Who are the Jailbitters and the Weapons of Mass Reduction: An Interview with Julia Ferguson about Workplace Wellness in Adams County, CO

As Fitbits and other wearable activity trackers become increasingly common for individual and group use, it is easy to wonder how successful they are at increasing and sustaining fitness. Kristen Daudelin and I were therefore excited to talk on June 25, 2015 with Julia Ferguson, Sustainability Coordinator at the Adams County Manager’s office in Brighton, CO, about the FitBitters Challenge program she coordinates for the county to use Fitbits to increase employee fitness. She told us about how her office set it up, what the County has learned so far, and how, part way through the initiative, the program has increased fitness, as hoped, and has also increased morale and comradery.

How the Program Started

The Office of Performance, Innovation, and Sustainability started planning in February 2015 and the six-month challenge launched April 1. The Office obtained roughly $15,000 funding to purchase the devices and incentives for the program.  The $100 Fitbit Flex were purchased for $80 each with a discount from Fitbit, and employees were asked to contribute $20 towards their portion of the device; the County covered the remainder of the cost.  Employees were also required by law to be taxed on the benefit, which was approximately another $20. Employees keep their Fitbit at the end of the program, or even if they drop out.

Employees were notified about the program, and a web form was available for signing up. When it was made available, at 8 am, 30 people signed up in 10 seconds. The cut off for signing up was at 120 participants, but 180 registered before the form could be shut down.

Employees were allowed to participate using their own device, resulting in 242 total participants in the Challenge, out of 1800-2000 employees (a number that fluctuates since some are seasonal). The only requirement, besides signing up quickly enough, was that employees had to be benefit eligible.

The County used a third party vendor for the pre- and post-assessments, which are optional, as required by their legal department. For the 188 participants who choose to have them, they record weight, BMI, body fat percentage, blood pressure, and waist circumference (how often are health assessments repeated, only beginning and end? Yes, just a pre- and post- assessment). The County receives aggregate data regarding the health assessments from a third party vendor in a HIPAA compliant fashion. Demographics of participants: 35 men and 153 women, most in their 40s, followed by 30’s, and then 50’s.

What Happened the First Three Months

Julia provided an orientation sheet for participants. She provided training as needed to help people to set up their Fitbits and encouraged them to join teams. They used Fitbit’s app (with their own branded site for the county? No, just the Fitbit.com dashboard. Unfortunately at the time we started the program there was no way to brand it for corporate/company programs. I believe Fitbit is working on developing that capability. ) to set up their teams of 4-6, and over 200 of the 242 participants joined teams.

Over the past few months, Julia set up monthly challenges and sent out encouraging, lighthearted, weekly emails. Each competing group used a group page and a personal page. Several teams have very clever names, including:

  • Jailbitters (from prison workers)
  • Weapons of mass reduction
  • Fit to be fabulous
  • Thin to win
  • Lean and mean
  • Blister sisters
  • 6 ferociously fit females
  • Preventative maintenance (custodial workers)

How the Program Will End

Julia and her office’s efforts included everything from promoting the program, troubleshooting and training for participants, monitoring use, and planning incentives and prizes. Teams will have until the end of September until the competition closes and prizes are distributed.

Participants receive entry into prize drawings when certain challenges are achieved.  These challenges become progressively more difficult over time. Julia has noticed that people are not asking about the prizes but are instead self-motivated and encouraging towards others.

Forms of Assessment

The vendor is supplying reports of aggregate data while Julia is careful to make sure that legal and communication teams work together. So far, a few people have expressed concern and a few people have dropped out; the few people who have dropped out have done so because they have stopped working for the county such as for retirement. Only 3-4 participants have otherwise left.

What Julia Has Learned So Far

Julia personally has learned a lot in the process including workplace labor laws and HIPAA compliance. The Office of Performance, Innovation, and Sustainability is interested in individual versus group motivation and other intangibles, such as how to motivate and engage employees. Even though this is a voluntary program, Julia learned that she could not offer prizes for activities to ensure that everyone has the same opportunity to get prize entries.

On a larger scale the County has surmised that employees are very self-motivated. In addition to the tools provided through the FitBitters Challenge, employees are using mobile devices and Fitbit forums. Furthermore Julia notices colleagues walking more even when they aren’t participating in the program. People say that it is helping them motivate their families to increase their fitness and that they are meeting people at work they would normally not come in contact with, so there are social as well as fitness benefits. A post survey will include some of these less quantifiable metrics, also attitude workplace.

What Julia Would Do Differently

Adams County has learned several lessons in regards to effective pilot program implementation using ‘wearables’ that will inform future program development. More effective communication at the beginning about the web form and being able to stop it when the goal number reached is the first. Also, some people didn’t have the access to emails and couldn’t participate because they were not part of roll-out. Next time around, the County would utilize a dummy account so that the coordinator would not need to spend hours subtracting her own data as a participant for each group. For larger programs that are beyond the pilot phase and cost is not a constraint, other options include opening the program to all employees and hold more events such as a field day or nutritionist talks.

Advice from Julia

Julia had a lot of valuable advice for us. She told us to be careful when communicating about the intent of the program and deciding how devices are distributed. Due to the popularity of these devices, people may enroll and then lose interest in participating, so it is important to encourage people to enroll only if they will remain active participants.  She inferred that possible issues might be encountered outside the 18-34 age range when it came to troubleshooting the technology. Julia suggested reaching out to sustainability coordinators and asking participants for donations as well as reaching out to Fitbit in hopes of getting returned or unwanted Fitbits. Other suggestions included reaching out to Target, Sports Authority and Best Buy with a vinyl sticky that could go on cases of devices or electronic recycling programs. Julia also suggested reaching out to gyms.


Julia closed by saying that she was happy to share with others the cost effective $15,000 program that has had a huge impact on their county. Post assessments of health measures at the end of the program will provide more information about the value of the program in terms of reducing health care costs and improving health, but in the meantime employees are more motivated, more productive, and more active because of their participation!

My thanks to both Julia Ferguson, for her time, and Kristin Daudelin, my summer intern, for her assistance interviewing Julia and writing this with me.

August 12, 2015 at 7:01 am Leave a comment

This fall I’m a Tisch Faculty Fellow

I am honored to be selected to be a Tisch College Faculty Fellow this academic year. Jonathan M. Tisch College of Citizenship and Public Service is part of Tufts University. My initiative, RecycleHealth, is what I will work on as a fellow, and I believe it is public service. The goals of RecycleHealth is to collect unused wearable activity trackers from people who upgraded or are no longer using their devices, and give them to people who can’t afford them but are interested in increasing their fitness. We haven’t had our first meeting yet, but I am looking forward to it!

August 12, 2015 at 6:12 am Leave a comment

A Second Life for Unused Wearable Activity Trackers

If you have a Fitbit or other activity tracker and stop using it or upgrade, what do you do with the old one? There are few options to recycle or resell it. Enter RecycleHealth.

My hypothesis is that the people who are least likely to own wearables are those who might benefit most. I am requesting donations of unused wearables through RecycleHealth and then giving them a second life by using the refurbished, donated wearables in pilots with populations who rarely purchase and are unlikely to afford them.

RecycleHealth was described in the Boston Globe business section: http://www.betaboston.com/news/2015/07/02/recyclehealth-wants-to-donate-that-fitbit-sitting-in-your-sock-drawer/.

July 18, 2015 at 2:35 am Leave a comment

Emergency preparedness on campus: the amazing videos my students made

What makes an effective emergency preparedness video for college students? First, students have to want to watch it, then they have to like it enough to keep watching it, and finally they have to learn from it.

My students in Designing Health Campaigns Using Social Media conducted needs assessments that showed that videos needed to be short – generally under 1 or 2 minutes – and funny – but appropriately so. They also had advice from Mark Robertson that videos need a clear message and call to action.

Based on the plans they created, with goals, needs assessment, and competitive analysis, and having their choice of topic and tool, students created what I thought – and the class thought – were really effective videos. I was impressed not just by how well they handled their topics but by the creativity and unique approaches they used.

If you have feedback for them, please write a comment!


November 18, 2014 at 5:42 am Leave a comment

How to plan an emergency preparedness video for a university

Most people don’t think about the fine balance between making a point and entertaining people. Mark Robertson, Emergency Preparedness Coordinator, University of Nebraska – Lincoln (UNL), obsesses about it. He created a videos series for UNL Police on emergency preparedness. When preparing a lecture for Designing Health Campaigns Using Social Media at Tufts University, I looked on YouTube for examples of emergency preparedness videos from universities and started watching his. The animations are short, funny, and have a clear message.
Rather impressively, Mark creates the animations himself using GoAnimate in about an hour. He does the voice himself generally – which is why he sounded familiar when we spoke by phone. I asked him for advice for my students, and then realized this might be of broader interest.
Mark’s advice for planning emergency preparedness videos:
  1. Know what is the one message you want to get across.
  2. Humor is popular but it is dangerous too. If you are using humor, be certain that no one will take offense. Do not poke fun at students, faculty, or staff.
  3. Make your point and find a balance between making your point and entertaining people.
  4. Use sample audiences before publishing to make sure you aren’t hitting the wrong nerve and your point comes across.
  5. It is a challenge to get people’s attention for too long. Start out and pique people’s interest, and keep the video short.
  6. Even how you promote a video is important. Say something that piques their interest to get them to watch.
  7. Finally, be careful about your central characters because, if well-received, you will be stuck with them and may regret some of their eccentricities.

November 13, 2014 at 2:21 am Leave a comment

The Newest Health Tracker is a Mirror

Smart refrigerators, smart thermostats, smart toothbrushes – everyone is trying to create new digital health markets. While intriguing, it is sometimes hard to see how they will improve my health or quality of life. Until now: Sandra Rosenbluth, a student in Mobile Health Design, is revolutionizing the mirror.

Everyone has a mirror; they vary in size and quality, but none are smart until now. And smart in a way that might change how people think about diet and fitness, moving away from weight or BMI as a measure of success or failure.

Sandra describes how she conceived of the SmartWatch Mirror and how it works:

I was scrolling through my Facebook news feed one day, when I read a status that truly horrified me. A friend had written, “Since I started working out, I feel better and look better, but my weight on the scale hasn’t gone down, and I feel really sad.” This statement really stuck with me, even more so when she admitted she was addicted to her scale and couldn’t possibly throw it out. Therefore, when the time came to think of a smart device for my Mobile Health Design final paper, I designed the ShapeWatch Mirror.

The idea behind the ShapeWatch Mirror is straightforward: You can’t always rely on a scale to tell you whether a new diet or exercise plan is working, so rely on your mirror instead. The ShapeWatch Mirror has the ability to take a photo of the user, which it then sends to a phone or tablet. A contour outline is drawn around the outside of the user’s body, making a trace of his/her shape. That contour line can be merged onto previous outlines, showing the user exactly where his/her shape has changed. In other words, while the scale might show the same number, the contour lines can show loss of fat in the midsection and gain of muscle in the arms.
Using techniques I learned in Mobile Health Design, I was able to show how the ShapeWatch Mirror was truly aimed at its target audience by creating sample personas of potential users. By comparing the mirror to other smart devices, I was able to show how it utilized previous devices’ strengths, like tracking, while discarding weaknesses, like relying on weight as the sole measure of progress. Together, these techniques helped me design a strong product. To learn more about the ShapeWatch Mirror, read my full paper.

September 24, 2014 at 6:41 pm 2 comments

Why the #ALSIceBucketChallenge Went Viral: Almost the Perfect Storm

The ALS ice bucket challenge, better known as #ALSIceBucketChallenge or #icebucketchallenge, was almost the perfect storm for viral fundraising. In my course, Designing Health campaigns Using Social Media at Tufts University, we analyzed why the challenge went viral.

Not surprisingly, given its popularity, my students had all heard about it and watched challenge videos. About half had done it. Some researched amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, and including what they learned in their videos. While my students’ videos were undoubtedly shared, they did not have millions of views. The three most popular videos that I found in a search each had over 19 million views. Most popular was The Simpsons, an animation. Second was a compendium of fails, which included people who were supposed to pour water on someone and accidentally poured it on themselves. Third was Bill Gates, pulling the rope of a device he designed to dump water on himself.

The challenge videos were not only popular and entertaining, but resulted in a significant increase in donations. The ALS Association has received over $100 million from more than 3 million donors. They raised only $2.8 million in the same period last year hence had a 3,504% increase. Notably, the challenge was not started by them but by a person with ALS, 29-year old Peter Frates. A Boston-area resident, he posted his ice bucket challenge video on July 31 and the challenge spread mostly through the month of August 2014.

Time Magazine reported, “The Ice Bucket Challenge has been a social media phenomenon, grabbing the attention of millions of Americans including many celebrities and political figures. Some have speculated that it might forever change the way charities approach fundraising.” Bearing out that it was a social media success was not only video views but tweets. There have been more than 4.2 million tweets about the challenge, peaking at 1,877 tweets per minute.

An analysis of 1,500 randomly selected videos found that 20% of participants took the challenge indoors; 30% of participants were female; in 53% water was dumped by someone else; 26% of participants didn’t mention ALS; and only 20% of participants mentioned donating money. Given that many people used #icebucketchallenge without ALS in the hashtag, they may not have even connected the challenge to the disease. This is similar to Movember, which many men, including two of my students, participated in without knowing it was for prostate cancer and other men’s health issues.

The main criticism of the challenge was that it is an example of “slacktivism” in which people are more interested in bringing attention to themselves than to a cause while ostensibly participating. Other criticisms were that so many participants didn’t mention ALS, the waste of water, especially where there are droughts, and the lack of information about how the windfall will be used. In fact, the detailed analysis of where the ALS Association spends money was in HealthNewsReview.org. Personally, what I thought was missing was more information about the disease itself, including advice on how to help people with ALS and their caregivers.

The main benefits are the increase in donations and the greater awareness of ALS. Possible side effects are that many people shot and uploaded a video for the first time, making it more likely they will do so again, and that some participants may have engaged in fundraising for the first time. However, does this mean they are more likely to again?

Undoubtedly every health organization is hoping to capture some part of the success of the challenge to increase donations and awareness of their health issue. The copycats are emerging, an example of which is Doubtfire Face for Suicide Prevention: Started by a supporter of the American Foundation for Suicide Prevention, it honors the late Robin Williams by replicating his pie-in-the-face scene from “Mrs. Doubtfire.“ Another one also uses a pie: Eat Pie for HI (Hyperinsulinism is abbreviated HI). And there are others, many involving a video and hashtag.

My students and I discussed why the challenge’s viral nature may be hard to replicate: fatigue, lack of novelty, and the difficulties of orchestrating virality. Fatigue is already occurring with the ice bucket challenge even though new videos are still appearing, albeit at a much slower rate. People like novelty and have limited attention spans, which is why the Livestrong yellow wristband spread until a rainbow of bracelets for every cause saturated the market. Another reason that the challenge may be hard to replicate is that it was not planned by the ALS Association but was something a person with ALS did that caught people’s attention. Most of what goes viral in social media is not orchestrated.

The challenge was almost the perfect storm. The factors contributing to this were:

  • The 24-hour time period to complete the challenge so little time for procrastination
  • Hot summer weather made it fun and refreshing to complete the challenge, reminiscent of childhood fun
  • Many people are on vacation, or have more flexible schedules, in August when it peaked
  • The challenge had very simple rules, low cost, and low risk making it easy to complete
  • At the same time there was a little vulnerability in appearing in a video and doing so under sub-optimal but not embarrassing circumstances
  • It could be done by all ages and abilities
  • The challenge connected people through the challenging process as well as the sharing of videos, in fact, many did the challenge with another person pouring or in a group with friends or colleagues
  • There was room for creativity, humor, and personal expression in how the challenge was completed yet also room to make a statement about ALS
  • ALS is a disease affecting as many as 30,000 Americans so most people participating in the challenge probably don’t have ALS or know anyone with ALS and can participate in a light-heartedly way that might not work for a more common or better known disease.

The ALS Association didn’t provide instructions, but did offer their thanks for donations and posted two warnings. One was that the challenge “may not be suitable for small children, the elderly, anyone in poor health or animals.” The other suggested thoughtful water usage.

What is next? As one of my students questioned, will the challenge migrate to the Southern Hemisphere as cooler weather arrives in the US? Can all these factors come together again and can a viral campaign be planned by a health organization? Probably not, because so many factors came together and contributed to the challenge’s success. Given the likelihood that health organizations are planning campaigns, they may achieve better success by working with, and supporting, the efforts of individuals like Peter Frates. My hope is that new campaigns have a great focus on awareness and prevention, and on how to help people who have a disease like ALS and their caregivers, not just on donations.

September 23, 2014 at 9:01 pm 1 comment

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Lisa Gualtieri, PhD, ScM

Lisa GualtieriLisa Gualtieri is Assistant Professor at Tufts University School of Medicine in the Department of Public Health and Community Medicine. She is Director of the Certificate Program in Digital Health Communication. Lisa teaches Designing Health Campaigns using Social Media, Social Media and Health, Mobile Health Design, and Digital Strategies for Health Communication. Contact Lisa: lisa.gualtieri@tufts.edu



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