Dr Robyn Whittaker Clinical Trials Research Unit Using mobile phones to deliver person-centred population health programmes
Mobile phones in health <ul><li>Appointment reminders </li></ul><ul><li>Reporting test results </li></ul><ul><li>Text medi...
<ul><li>Population health programmes </li></ul><ul><ul><li>Stand-alone </li></ul></ul><ul><ul><li>Person-centred/individua...
Examples <ul><li>Txt messaging stop smoking support  (00/01) </li></ul><ul><li>Video messaging stop smoking support  (06/0...
STOMP programme <ul><li>Voice or web registration </li></ul><ul><ul><li>smoking history, triggers etc </li></ul></ul>0 wee...
Why mobile phones? <ul><li>Wide reach - more mobile phone accounts than people </li></ul><ul><li>Delivery via method that ...
<ul><li>Household Economic Survey  </li></ul><ul><ul><li>Less socio-economic gradient than access to internet </li></ul></...
STUB IT participants 24% Maori 10% Asian 7.5% Pacific
STOMP: % quit at 6 weeks Age Gender Ethnicity Income Region <ul><ul><li>Overall relative risk 2.8, 95% CI 2.1-3.5, p <0.00...
Functionality meets theory <ul><li>Benefits/barriers </li></ul><ul><li>Outcome expectations </li></ul><ul><li>Self-efficac...
Functionality meets theory <ul><li>Benefits/barriers </li></ul><ul><li>Outcome expectations </li></ul><ul><li>Self-efficac...
Proactive & timely <ul><li>STUB IT </li></ul><ul><ul><li>select two message time periods </li></ul></ul><ul><ul><li>automa...
Ask for help when/where needed <ul><li>Text ‘CRAVE’ </li></ul><ul><ul><li>Get immediate txt or video in response </li></ul...
Provide observational learning <ul><li>Role models </li></ul><ul><ul><li>‘ Ordinary’ kiwis going through quitting or same ...
 
Promote social support <ul><li>STOMP: Txting friends & family on quit day in order to get messages of support </li></ul><u...
 
What they liked about STUB IT <ul><li>“ The constant/daily support” </li></ul><ul><li>“ Felt like I was quitting as a grou...
Provide long-term support <ul><li>MEMO:  </li></ul><ul><li>Mobile website for summary info & how to get help out to 12 mon...
Tailored <ul><li>Select Quit Date </li></ul><ul><li>Select role model or topics of interest </li></ul><ul><li>Select appro...
Provide interactivity <ul><li>Data collection questions </li></ul><ul><ul><li>How many cigs have u smkd in past 7 days? </...
Results - STOMP <ul><li>1705 participant RCTrial </li></ul><ul><li>Doubled short-term quit rates </li></ul><ul><ul><li>28%...
 
Results – STUB IT <ul><li>Failed to recruit sufficient participants to show statistically significant difference </li></ul...
Acknowledgements <ul><li>Prof A.Rodgers, Dr S.Merry,  RB.Lin,M.Wills, M.Jones, T.Corbett, Dr D.Bramley, Dr T.Riddell, Dr S...
Publications <ul><li>STOMP </li></ul><ul><ul><li>Rodgers et al. Tobacco Control 2005 </li></ul></ul><ul><ul><li>Bramley et...
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Using Mobile Phones to Deliver Person-centred Population Health Prograames

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Dr Robyn Whittaker
Clinical Trials Research Unit, University of Auckland
www.ctru.auckland.ac.nz
(P37, 1/10/09, Skellerup Room, 4.25)

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Using Mobile Phones to Deliver Person-centred Population Health Prograames

  1. 1. Dr Robyn Whittaker Clinical Trials Research Unit Using mobile phones to deliver person-centred population health programmes
  2. 2. Mobile phones in health <ul><li>Appointment reminders </li></ul><ul><li>Reporting test results </li></ul><ul><li>Text medication reminders </li></ul><ul><li>Support self-management </li></ul><ul><ul><li>Self-testing & adjustment medications </li></ul></ul><ul><li>Telemedicine </li></ul><ul><li>Remote sensors </li></ul><ul><li>Access to personal health information </li></ul>
  3. 3. <ul><li>Population health programmes </li></ul><ul><ul><li>Stand-alone </li></ul></ul><ul><ul><li>Person-centred/individualised </li></ul></ul><ul><ul><li>But at less cost </li></ul></ul><ul><ul><li>With the reach of mass media </li></ul></ul><ul><li>Behaviour change support to reduce the risk of disease </li></ul>
  4. 4. Examples <ul><li>Txt messaging stop smoking support (00/01) </li></ul><ul><li>Video messaging stop smoking support (06/09) </li></ul><ul><li>Multimedia messaging depression prevention </li></ul><ul><li>(2008/11) </li></ul>
  5. 5. STOMP programme <ul><li>Voice or web registration </li></ul><ul><ul><li>smoking history, triggers etc </li></ul></ul>0 weeks <ul><li>Quit Day </li></ul><ul><li>free text messaging begins </li></ul>1-3 weeks Daily text message countdown + action plan Quit calendar web page Personalised text message tips Introduction to CellPall (“quit buddy”) Text your friends “ TXT crave” 4 personalised text message tips per day Quiz or poll eg “top 5 reasons to quit” Web page Quit Meter (eg $ saved), profiles Target Date Quit Relapse 6 weeks 26 weeks
  6. 6. Why mobile phones? <ul><li>Wide reach - more mobile phone accounts than people </li></ul><ul><li>Delivery via method that is already integrated into daily life </li></ul><ul><li>Always with people regardless of location </li></ul><ul><li>Less ‘digital divide’ than with other technological methods </li></ul>
  7. 7. <ul><li>Household Economic Survey </li></ul><ul><ul><li>Less socio-economic gradient than access to internet </li></ul></ul><ul><li>ACNielsen Survey 04 </li></ul><ul><ul><li>No difference between Maori & non-Maori % using mobile phones </li></ul></ul><ul><ul><li>Regular txt messaging higher in Maori and Pacific than others </li></ul></ul>
  8. 8. STUB IT participants 24% Maori 10% Asian 7.5% Pacific
  9. 9. STOMP: % quit at 6 weeks Age Gender Ethnicity Income Region <ul><ul><li>Overall relative risk 2.8, 95% CI 2.1-3.5, p <0.0001 </li></ul></ul>
  10. 10. Functionality meets theory <ul><li>Benefits/barriers </li></ul><ul><li>Outcome expectations </li></ul><ul><li>Self-efficacy </li></ul><ul><li>Positive reinforcement </li></ul><ul><li>Observational learning </li></ul><ul><li>Preparation cues/triggers </li></ul><ul><li>Social support </li></ul><ul><li>State behavioural intentions </li></ul><ul><li>Tailoring </li></ul><ul><li>Engagement </li></ul>
  11. 11. Functionality meets theory <ul><li>Benefits/barriers </li></ul><ul><li>Outcome expectations </li></ul><ul><li>Self-efficacy </li></ul><ul><li>Positive reinforcement </li></ul><ul><li>Observational learning </li></ul><ul><li>Preparation cues/triggers </li></ul><ul><li>Social support </li></ul><ul><li>State behavioural intentions </li></ul><ul><li>Tailoring </li></ul><ul><li>Engagement </li></ul><ul><li>Provide information </li></ul><ul><li>Proactive & timely messages </li></ul><ul><li>Video messaging </li></ul><ul><li>Ask for help on demand </li></ul><ul><li>Social network/contacts </li></ul><ul><li>Long-term </li></ul><ul><li>Direct & individual </li></ul><ul><li>Interactive </li></ul>
  12. 12. Proactive & timely <ul><li>STUB IT </li></ul><ul><ul><li>select two message time periods </li></ul></ul><ul><ul><li>automatically sends out randomly within those time periods </li></ul></ul><ul><ul><li>e.g. first cigarette in the morning, lunch break, after work </li></ul></ul><ul><li>“ Good reminders of what I’m trying to do” </li></ul>
  13. 13. Ask for help when/where needed <ul><li>Text ‘CRAVE’ </li></ul><ul><ul><li>Get immediate txt or video in response </li></ul></ul><ul><ul><li>Context-specific (drinking, stressed, boredom) </li></ul></ul><ul><li>Text RELAPSE </li></ul><ul><ul><li>Get 3 messages over next 2 hours </li></ul></ul><ul><ul><li>Motivation to keep going </li></ul></ul><ul><ul><li>Go to website & increase messages </li></ul></ul>
  14. 14. Provide observational learning <ul><li>Role models </li></ul><ul><ul><li>‘ Ordinary’ kiwis going through quitting or same issues as them </li></ul></ul><ul><ul><li>Talk about what difficulties they have experienced & what they did to get through it or how they faced it </li></ul></ul><ul><ul><li>Feel good cos got through another day/ sorted a problem </li></ul></ul>
  15. 16. Promote social support <ul><li>STOMP: Txting friends & family on quit day in order to get messages of support </li></ul><ul><li>STOMP: Quit buddy </li></ul>
  16. 18. What they liked about STUB IT <ul><li>“ The constant/daily support” </li></ul><ul><li>“ Felt like I was quitting as a group” </li></ul><ul><li>“ Real people doing it” </li></ul><ul><li>“ That people were sharing their own experiences so I was not feeling alone” </li></ul>
  17. 19. Provide long-term support <ul><li>MEMO: </li></ul><ul><li>Mobile website for summary info & how to get help out to 12 months </li></ul>
  18. 20. Tailored <ul><li>Select Quit Date </li></ul><ul><li>Select role model or topics of interest </li></ul><ul><li>Select appropriate time periods </li></ul><ul><li>Use nickname </li></ul><ul><li>Relapse programme </li></ul>
  19. 21. Provide interactivity <ul><li>Data collection questions </li></ul><ul><ul><li>How many cigs have u smkd in past 7 days? </li></ul></ul><ul><li>CRAVE </li></ul><ul><li>Polls & surveys in STOMP </li></ul><ul><ul><li>How long does it take nicotine 2 leave yr body? 2hrs, 2days or 2 wks </li></ul></ul><ul><li>Submit video messages in STUB IT </li></ul><ul><li>Participants website </li></ul>
  20. 22. Results - STOMP <ul><li>1705 participant RCTrial </li></ul><ul><li>Doubled short-term quit rates </li></ul><ul><ul><li>28% cf. 13% (RR2.20, 95% CI 1.79-2.70) </li></ul></ul><ul><li>Equally effective for all sub-groups </li></ul><ul><li>As effective for Māori as non-Māori </li></ul>
  21. 24. Results – STUB IT <ul><li>Failed to recruit sufficient participants to show statistically significant difference </li></ul><ul><ul><li>36.7% have not gone back to daily smoking at 6 mths cf.25.8% </li></ul></ul><ul><li>Why? </li></ul><ul><ul><li>Readiness to quit of target popn </li></ul></ul><ul><ul><li>‘ Ahead of the curve’ wrt mobile technology </li></ul></ul><ul><ul><li>Competition/Incentives/Low coverage </li></ul></ul>
  22. 25. Acknowledgements <ul><li>Prof A.Rodgers, Dr S.Merry, RB.Lin,M.Wills, M.Jones, T.Corbett, Dr D.Bramley, Dr T.Riddell, Dr S.Denny, R.Maddison, C.Bullen, H.MacRobbie, P.Salmon, V.Parag, Dr K.Stasiak, M.Shepherd, Dr H.McDowell, I.Doherty, Dr S.Ameratunga </li></ul><ul><li>E.Dorey, J.Strydom, J.vanRooyen, S.Chua, M.Malik </li></ul><ul><li>Funders: </li></ul><ul><ul><li>Health Research Council of NZ </li></ul></ul><ul><ul><li>National Heart Foundation </li></ul></ul><ul><ul><li>Cancer Society of NZ Ministry of Health </li></ul></ul><ul><ul><li>Auckland UniServices Ltd Digital Strategy </li></ul></ul><ul><ul><li>Vodafone NZ Ltd Oakley Foundation </li></ul></ul><ul><ul><li>Alcatel </li></ul></ul>
  23. 26. Publications <ul><li>STOMP </li></ul><ul><ul><li>Rodgers et al. Tobacco Control 2005 </li></ul></ul><ul><ul><li>Bramley et al. NZMJ 2006 </li></ul></ul><ul><li>STUB IT </li></ul><ul><ul><li>Whittaker et al. JMIR 2008 </li></ul></ul><ul><li>[email_address] </li></ul><ul><li>www.ctru.auckland.ac.nz </li></ul>

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