Facilitating cross-talk in mHealth intervention development


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Slides presented as part of our presentation at mHealth Summit 2013

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  • Welcome to our talk. I am an emergency physician and an mHealth researcher, and I will be moderating this symposium today. I am going to start by giving you a little background on the rationale for why we put this symposium together, and on our goals for our discussion today.
  • So I don’t need to sell you on the value of mHealth. We all know that the healthcare system, as it exists, is broken. And we know that our society needs help.
    In my practice setting, the emergency department, alone -- a small percent of the patients represent a large % of visits. But even those people who aren’t “frequent users” articulate a host of psychosocial reasons for being in the ED. And they cost a lot of money.
    Unluckily, we simply don’t have the resources to help these people. Studies show that even people with GOOD INSURANCE can’t get followup. It’s especially tough to get psychosocial or behavioral resources. mHealth holds the promise of being able to help these folks.
    50% of my patients can’t get follow-up
    10% are “frequent users” of the ED
    We have a dearth of preventive care
  • Indeed, pts – even the high-risk ones seen in the ED -- have access to cellphones. Please note, however, that less than half of them have smartphones.
    Many of them tell me that they WANT a cellphone program to help them manage their weight, their anxiety, their smoking.
  • And they’re TRYING to get what they want. According to Susannah Fox’s data, of adult American cellphone users:
    About 1/3 look up health-related info on their phone
    About 1/10 have downloaded an app or use texting programs for help.
    This disparity between what kinds of phones ppl have, and what they’re doing with them, represents an opportunity. Clearly, the apps and texting programs that are out there aren’t serving our patients’ needs.
  • Indeed: we know that…
    Out of ~20,000 consumer-facing health apps, less than 20% of them have ever been downloaded. Just five apps account for 15 person of all health app downloads
    The minority of apps out there are based on “evidence.”
    Even fewer are used more than once! ONLY 20% CAPTURE USER-ENTERED DATA
    Pain mgmt
    Smoking cessation http://www.ajpmonline.org/article/PIIS0749379713004790/abstract
  • I can tell you the clinician’s perspective.
    I can tell you the patient’s perspective.
  • And although I don’t have a technical background, I’ve worked with a number of companies over the past few years, and these are the frustrations that I’ve heard from them:
  • 16% report using health-related apps “regularly”
  • I know that we’re all trying. That’s why we’re here. And after all:
  • Goal of the talk: brief overview of how & why to use behavioral theory to inform mHealth intervention development
  • (“I’m not drinking cuz I’m thirsty!”)
    (Dude, that’s good info, but that’s not the way you’re going to say it to me)
    (Here, let me write this for you!)
    Add what we learned: Caring, Timing, No DARE program! PSA announcements! “Don’t tell me not to drink, tell me you care about how I drink & help me do it safely”
    Also learned that our texts don’t sound like their texts.
  • Needs conclusion slide
  • Facilitating cross-talk in mHealth intervention development

    1. 1. Facilitating cross-talk: How to bridge the interdisciplinary divides in mHealth intervention development Megan L. Ranney MD MPH Department of Emergency Medicine Alpert Medical School, Brown University @meganranney
    2. 2. The value of mHealth… @meganranney
    3. 3. Percent of Emergency Department patients with cellphones Ranney Annals of EM 2012 @meganranney
    4. 4. According to @PewResearch 2012 Data http://www.pewinternet.org/Reports/2012/Mobile-Health/Key-Findings.aspx @meganranney
    5. 5. What isn’t working with mHealth? • < 30% of apps downloaded more than 50 times • < 10% used more than once • Few are evidencebased or linked to the healthcare system http://www.imshealth.com/deployedfiles/ imshealth/Global/Content/Corporate/IM S%20Health %20Institute/Reports/Patient_Apps/IIHI @meganranney
    6. 6. Where is the evidence? How do I know they’re good? Are they safe and private for my patient? Do they exist for my OS? Do they exist for my disease? She doesn’t even look at my data! @meganranney
    7. 7. Why do the researchers insist on testing this a gazillion times? They’re asking for the impossible! I need to deploy this quicker. My investors need ROI!
    8. 8. @meganranney
    9. 9. “If knowledge and feedback was all it took to change unhealthy behaviors, psychologists would be superfluous in the world” (Leslie Schover) http://thehealthcareblog.com/blog/2013/10/11/health cares-tech-disconnect-why-arent-we-building-theproducts-patients-really-need/ @meganranney
    10. 10. Thank you! @meganranney
    11. 11. Creating Technology Interventions that are UsefulRochelle K.Used and Rosen, PhD Beth Bock, PhD Centers for Behavioral & Preventive Medicine
    12. 12. Outline  Behavioral theory for mHealth interventions  What’s been missing: • Deficiencies in current applications of behavioral theory to mHealth design  Filling that gap • Efficient steps based on behavioral & social science • ACTIONABLE data • Role of qualitative inquiry  Example
    13. 13. Why use Behavioral Theory?  Provides framework upon which to build an intervention  Provides a testable model for how variables relate to one another  Behavioral Theory for mHealth  Understand when, how and why people change their behavior  Whether they maintain those changes ? user experience ? & App design
    14. 14. Behavioral Theory guides intervention:  Content Ex: Self-Efficacy Theory  Initiation of program Ex: Stages of Change model  Interaction between the user & the device/app Ex: Systems Contingency Approach  Amount, frequency & type of communication Ex: social-ecological model
    15. 15. What’s been lacking • Most mHealth interventions have been one-step (receive data –> provide output) – But are increasingly becoming interactive • Most have no theoretical basis underlying the intervention – So if it works, we don’t know ‘why’ • Current theory may be inadequate as interventions become more interactive and dynamic – Suggests the need for new approaches and strategies
    16. 16. User Analytics doesn’t tell us about : Meaning
    17. 17. Qualitative Research methods for mHealth • Focus Group Discussions (FGD) – Series of groups, each with 6-8 people – 5 key topic areas – Information: breadth and trends • Individual In-depth interviews (IDI) – 10-30 individual interviews – 5-8 key topic areas – Information: depth and personalization
    18. 18. Recent research and resources • Dennison et al. 2013 – Opportunities and Challenges for Smartphone Applications in Supporting Health Behavior Change: Qualitative Study. Journal of Medical Internet Research 15(4) • Palmier-Claus et al 2013 – Integrating mobile-phone based assessment for psychosis into people’s everyday lives and clinical care: A qualitative study BMC Psychiatry 34(1) • Hingle, Nichter et al 2013 – Texting for health: the use of participatory methods to devleop healthy lifestyle messages for teens. Journal of Nutrition Education and Behavior 45(1) • Special issues on mHealth – Translational Behavioral Medicine September 2013 – Journal of Substance Abuse Treatment September 2013 • Technology-based interventions for the treatments and recovery management of substance use disorders
    19. 19. Initial approach… Planned approach: focus groups • • • • Show design ideas to target population Get feedback Adjust delivery & design Conduct pilot study Initial Design • • • Enroll in TMAP to learn safer drinking strategies Complete a survey for personalized text messages. Receive text messages for 6 weeks
    20. 20. Planned text messages Behavioral strategies • Still thirsty? Switch to water. You’ll thank yourself tomorrow! Tips & Suggestions • Eat foods with lots of protein and fat, like cheese and nuts, before drinking. Factual messages • It takes the body 60-90 minutes to feel the effects of alcohol on a full stomach. Drink slowly.
    21. 21. Advisory Panel • Linguistic Theory: McWhorter “Text as fingered speech” • Advisory panel with representative population – Weekly meetings – Texts generated during the meetings (in vivo) – on topics drawn from focus group results AND – They texted us sample texts daily during the week (ecologically valid) – Produced “library” of over 300 texts • RCT (2014)
    22. 22. The Challenges for mHealth • Using behavioral theory to design interventions • Using technology in an ecologically valid way • Incorporating qualitative methods early in development to produce – A product that is desired by the target audience – That will be used by the target audience – That they find useful and that will change behavior • Avoid the *wow factor* running the science
    23. 23. Thank You!