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Achieving Patient Adoption: Should Digital Health Tools Smile?

By Jim Joyce, CEO & Co-Founder of HealthBeacon and Dr. Zara Fullerton Kinsella, Medical Science Liaison for HealthBeacon

This is the second series reflecting on the adoption of healthcare technologies. In this piece, Jim Joyce asks the question – “Should Digital Health Tools Smile?”

“I gave them a smile, they gave me one back, so I gave them another”– Unknown

Should Digital Health tools smile at you?  I’m called into a packaging meeting for final sign off on the box that will deliver HealthBeacon Smart Devices to patients across the USA. In this case, it is for a partnership with one of the biggest healthcare providers in the USA. Our brilliant tech and design team have spent considerable time brainstorming the box and answering questions: Will a patient know what to do when they receive it? Is it easy to open? Easy to take the device out? Will it be intuitive to plug-in and set up? These are all critical questions that we believe we have a good handle on, but my team has one final point of debate. Should we put a smile on the inside flap of the box? For me, the answer is clear, but we paused for a moment to consider the smile. As a company, we operate globally across 14 countries and even within the US the meaning of a smile may be interpreted differently across different states, context and demographics.

Our history with the question, “Should it smile?”, goes back to our earliest prototype.  Since the beginning, each time a patient disposes of their used injection into the HealthBeacon Smart Sharps Bin,  the device smiles at you through the LCD screen.

We initially included the smile because the first versions of our device needed up to 60 seconds to send the time-stamped image of the medication disposal to our servers through a mobile network. During the transition time, many people thought the device might not be working so we introduced the smile during the transmission with the words, “Well Done”. The feedback from our patients was great.  “I love how it smiles at me” and “I don’t want to disappoint my HealthBeacon, because I know it wants me to feel better”. The small smile on the screen introduced a bit of humanity to a fairly technical activity of injecting yourself subcutaneously and then disposing of your used injection into our device. Now our devices are communicating immediately, but we have kept the smile.

I was recently at a lecture hosted by the Euronext Stock Exchange, where Dermot Crowley, Deputy CEO of the hotel group, Dalata, paused for a moment to talk about the importance of guests being greeted by smiling staff at each of their hotels. He stated that the first thing he notices is whether the staff smile. It is a critical moment when a guest walks into our hotels, they may be tired from travel or disorientated and being welcomed with a smile can make all the difference.

So why the debate on whether to include a smile? What’s the counterpoint? You’re not taking something seriously and healthcare is serious? You’re not being authentic in your smile? Once a European pharmaceutical executive told me I was being “too American” and the smile might be considered condescending, “it won’t work here, we just don’t smile that much.”

I asked Dr. Zara, our Medical Science Liasion to comment on the science behind the smile:

“Smiling is something we are all familiar with; many of us smile more than 20 times a day and children often smile as much as 400 times in a 24 hour period but what about the science behind these smiles? 

There has been a vast amount of research focusing on the smile, dating as far back as 1862, when French anatomist, Guillaume Duchenne described the results of his work stimulating facial muscles with electric currents and emphasised the significance of eye muscle contraction when smiling. Today, this Duchenne smile, is more commonly referred to as ‘Smizing’.3

The ability of facial expressions to impact our mood was first described by William James and Charles Darwin 4,5 and has been the subject of much research.6 Smiling has been associated with the release of neurotransmitters such as serotonin and dopamine with associated health benefits.

The long-term benefits of smiling are also fascinating.2 Smiling has been linked with increased lifespan in professional athletes and higher levels of marital satisfaction and wellbeing.9 Furthermore, research by Hewlett Packard and Dr. Lewis found that a single smile can result in the same level of brain stimulation as consuming 2,000 bars of chocolate, or obtaining a significant amount of cash.10 

At HealthBeacon we believe we can back up the smiles. It’s part of the culture and it makes sense that we would embed our culture in our technology, communications and packaging.  We want our technology to remove pain, burden, isolation and reduce complexity. We understand that we are a small piece of a big puzzle to help our customers live happier and healthier lives. In a recent in-person survey at HealthBeacon, 90% of our staff spontaneously responded to a smile with a smile. Since smiling is clinically proven to be contagious we are hoping we will infect the last 10% of the staff.

Are we serious enough? The evidence suggests that smiling in the workplace has a direct correlation to productivity and competence, but it does have its limitation and there are times when the absence of a smile is an important message. In our new HealthBeacon Companion App, we are working on a module that will have people earn their smile, it’s early days so we don’t yet know the impact, but we will keep you posted.

So for the inside flap of the box, it’s a “Yes”. We believe the evidence is clear and it will bring a bit of humanity to the box. Sometimes it just makes sense to not overthink things and smile.



This article was written by Jim Joyce and Dr. Zara Fullerton Kinsella, HealthBeacon. Zara has a keen interest in digital health, particularly in the potential for disruptive technologies to enable individualised models of care, within the context of limited healthcare resources.


[1] Goodman, R., 2011, The Untapped Power of Smiling, Forbes. https://www.forbes.com/sites/ericsavitz/2011/03/22/the-untapped-power-of-smiling/#1284fb7d7a67
[2] Jaffe, E., 2010, The Psychological Study of Smiling, https://www.psychologicalscience.org/observer/the-psychological-study-of-smiling
[3] Duchenne G.B., 1990, The mechanism of human facial expression, translation R.A. Cuthbertson, Cambridge University Press
[4] Darwin, C., 1872, The Expression of the Emotions in Man and Animals, London: J. Murray
[5] Goleman, D., 1989, A Feel Good Theory: A Smile Affects Mood https://www.nytimes.com/1989/07/18/science/a-feel-good-theory-a-smile-affects-mood.html
[6] Skibba, R., 2016, Psychologist argue about whether smiling makes cartoons funnier, Nature Journal of Science, https://www.nature.com/news/psychologists-argue-about-whether-smiling-makes-cartoons-funnier-1.20929
[7] Riggio, R., 2010, There’s Magic in Your Smile, https://www.psychologytoday.com/us/blog/cutting-edge-leadership/201206/there-s-magic-in-your-smile
[8] Abel E. and Kruger M.,2010, Smile Intensity in Photographs Predict Longevity, Psychological Science, 21, 542–544
[9] Harker L. and Keltner D. 2001, Expressions of Positive Emotion in Women’s College Yearbook Pictures and Their Relationship to Personality and Life Outcomes Across Adulthood. Journal of Personality and Social Psychology, 80, 112, 124
[10] Rickman, C., 2019, The Happiness Bible: The Definitive Guide to Sustainable Wellbeing

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