Care ≠ Compliance: Rethinking Behavior in Health Tech

Care ≠ Compliance: Rethinking Behavior in Health Tech

Many health tech tools claim to “change behavior.” They offer reminders, nudges, rewards, but too often they confuse compliance with care. This post explores the difference between influencing behavior and supporting people, and asks what it would look like to design health technology that respects autonomy, context, and complexity instead of trying to control outcomes.

Introduction

It’s become common to talk about behavior change in health tech, as apps aim to improve adherence, wearables reward step counts, and dashboards push alerts for missed meds.

But underneath the good intentions, there’s a quiet confusion: we’ve started treating compliance as if it were care.

The logic goes like this:

  • If a patient follows the protocol, they’re doing well.
  • If they don’t, they’re “non-compliant.”
  • The solution? More nudges.

This might work in narrow settings, but in real life, behavior is more than a checkbox: it’s context, emotion, constraint, and meaning.

What’s the Difference?

Compliance is about control. It asks: 

Did the person do what we told them to do?

Care is about support. It asks: 

What does this person need right now?

A compliant patient might take their meds but still feel unsafe, unheard, or confused. A caring system asks why behavior happens and not just how to fix it.

The Problem With Nudging

Behavioral science has brought powerful tools into health: prompts, defaults, framing, feedback, but nudges are not neutral. They reflect values. They push in specific directions, and they often ignore what’s behind the behavior.

Let’s take a common example:

A patient doesn’t log their blood sugar.
A health app responds by adding pop-ups, emojis, or points.
But the reason they stopped logging could have been shame, burnout, or fear of being judged.

Let me be perfectly clear: no nudge will fix that, only listening will.

The Risk of Coercion

When health tech becomes too focused on outcomes, it can quietly slip into coercion:

  • Limiting access based on behavior
  • Penalizing “non-adherence”
  • Framing the patient as the problem when the system is failing

Even good UX can become harmful when it’s built on the wrong assumptions. Design is about power.

Designing for Agency

So how do we design tools that support behavior without controlling it?

Here are some principles to start with:

  1. Start with listening
  2. Make values explicit
  3. Create room for refusal
  4. Support reflection
  5. Build feedback loops

This shifts the goal from manipulation to partnership, from fixing behavior to understanding it.

Conclusion

When we talk about behavior change, we need to be honest about what we’re doing.

Are we supporting people, or trying to shape them?

Are we building tools that respond to complexity, or flatten it?

Design can help people take better care of themselves, but only if we stop confusing care with control.

Footnotes

  1. Thaler, R. H., & Sunstein, C. R. (2008). Nudge: Improving Decisions About Health, Wealth, and Happiness. https://www.penguinrandomhouse.com/books/175350/nudge-by-richard-h-thaler-and-cass-r-sunstein/
  2. Mol, A. (2008). The Logic of Care: Health and the Problem of Patient Choice. https://www.routledge.com/The-Logic-of-Care/Mol/p/book/9780415468670
  3. Patel, M. S., Volpp, K. G., & Asch, D. A. (2018). Nudging people toward better health. https://doi.org/10.1056/NEJMp1800008
  4. Gurevich, M., & Syed, S. (2022). The Ethics of Digital Nudging in Health Care. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8991223/