Enjoyment usually outperforms self-efficacy as a predictor of success.

Enjoyment also predicts follow-through better than perceived importance.

For health programs, adherence isn't always an the active ingredient, but it should be.

Design health interventions to ensure participant repeatability, then let outcomes follow from repetition.

For my colleagues and me, whose task it is to improve population health, we architect specific health interventions because doing so gives us a measurement advantage. Through good intervention design, we (or the intervention's facilitators) can track attendance, program completion, vital signs, functional capacity, clinical labs, and downstream health utilization. Yet, despite our best design efforts, we still chronically face a fundamental challenge: program adherence.

When intervention attrition inevitably occurs, we often blame the population pool. I mean, discipline is hard, right? So, as behavioral scientists, we play with the variables. We lower the stakes. Maybe we try new nudges, like increasing the reminders, manufacturing accountability, and/or adding more education to amplify the clinical case. But, in my opinion, for too long we've been missing the simplest variable: what the pursuit feels like to the person we hope to engage.

Since I wrote The Fun Habit, there's been growing evidence-based support for my assertion that people tend to stick with what they enjoy more consistently when compared to other variables. Simply put, we follow through when the process is psychologically rewarding, not merely when the outcome is logically important.

Even though this phenomenon is well understood academically, I find it's still met with resistance time and time again in medical and/or health settings. To some, it sounds like a whimsical assertion that we need to "entertain" patients and clients. Other times, the resistance is in the form of aversion to treating disease management like a leisure product. Unpacking this resistance is out of scope for this article and will be addressed in a future article. For now, let's focus on the fact that, despite this aversion, the evidence supports a precise point: enjoying what you're doing is paramount to adherence. Fun (deriving pleasure from an activity) is our nervous system's real-time valuation of whether a behavior is worth repeating.

Why "importance" fails at the moment of choice

Research led by Dr. Kaitlin Woolley and her colleagues helps name the problem. Across multiple experiments, their research has found that people pursue goals longer when they find the pursuit enjoyable and personally rewarding. Perceived importance matters less than most of us assume. In their study, the effect held across goal domains and cultures and was evident in both self-report adherence and behavioral measures such as step tracking.

Why is this true? Perceived importance is a........

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