The researchers recognized that two significant barriers to patients regularly checking their feet as directed were lack of time and forgetting to do so on a daily basis. To address these barriers, the project team implemented a multifaceted approach.

First, they worked to integrate foot checks into patients’ existing daily routines to minimize demands on their time. Patients were encouraged to schedule their mandatory daily foot checks at times they were already setting aside for other regular activities like brushing their teeth, taking medications, or during TV commercial breaks. This helped eliminate additional time burden by combining foot checks with routines they were already committing a few minutes to each day.

Next, the researchers leveraged modern technology solutions and behavioral science insights to help patients form the daily foot checking habit and overcome forgetfulness. They provided each patient with a Bluetooth-enabled smart scale that could sync to a mobile app. Patients were instructed to weigh themselves daily after getting out of the shower as part of their normal morning routine. The smart scale was programmed to automatically prompt patients to check their feet at the same time by displaying a message on its screen and vibrating.

Studies show that embedding a habit into an existing routine makes it much more likely to stick. Weighing themselves and having their feet prompted simultaneously helped patients form the foot check behavior into their daily morning shower practice without requiring extra effort or time commitment. The notification from the scale served as an external cue to trigger the foot check response automatically. Cues are important for habit formation and maintenance according to behavioral theory.

To further reinforce the daily habit and counteract forgetfulness in the long run, the research app sent patients a reminder notification if they did not register a morning weight and foot check by 11 AM each day. Behavioral findings indicate that combining positive and negative reinforcement strengthens new behaviors. The prompt from the scale provided positive reinforcement of the foot check routine, while the reminder served as a minor negative consequence for skipping the check to further motivate patients.

At the same time, the app allowed patients to log details of their foot checks including any noted issues or concerns. Research shows that self-monitoring supportshabit formation. By having patients electronically document their checks, it increased their motivation and commitment to follow through with the behavior each day. It also enabled remote monitoring by researchers and physicians who could follow patients’ logs and promptly intervene if any red flags emerged.

The app incorporated behavioral nudges and motivational messages tailored to each patient based on their progress and goal achievement. For instance, it would display positive feedback like “Great job on 7 days in a row of checks!” for those adhering well or gentle reminders like “Don’t forget to check today – it’s important for your health” for those missing more checks. Behavioral researchers understand that specific, timely feedback and reinforcement encourage continued healthy behavior change.

The project team also connected patients in an online support group through the app where they could encourage and remind each other about maintaining their foot check routines. Social support networks play an important role in sustaining healthy habits long-term. Peer collaboration and accountability supplemented other efforts to reinforce patients’ motivation over time as new routines became firmly established.

These multi-component strategies utilizing principles of behavior change science proved highly effective. After 6 months, nearly 90% of patients reported checking their feet daily with the help of the new system compared to less than 10% at baseline. Rates of foot complications significantly dropped as well through close monitoring and early intervention. The research demonstrates that by thoughtfully addressing specific barriers like time constraints and forgetfulness upfront through combined technological and behavioral approaches, positive health behaviors can be successfully adopted on an ongoing basis despite initial challenges.