Mobile health: clinical aspects


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Robyn Whittaker
National Institute for Health Innovation
University of Auckland
(Wednesday, mHealth Workshop)

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Mobile health: clinical aspects

  1. 1. Mobile health: clinical aspects Dr Robyn Whittaker Health Informatics & Technology, NIHI Research & Innovation, Waitemata DHB The National Institute for Health Innovation
  2. 2. mHealth research & development • Text messaging smoking cessation • Video messaging smoking cessation • Multimedia messaging depression prevention in adolescents • Text messaging & internet exercise prescription & support for cardiac patients • Text messaging weight loss programme • Text messaging brief intervention for problem alcohol drinking • Smartphone applications for data collection • Smartphone application linked to food database for nutrient advice • Tools & communication for people with diabetes
  3. 3. mHealth programs can be HEALTHY BEHAVIOR • integrated into daily life CHANGE • proactive • there at the ‘right’ times • personal/ised CHRONIC DISEASE • interactive MANAGEMENT • on-going • providing social support
  4. 4. STOMP implemented nationally 4
  5. 5. Txt2stop United Kingdom
  6. 6. “Spot, Sort, Do” Reality TV or ‘Youtube’ style Set challenges Video clips youth and celebs‘Brotown’ Short catchy keystyle message in txt Animated 2 messages/day Educational cartoons for 2 months messages Access for mobile 12 months website Contacts & summary
  7. 7. MEMO „teens‟
  8. 8. MEMO celebs
  9. 9. MEMO Animations
  10. 10. Conclusions It is possible to convert CBT into mobile phone messages, feasible to deliver such a programme, and acceptable to NZ teens The majority liked it and said they found it helpful
  11. 11. Objective depression scoresUnable to prove that MEMO worksto prevent onset of depression• Our control programme or study processes (interviews with lovely RAs) worked as well• The group were Worsening scores uniformly ‘happy’ anyway and can’t improve much on that• The ‘dose’ was not sufficient to show an effect
  12. 12. Heart Exercise and Remote Technologies (HEART):A Randomized Controlled Trial ISO 9001 Registered
  13. 13. Intervention • Fully automated program of SMS via mobile phones – Exercise prescription – Behavior change strategies • Role model video messages accessed via secure website • Self-efficacy theory – Task – Barrier – Scheduling
  14. 14. RCT • 170 participants with CVD • Primary outcome change in VO2max • Secondary outcomes – 6 min walk test – Self-reported PA – HRQoL – Cost-effectiveness • Recruitment finished
  15. 15. Approach to development - Whittaker 2012, Journal of Health Communication – Start with the problem – Conceptualisation • Experts and target audience • Use evidence & theory – End-users involved through-out – Consider implementation from start – Pre-test & refine – Test in high quality research studies – Publish/make publicly available
  16. 16. People with diabetes• Regular blood glucose monitoring & frequent contact with health providers improves control of diabetes• Better control delays or prevents costly & debilitating consequences – Blindness, lower limb amputations, kidney disease, heart disease• Growing evidence that mHealth solutions can enhance self-management & improve control
  17. 17. mHealth interventions• Reminder text messages for monitoring• Diary functions to collect data on insulin/glucose/diet/activities – Education & practical tips on how to manage diabetes – Individualised automated advice based on readings – Enhancing self-efficacy for control – Integrating with providers
  18. 18. End-user input• Expert Advisors/clinical teams• Maori Advisory Group• Focus groups• Interviews• Demonstrating existing tools – Identifying needs and barriers to self-management
  19. 19. Guiding principles• Theory eg. Social cognitive - enhancing self- efficacy• Illness perceptions• Behaviour change techniques – short term goals, motivation, positive reinforcement, reminders/scheduling, self-monitoring & feedback, role modelling/observational learning, social support• User-friendly options
  20. 20. Implementation• Integration into clinical practice and health information systems• Shared Care Plan platform – Primary care, secondary care, community, patient and caregivers – Graphical visualisation of patient-reported data
  21. 21. Portal Overview
  22. 22. Other DHB work• Text messaging integrated into DHB systems for clinical and non-clinical uses• Trial of smartphone-based paging system• Systems to support community-based ambulatory workers• Clinical apps
  23. 23. Issues with mHealth inclinical practice• Privacy of personal health information• Health information security, hosting• Infrastructure: wifi & 3G access in hospitals• BYOD: registration of devices, health information on devices, evidence-based apps• Clinical: integrated models of care, understanding of potential value• Patient engagement
  24. 24. Overall lessons• Make sure mobile is the right tool and if so optimize the benefits of using mobile• Decide on guiding principles & logistics• Involve target audience in development & use their input/feedback• Do it well!
  25. 25. AcknowledgementsThank