were initiativesup and running in Park Wood, but there wasnot always enough support for individualswanting to start new activities. Anne hadbeen thinking of setting up a walking club.She had quite a developed idea of how shecould go about setting it up, and what shewould need to know. We saw a potentialresource in ideas like these, which could betapped by a system offering a space andsupport to enterprising individuals.

June and Don socialise regularly with twoother couples who all suffer from immobilityof various kinds, including joint problems andarthritis. Here was a small social group ofsimilar age, motivation and with similarconditions. With several participants we foundthat family and close friends play a big role in supporting one another to take up andmaintaining activity.


From our interviews and with the help of localstakeholders we developed a picture of the people livingon Park Wood and their motivations. Based on ourunderstanding and insights we were quickly able tobrainstorm over 200 ideas to get people active.


03Finding a direction

The shallow dive gave the design team asense of the issues and lots of ideas fromresidents and local stakeholders. We couldsee that any service we developed wouldhave to remove barriers to activity, actual orperceived, build motivations and create theopportunity to be active.

The main driver for activity we had seen wasgetting from A to B. So we imagined a ParkWood where cars were restricted to theperimeter and travel had to be done on footor by cycle rickshaw, peddled by teams ofretirees during the day and by young peopleat night. We imagined giving everyone a dog.We developed half a dozen ways to increasewalking, by creating destinations such asmobile shops that were always close enoughto walk back from.

Reviewing these ideas, two clustersemerged: – One included ideas such as a Park Wood

Olympics, or using the passion forgardening to turn Park Wood into a ParkWood Estate Farm, with its own localeconomy and currency. While exciting,these ideas took the estate as a whole astheir starting point – much like conventionalcommunity projects. They did not startfrom the motivations of individuals, whichwould be the basis for a co-createdsystem that could work anywhere.

– More promising was a second cluster of ideas geared to individual and small groupactivity, such as 'flash walking', dog loans,and 'adopt-a-grandparent'. Here we couldsee the potential to develop a platform thatcould be replicated nationwide. Amongthem was 'Fitmobs', the idea that wouldbe developed into Activmobs, as aplatform for activity.

Fitmobs – the evolution of the ideaThe idea we called Fitmobs was inspired byJune and Don’s tight social group and alsoby Tupperware parties. Tupperware partiescreate the social obligation to buy throughthe motivational potential of small groupinteraction. The team’s thinking was thatsmall groups for activity – Fitmobs – wouldencourage a social commitment to get activeand stay active.

Fitmobs would be informal and self started.People would choose their own activity.From the shallow dive we knew that asuccessful service would need to avoidpresenting activity as an added obligation.Rather, it would tap into what was alreadyhappening in people’s lives.

Informal activity groups do already exist –pick-up football games are an obviousexample. But in Park Wood, and especiallyfor older people, while many of the elementswere there, barriers remained. We could seethat to get such groups going and to sustainthem, a surrounding infrastructure of supportand some basic rules would be needed.

We saw a parallel with 'flash mobs' –informal, non-hierarchical groups that cometogether via text messaging, often just forfun, but sometimes for more seriouspurposes. We felt that the term 'mobs'captured the spirit of what we were doing. It

Returning to the RED studio we immersed ourselves inthe context of Park Wood – the people we had met,photos of their homes and the ideas we had generated inour workshops.


implies a less formal commitment thanorganized classes. The term 'mob' is radicalin origin and a long way from the language ofexisting health care services.

In addition to insights from Park Wood, ourideas for the support system drew on socialsoftware, like Friendster and the BBCs iCanplatform for community activism. Theseapplications facilitate virtual and physicalconnection and collaboration betweenindividuals. Social software can be used toconnect people through their interests andemploys friend-of-a-friend networks as arecommendation system. The same enablingtechnologies could connect people to formmobs.

We also borrowed the concept of loyaltypoints, from systems like Nectar cards orGreen Shield Stamps, to provide part of theincentive to mob. We provisionally termedthis 'Health Miles'.

Combining the strongest elements of ourideas, we worked up and presented aproposition for the focus of the deep dive toour partners in Kent County Council.

The propositionWe envisaged informal self-organising,groups of between 2 and 15 people, formedaround activity, with no exclusion on thebasis of age. The groups could pursue anyactivity they liked, as long as it benefited thehealth and well-being of the participants, anddid not negatively impact on the health andwell-being of others.Fitmobs would be validated by a facilitating

body, which we called 'Fithub'. This wouldprovide an online database of registeredFitmobs, software to measure progression,and information on starting your own Fitmob.

It would also act as the host for a 'HealthMiles' system of credits. These would bebased on measures of each Fitmob’s activity,and credited to a card of account held bythe Fitmob. Health Miles cardholders wouldreceive discounts from public facilities, shopsand services. Other support elementsincluded seasonal activities and inspirationalguidance for those thinking of starting aFitmob.

Overall, we saw Fitmobs working throughmotivation by common enthusiasms, socialinteraction and Health Miles.


Based on our insights and experiences on Park Wood wewrote and drew dozens of scenarios in which Park Woodwas a more active place. Inspired by Tupperware andSocial software we developed a set of ideas that wereabout supporting small groups to collaborate to producetheir own health.


04Into the deep dive

The design team then went back to ParkWood to develop the concept. We were notseeking to demonstrate a system to improvewell-being – a pilot – but rather were settingout to develop a working model for one – aprototype. The emphasis was on trying ideasout and adjusting as we went along, usingfeedback immediately rather than at the end.

Over five weeks we alternated a week in theRED studio in London developing ideas witha week in Park Wood testing them out. Thiswas an iterative and simultaneous process -we were carrying out many activities inparallel.

For the deep dive, we added two webdesigners to the team to help us define theonline elements, and brought in two graphicand brand designers to work on the identityof the system. In addition, Anne-Marie, apersonal trainer who had originally beenrecruited to advise us on activity andexercise, soon became a core part of theproject as the proto ‘mob trainer’.

The focus at this initial stage was to learnhow mobs could be created and sustained.The team was not sure what types of mob

Park Wood residents would take up, norwhat kinds of incentives would be effective inencouraging participation. Questions of howto measure progress were also left open.

The first step was to spend a day on theestate talking the Fitmobs concept throughwith people. Favorable responses confirmedthat we were thinking along the right lines.However, the ‘fit’ in Fitmob was consideredsomewhat off-putting as it sounded like‘keep fit’, so taking John’s suggestion wechanged it to the more generic Activmobs.

We then recruited people in Park Wood tostart and participate in mobs. A 'soundingboard' met every week in the communitycentre on the estate to give their reactions tothe Activmobs idea. We also advertised theidea in the local press, through flyers, and onthe Kent County Council intranet, askingpeople to set up unfacilitated mobs.


05Meet the mobs

In the five weeks of the deep dive the designteam facilitated the creation of three mobs:Welliemob – a group of friends who mobbeddog walkingBackmob – an older group who took upgentle exercising under the supervision of thetrainerTimemob – a group walking to local sites ofhistorical interest

WelliemobHelen, Emma, Alison, Karen and Julie are intheir late 30s and early 40s. They know eachother from meeting at the school gates everymorning before dropping off their kids. Oftenthey’ll meet up after the school run for coffeeand a natter.

They own eleven dogs between them. Julieand Alison walk their dogs together regularlyanyway. Mobbing their walking, they said,would help make it ‘more of a thing’.

When the project team met them they wereall interested in losing a bit of weight orgetting fitter. Last January, Helen and Emmahad joined a gym. But after three sessionsthe novelty wore off and they stopped going.Alison used to go to the gym too, but shestopped when she took up smoking again –she couldn’t afford to do both.We first met them just after 9 a.m. on a

frosty morning at Mote Park. They’d warnedus to bring our wellies. We introduced themto Anne-Marie. Initially their walking wasleisurely at best. She got them to walk fasterthan they normally would, and set themsimple targets – to complete their normalwalk in a quicker time, to walk as far aspossible in an hour and to do short runsbetween trees.

On a second meeting she worked with thosethat were motivated to do more jogging, andprovided encouragement and reassurance tothe others who were finding it difficult. Thewomen continued to maintain the pace afterAnne-Marie left.

There was an immediate activity impact: ‘I'vedone more exercise in the last week than thelast three years’, Emma told us. They foundlosing weight through dog walking anattractive proposition in terms of fitting intotheir lifestyles - much easier than a trip to thegym: ‘It’s not a chore, you’re chatting, it’sfresh air, and the dogs are bounding aroundyou.’

Helen was clearly enjoying getting out - andtold us that she was feeling much betterabout herself: ‘I usually get low this time ofthe year - this time I'm feeling much better.It's a laugh.’ And it wasn’t just the mobbersthat felt better. Emma noticed a difference inNipper - her dog - with the extra exercise hisbreath had stopped smelling!

We returned to Park Wood to develop our ideas byfacilitating three prototype mobs. Welliemobs wereinterested in loosing weight through their dog walking, apersonal trainer helped stretch their activity to make itmore effective for fitness.


BackmobJune and Don, who we’d met on the shallowdive, agreed to be our second prototypemobbers. It was difficult for June to take adecision on what they might like to do, untilAnne-Marie started to tell her some storiesabout the effects of gentle exercising on herclients. We saw June lean forward: ‘I’mlistening now - if you can do somethingabout my aches and pains’.

Pat and Peter were natural partners forJune’s mob. Pat had worked as a nurse butretired in 1999 due to arthritis. She has hadtwo hip replacements and major backsurgery. She is able to walk to the shops,but suffers periodically from severe pain thatoften keeps her awake at night. Peter retiredearly to look after Pat. Although ten yearsolder he was pretty healthy. However he hadstarted to notice his back aching whenworking in the garden.

Pat was nervous about making things worsebut had ‘confidence in Anne-Marie’. Theteam had suggested to June that the mobcould do something in their homes, butgetting out of the house was clearlyimportant for the Backmob. We booked thelocal day centre which wasn’t used duringthe evening.

After finding out about everyone’s medicalconditions, Anne-Marie devised a simple setof exercises. She had brought along someequipment, including mats, a small

trampoline, weights, two Swiss balls and astereo. Throughout the exercise session shehelped build the group dynamic and paidparticular attention to Pat and Don becauseof their back and hip problems. With Barrie,who was the fittest of all of them, she setmore challenging exercises.

At the end of two weeks, all the Backmobmembers had clearly enjoyed their activityand could see improvements in their flexibilityand mobility. June told us:

‘I can honestly say that I have really enjoyedit more than I thought I would…I must admitthat first week I felt really good… I got upand could bend over the bath and wash myhair…I couldn’t get over it.’

Previously apathetic about exercise,Backmob members were now saying theywanted to keep going. After the first sessionsPat and Peter went out and bought new kit.‘If it comes rain or shine I still feel I wouldgo’, Pat told us. Keeping pain at baybecame a strong motivation in itself.


2 couples on the estate formed backmob when we toldthem that regular exercise could help reduce their achesand pains. The Monday night exercises, in the localcommunity center became the social highlight of the week.


TimemobJohn, the local history enthusiast from theshallow dive, agreed to lead a prototype mobtoo. He made a poster and got three peoplealong on his first Timemob activity – ahistorical walk around the sites of Maidstonecity centre. He showed us wherearchaeologists had found a mammoth, and amonument that was originally on the top ofthe Houses of Parliament.

For John, walks like this were somethinghe'd been trying to get off the ground for awhile, and this was the opportunity. His planwas to vary the distance and nature of thewalk each time.

John’s mob was very different to Backmoband Welliemob. Whereas they were built onexisting social networks, he had to advertisein order to recruit people. He was co-ordinating his mob.

John got people to join his Timemob by putting a posterin the window of the healthy living center. People camealong because they were interested in the local historyaspect of the walks, they didn’t even think of the healthbenefits.


deep dive, some of the people in ourfacilitated mobs didn’t know what activitiesto start. Many of the activities suitable formobbing aren’t commonly conceptualised asgroup activities.

Some of those we talked to, were not awareof the specific benefits of exercise that mighthelp them make a decision. One lesson isthat the Activmobs system should clarify thebenefits of exercise – including pain relief,improved energy levels and better sleeping –through real life stories and testimonials.

Open boundariesDuring the deep dive, the team identified theneed for both closed mobs and open mobs.Welliemob, for example were adamant thatthey wouldn’t have anyone join them unlessthey were friends, or a friend of a friend – aclosed mob. Timemob, by contrast, wasformed by ‘advertising’ for people to comealong. In the sounding board and from oursurveys on Park Wood, more people saidthey wanted to join existing open mobs thanstarting their own.

Even though we had a target age range werealised that it would be detrimental to theimage of the service for its use to berestricted to 40-70 year-olds. People todaydefine themselves more by lifestyle than byage. This is a new way of delivering healthservices, requiring a new approach tosegmentation.

In reality it is difficult to restrict the use of aplatform – ultimately you have to allow forself-segmentation. Given the broader aim ofpreventative health it would also be counter-productive to restrict mobs to older people,since the system helps develop better habitsin earlier life.

When Timemob started we were concernedthat, being a local history group, it wasn’tenough about physical activity. However, wewere influenced by input from a GP on theestate who saw depression arising fromsocially isolated as the most serious problemin Park Wood, underlying much illness. In hisview, even low or no activity mobs, say onbingo or book groups, would be beneficial tosome. We suspected that they might alsolead to other kinds of activity. The mostimportant thing was that it gave memberssomething to do. As Susan, one of theTimemob members, put it:

‘It’s fun getting together – it’s nice to get outand do things…I never thought about it asimproving your health’.


06All about Mobs

Groups are goodThe small group model made mobs fun, asocial occasion and a personal commitment.As Pat told us, individuals didn’t want to ‘letthe side down’ by not turning up. In the rightconditions, mob members would egg eachother on, providing the motivation to pushharder.

Groups also provided self-confidence andpersonal security. Welliemob members alltold us about feeling intimidated amongststrangers when joining an exercise class. Bycontrast, with their friends they were lessworried about making a fool of themselves,and felt free to try something new.

Groups form in the first place because theyhave similar lifestyles, ages and values. Thisgives the opportunity to work with commonmotivations and to design activities takinginto account common conditions orlimitations. The Backmobbers all sufferedfrom joint problems, arthritis or back injuries.Similarly, the majority of the Welliemobmembers were concerned with losingweight.

Finally, groups also offer economies of scale– the cost of providing a trainer to six peoplecompares favourably with an appointment foreach of them with the GP.

Mobs belong to mobbersOwnership of the service lies with mobbers.To reflect this we named the mob magazine'your.mob' and the website'wearemobs.org'. We didn’t want Activmobsto be the focus, but the mobs themselves,whether it was Welliemob or Timemob.

This is not a standardised proprietary servicecarrying a health authority logo. Rather, it is asituation where an individual (or individualswithin a group) chooses to opt in to aservice. Mobbers don’t necessarily have tofeel like shareholders, but they do need tofeel it’s their mob, and that the system meetstheir needs and desires.

Mob-u-likeThe Park Wood experience suggests thatpeople will often tend to mob things thatthey are already doing, like dog walking.Some mobs would address specific well-being issues, like Backmob. Similar mobscould be run for stress and might berecommended by a doctor. From a smallsample survey of Park Wood the mostpopular mobs people thought they wouldstart were walking and dancing (the latterchosen exclusively by women).

One of the attractions of a mob would be totry something new. In one unfacilitated mob,an initiator started lunchtime training for the‘Tesco walk for life’. In another, a group tookup trampolining.

People will start and sustain mobs as andwhen they want, but they may needinspiration and information. At the start of the


07Motivation and Feedback

Early on the RED team realised the centralimportance of measuring activity as a meansof motivation, not only to start activity butalso to sustain it. We organised two one-dayworkshops of diverse experts to help usdevelop practical solutions to the issues ofmotivation and feedback.

The motivation workshop included a servicedesigner (because we wanted to learn fromthe way commercial services activatemotivation), policy analysts working onmotivation in public services, our personaltrainer and a sports psychologist (becausewe wanted to learn from motivationalstrategies developed in this specialist field).

For the feedback workshop we invited ahealth expert with a holistic perspective,experts in social software who were familiarwith the role of feedback, and an interfacedesigner from Sony who was familiar withvisualising feedback. We also invited a sportsscientist specialising in measuring physicalfitness, and a Kent County Council statistician.

The agreement from both workshops wasthat goals should be self-set and rewardsself-selected. Measurement should happenin a way that is relevant to the individual. Thestrongest message to emerge was 'keep itsimple'. Complexity within the system canlead to reduced participation and increasedcost. Let people handle the complexity at thepoint at which it arises.

If you’re fit you’ll feel fitBy the end of the workshops we hadredefined our concept of Health Miles. At firstwe had thought of measuring hours ofactivity or actual improvements in fitness asthe basis for rewards. The local GP, however,questioned the value of measuring fitnessobjectively, arguing that the best measure iswhether people feel fitter themselves. Thehealth experts in the feedback workshopechoed this view. There were also practicaldifficulties. The sports scientist pointed outthat it would be complicated and might be adisincentive to expect mobbers to undertakeextensive quantitative measurement at home.

Charting progressInstead, we explored more qualitativemeasures. We sketched out a 'well-beingchart' that would prompt people to notetangible changes such as improved sleep orflexibility. We also provided a place formobbers to write notes to themselves onchanges they noticed themselves. Forexample, this is where June could recordthat she could bend over the bath. Themeasurement system would become themobbers own. These charts would bedelivered online for those with access, andby a National Lottery-style form for thosewithout.

Inspired by bank statements, the workshopdeveloped the idea that all participants wouldreceive a three-monthly printed ‘statement’that showed improvements. With input frommobbers, the sounding board and Anne-Marie, we developed the well-being chartfurther into three easy-to-complete well-being cards. The mobbers responded well tothe idea of this monthly task.

Completing the cards became therequirement for the provision of vouchers fordiscounts and a trainer. This individualqualitative self-assessment would be used toshow the effectiveness of the system as a

Motivation and Feedback emerged as two key issues tobe addressed. We assembled a diverse range of expertsfrom sports, economics, policy and design to help usdevelop practical solutions.


whole. Kent County Council were excited bythe prospect of being able to say that, forexample, Park Wood is sleeping three pointsbetter and is five points more self confident.The measures could be used to reportagainst PSA targets.

The numbers gameFinally, it was clear that some quantitativefeedback could be useful and motivating –be it losing four pounds in weight or halvingthe time of a regular walk. With input fromWelliemob and Anne-Marie, we developedprototype systems that were simple, fun andthat could be used with mobile phones andwebsites. They gave prompts formeasurements at appropriate intervals,involving both collective and individualachievements. These were often visual andrelated to meaningful or fun measures – suchas the number of football pitches or distanceto the moon. These quantitative feedbacktools could also be used to measureprogress towards bigger goals.

Multi-motivations Mobs are made up of individuals. The teamhad learned that each individual has theirown micro-motivation for participation inactivity, not all of which are about gettingfitter. They include reducing pain, losingweight, getting out of the house, enjoyingcompany, liking the countryside, wanting tobe a leader. The expert group in themotivation workshop confirmed this, pointingout that any goals or rewards would have tobe self-set or self-selected to be effective.

The team tried to design a universal rewardsystem and failed. Instead goals and rewardswere developed at different levels toencourage continued participation. ForBackmob the benefit of pain relief and thesocial occasion was enough to sustainparticipation. Seeing these benefits reflectedback in the well-being cards would help to

enhance this. For Welliemob, having apersonal trainer in itself was a motivation toget started, but it was clear that they wouldneed more encouragement to maintaincommitment over a period of time.

Diverse rewardsBut mobs are also groups, and groupachievements are an important part of thedynamic of individual motivation. Weextended our idea of rewards to the group –something for everyone to aim for together.These rewards could be for the mob to enjoytogether – like a day at the spa – or theycould be an individual reward, such as apersonal salsa class, but dependent on theachievements of the whole group. Mobbersand the sounding board contributorssuggested that these rewards could all beabout trying something new or different.Rewards could be provided from a menu ofoptions.

The team were specifically warned to bewary of relying too much on extrinsicmotivations, such as cash for fitness, sincethey could negate people’s own intrinsicmotivations. Rewards should themselvescontinue the virtuous circle, and encouragemore active and healthier living. Rewardswould be available periodically, morefrequently in the first six months, when mostpeople give up exercise.

Finally we worked on busting barriers. Weproposed that the Activmob platform wouldnegotiate bulk discounts on facilities,childcare and travel, and offer them toregistered mobbers. Those facilities offeringdiscounts would receive a mention in theActivemob magazine, which would list allactivity-related services in an area in oneplace. Each mobber would get a number ofvouchers that would be topped up eachmonth if they were used.


Working with the ideas generated by our ‘experts’ andour mobs we prototyped ways to help people visualisetheir progress and measure their achievement. We werecareful to balance individual and group motivations withintrinsic and extrinsic motivations.


08Support

TrainersFrom Anne-Marie we learnt that personaltrainers motivate by ensuring variety inactivity and by setting goals. Personaltrainers also make sure activity is safe andcalibrated to an individual’s ability, and that itis effective by helping people to push to theirlimits. From prototyping with the mobs welearnt that the trainer was essential.However, it also became clear that indifferent kinds of mobs the trainer is requiredto different degrees.

The team found that Welliemob needed justa 'light touch' trainer. The intervention wasminimal but significant. As mob membersnoted, advice and targets at the start and inthe second week were enough to improvethe effectiveness of the activity:

‘she doesn’t need to be there when youknow you are losing inches…it’s the initialmeetings.’

It was important that the women liked andcould identify with Anne-Marie. Theypreferred to work with a female personaltrainer, and it was the same for Backmob –to be able to choose your own trainerbecame a core part of the system.

Unlike Welliemob, it became clear thatBackmob would not function without atrainer. People with back and hip problemswould not exercise without the reassurance

and the expertise of a qualified fitnessprofessional. The nature of the activity, beingmore rehabilitative, also required professionalexpertise and equipment. Here the key wasgaining trust. But encouragement was alsoimportant:

‘she makes you feel that you can dosomething…she gives you a little bit ofconfidence in yourself…she makes you feelthat you are not stupid.’

Catalysing a market Rachel, a part-time trainer living elsewhere inKent, had seen the advert for unfacilitatedmobs in the local paper. Alongside her job,she finds the time to run three step-aerobicclasses a week. Rachel was part of anetwork of 10 part time trainers in the localarea. They all know each other, cover foreach other should one be ill, and they oftenrun classes in the same space. There iseffectively a market supply of part-timetrainers offering services that arecomplementary to conventional healthservices but not co-ordinated with them.

Rachel had passed the advert on to twocolleagues at work, who had also startedunfacilitated mobs. Even though she alreadyruns three successful classes, she thoughtthe Activmob platform would benefit her andher clients. For her, it would help in findingnew clients and different people to workwith. For her existing clients it would make iteasier to try another activity – for example,some of them had been thinking aboutstarting ballroom dancing.

A qualified trainer like Anne-Marie, Rachelhas to do courses every year to maintain herqualification. We realised that the Activmobsystem could offer her discounts on thistraining, as well as membership in tradebodies and liability insurance. Rather thanthreatening their livelihoods, Activmob wouldenhance the existing ‘private exerciseeconomy’.

Through our prototyping we realised the importance ofpersonal support for behaviour change. We uncovered a complimentary economy of professional and pro-amtrainers able to provide this service.


09Getting the word out

Have you heard about that mob thing?After the first Backmob session, June invitedtwo of her workmates to join. Rachel, whenshe saw our flyers, gave them out to fourother people. When we asked our mobbers,they could all give us the names of friends orfamily who they thought would like to join orstart mobs.

When we promoted our unfacilitated mobswe got 50% of our responses from flyersthrough people’s doors and an advert in thelocal press, but the other 50% came from asingle advert on Kent County Council’sintranet. Word of mouth andrecommendation, is the most powerful toolfor advertising and growing the mobs.

MagazineOne of the Backmob members wassufficiently impressed with the emergingmobs concept to volunteer to help us attractnew members. However, when talking aboutmobs she found it difficult to describe theconcept to people. The team came up withthe idea of a catalogue which later became amagazine to help to plug this gap.

From the start, we’d had the idea of anewsletter providing inspirational content andlistings. June suggested that we provide listsof activities to choose from when she haddifficulty making up her mind. Our

professional workshop had suggested amenu of rewards to give guidance. Thedesign team looked at copies of Avon,Kleeneeze and Bettaware catalogues forideas on format and tone.

The catalogue started life as Post-It notes onA3 paper. It evolved week by week, throughfour major iterations. When we showed theBackmob member a prototype, she thoughtshe’d be able to distribute about twenty ofthem to friends and family and at work.

Too much design is not good for thesystemJohn made a poster on his computer toadvertise his mob. In the early stages of thedeep dive, the RED team had producedsome prototype posters, with an Activmobbranding. The posters were designed so thatmob leaders would be able to fill in detailswhile retaining a standard ‘look’. Theinstigator of Timemob didn’t like them. Tohim the posters looked like they belonged toActivmobs not him. He was worried thiswould create a barrier to participation.

‘When they see something like this, theythink rules and regulations. It’s ‘thou shalt’,instead of getting there and doing it – it lookstoo good.’

The team learnt the lesson that not allservice touchpoints have to be ‘designed’ tobe trusted. We quickly dropped the posteridea. For this sort of system the elementsneed to be designed just enough for trustand use to emerge, and sometimes thatwould mean not being designed at all.

We needed a way to help people tell others about joiningan activmobs. The idea of a small magazine came fromone of our participants, the format was influenced by Avoncatalogue. The magazine contains both local and nationalcontent and a mixture of inspiration, advice and listings.


10The Activmob concept

The prototyping of a system for encouragingactivity in Kent showed up some excitingpossibilities for a radical new type of service.Initially this would work entirely outside theNHS, by supporting self-organised groups ofpeople through various tools, roles (such astrainers) and an online platform.

The earlier Fitmobs scenario was no morethan a set of hypotheses. The prototypingexperience on the ground in Kent gave theRED design team greater confidence inlaying out a more developed Activmobscenario, based on the lessons learnedduring that process:

PlatformThe platform is the base on which everythingelse is built, it defines the fundamentalprinciples and the access points, or'touchpoints'.

The core of Activmobs is the community ofmobs – a small group of individuals.

The main access points are the your.mobmagazine and the wearemobs.org website.Your.mob is a monthly magazine thatcontains both local and national content. It isinspirational and small enough to fit in apocket or bag. We envisage individualscoming across the magazine and beinginspired to set up a mob with friends orfamily. They might also be pointed tomobbing by a doctor (especially for thosewith chronic health problems). Or mobscould start in the workplace.

The Activmobs platform also supports theformation of groups through thewearemobs.org social software, connectingindividuals with common interests. Mobsgrow virally through shared experience andword-of-mouth. Mobs would spin offsubsequent mobs as mobbers are likely tobe members of multiple mobs.

Activmobs make activity a social occasion(even, aspires to create a new socialtradition). Just as Tupperware parties createthe social obligation to buy, Activmobscreate the social commitment to turn up andbe active. We envisaged situations wheremobbers would put pressure on one anotherto sustain activity, partly through a sense ofsolidarity, and partly out of incentives createdby group rewards (see below).

The platform also helps make the conditionsfor activity more favourable, through offeringdiscounts on facilities, childcare and travel.Thus we envisaged mothers with smallchildren dropping their children off at acrèche before taking part in an aerobicsmob.


The provision of discounts and rewards isconditional on monthly completion of a set ofwell-being cards. The well-being data is usedas a way to motivate the individual to sustainactivity, through periodical statementsreporting the tangible benefits of activity. It isalso aggregated to demonstrate the efficacyof the platform itself in improving well-being.

Improvement is also encouraged by a rangeof fun and easy-to-use tools that visualisequantitative progress. Commitment isencouraged by the periodic offer of collectiverewards, that can be obtained by reachingself-set commitment goals.

By creating an affiliation of mobs, all of whichare committed to activity, Activmobs wouldbecome both a lobbying movement with anability to negotiate discounts, and potentiallya lucrative market for providers of activityrelated products and services.

RolesThere are three primary roles within theActivmob system: the motivator, theActivmob trainer and the mobber. Individualsare likely to fulfil two or more roles at anytime.

The key role is that of the mob motivator.Motivators use their social, motivational andorganisational skills to get groups going andkeep them going. The platform provides thetools for motivators to network and share

ideas both virtually and face to face.Motivators who run mobs open to anyone tojoin are incentivised by rewards for recruitingand sustaining mobbers, and supportedthrough discounts on the cost of runningtheir mob, like printing and mobile phonecosts.

Each self-formed mob is given a trainer tohelp them find the right activity, providepractical advice, motivation and shape theactivity to improve fitness. Trainers areprofessionally qualified to level 2 or 3. Mobslooking for support can choose their trainerfrom your.mob magazine or the website.Activmob trainers are incentivised bydiscounts on professional development,trade body membership and insurance.

Mobber

ActivemobTrainer

Mob Trainer


ToolsWith such an intangible and opt-in servicethe experience of the touchpoints, such asliterature and websites, become even moreimportant. Tools are delivered throughyour.mob magazine and the wearemobs.orgwebsite. Tools help create both favourableconditions for activity, and the motivation foractivity.

Some tools work to create opportunities:Vouchers – discounts on facilities, childcareand travel topped up on a monthly basis oncompletion of the well-being cards. ‘Find a mob’ tools – search mobs in yourarea by postcode online or read listing inlocal magazine.‘Suggest a mob’ – vote online and by phonefor mobs that you would like to start in yourarea.‘Start-a-mob’ tools – registration andadministration tools for motivators.

Others work to create motivation:Inspirational tools – the ideas and newssection of the your.mob magazine andwearemobs.org.Qualitative feedback tools – qualitative well-being cards and periodical well-beingprogress reports. Quantitative feedback tools – fun and easy touse tools that visualise quantitative progress.Commitment goals and rewards – periodicoffer of collective rewards obtained byreaching self-set commitment goals.

The activmob website hosts tools to make it easier to formgroups, visualise progress and to co-ordinate your mob.The prototype is online at www.wearemobs.org


11Delivering activmobs – next steps

Based on our investigations into theeconomics of the system and the characterof a co-created service, here we sketch outthree propositions for funding and deliveringthe Activmob platform. All would aim to start,sustain and grow mobbing, and demonstratepositive contributions to personal well-being.

Option 1 - A PilotThe conventional way forward would be forKent County Council to fund a pilot over alimited period of time in Park Wood and anadditional location in Kent, based on afurther development of the platform and toolsoutlined here. If successful Kent CountyCouncil and the Primary Care Trust would beable to justify longer term funding throughsavings on social services and health care.

Option 2 - A self-funding socialenterpriseA second approach would be to establish anot-for-profit social enterprise – effectively a

support service for well-being. The enterprisewould start first in Maidstone, propagatedthrough a franchise model to other towns.

Activmobs would be subsidised by revenue-generating services such as Workplacemobs, a service to create a healthyworkforce based on the Activmob platformand tools. Such mobs would offer employersbetter value than health insurance or gymmembership at lower cost, and with ademonstrable productivity benefit.

Option 3 - EmergenceThe third proposition is to prove the platformover six months, and in doing so let thefunding model emerge. Funding might comefrom local authorities or healthcare trusts.Support might equally come fromtelecommunications, television channels,pharmaceutical and sports companies, or acombination of these.

Among early adopters the network should beeconomically sustainable. Existing serviceslike newspaper adverts and discount cardscan be used in place of expensivemagazines or infrastructure. The businessmodel would be developed through doing,and the start up could be led by aninnovative social entrepreneur supported byseed funding.

Whatever the approach, the platform willneed to be maintained and developed in aculture of innovation, with design playing asupporting role as the system is continuallyredefined by its users.

12Acknowledgements

Open Health was a collaborative project withinvaluable contribution from the projectpartners, extended project team and userresearch participants in both Kent andBolton. We would like to thank andacknowledge all those who helped usthroughout this project and in writing thisreport including:

The RED team for this project comprised:Colin Burns, Jude Codner, Hilary Cottam,Tory Dunn, Kirstie Edmunds, Holly France,Charles Leadbeater, Nicholas Morton, RobinMurray, Chris Vanstone, Jennie Winhall.

The Health project team:The team was helped during the project bythe project team: Richard Linnington, JamesKent and Noel Lyons (Kent Lyons), MattHyde and George Agnelli, (Matt & George)Tracy Currer, Kate Taylor, Helen McCarthy,Justine Wilkinson and Anne-Marie Leggatt.The project process was captured on film byphotographer Giulio Mazzarini.

RED advisors and contributors:We would also like to thank those whohelped us to develop our ideas: live|work,Engine, Plot, Callum Lowe, Jim Maxmin,Robin Stott, Mathew Lockwood, MartinBontoft, Pam Garside, Trudi Ryan, ChristineBundy and Gary Lee.

User research participants:In addition we would particularly like to thankthe residents of the Parkwood Estate inMaidstone and the people with diabetes inBolton who took such an active role indeveloping the prototypes.

Professionals:We would also like to thank the members ofthe Bolton Diabetes Network and KentCouncil who worked with us and withoutwhose enthusiasm our work would not havebeen possible.

Bolton:David Fillingham and Carole Smee fromBolton Hospital, Kevin Snee, StevenLiversedge and Hannah Dobrowolska fromBolton Primary Care Trust, John Dene, HarniBharaj, Adam Robinson, Renate Ormerod,Louise Hilton, Jane Pennington, Nita Patel,Jayshri Pankharnia, Mike Hollinshead, SteveWilson, Patricia Eccles, Peter Hilton, SharileeThorpe,Tracey Higginson, Jackie Bene,Jackie Hibbert, Annette Young, JulieMacangus, Sue White and Anne Robinsonfrom the Bolton Diabetes Network.

Kent:Keith Ferrin, Peter Gilroy, Mike Pitt, GraemeBrown, Judy Doherty, Caroline Toher, andRichard Spoerry from Kent County Council.

Design Council34 Bow StreetLondon WC2E 7DLUnited Kingdom

Telephone +44 (0)20 7420 5200Facsimile +44 (0)20 7420 5300Email [email protected]

© Design Council January 2006 Registered charity number 272099

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 2.5 Licence.(http://creativecommons.org/licenses/by-nc-sa/2.5/)

The Design Council must be credited as authors. Work is only altered with our permission. Work is not resold.

www.designcouncil.org.uk/red/health

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