The MEMOTEXT® mobile heathexperience. From product to methodology… Amos Adler M.Sc. MEMOTEXT Personalized Adherence Solutions
From product to methodology – Problem/issue – Methodology – Outcomes/Results – Best practices – Challenges
The Problem:Technology ≠ behavior changePatient Adherence / Medication Compliance and technology interventions• Systemic Adoption• Patient Adoption• Everyone is different + people change• Does it scale? 1. How patients interact between health and technology 2. How marketing must meet with health 3. How academia interacts with commercialism to become ‘agile’ mHealth is a series of intersections. ~Roni Zeiger
Adherence is adiscipline, MEMOTEXT is amethodology1. Systemic Adoption2. Patient Adoption Analysis & CATWOE2. Everyone is Stakeholder different + Visioning people change3. Does it scale? Intervention Evidence Base Validation Design Deploy Iterate Requirements Intervention
Methodology Condition specific intervention design Condition/ Literacy Self Efficacy Depression Knowledge Test Medication Barriers Barriers Barriers Type II Adams et Sarkar et al., 2006; (Katon et al., Depression screen Diabetes al., 2009; Aljasem et al., 2009). Likewise, Jeppesen 2001; Kavanagh et Moreau et al. Anxiety/Distress et al., al., 1993). (2009) Scale 2009 QoL SF36/12 Anticoag/AF (Higgins & Chu; Kim; Kwang; Regan, Park, 2009) Self Efficacy Scale 2004). Hx …integrating with individual patient needs for education, incentives, interactive coaching, motivation, reminder cues and stakeholder/peer support.
Assessment + Intervention Iterative Assessment Individualized communications Understand needs, motivations, behaviours. • Iterative screening instruments used to determine personal Patient Recruitment barriers to adherence. engage patient populations via • Patients assessed throughout program. partners, HCPs and communications planning. • Individual Assessment Segmentation & Re-Segmentation every 6-12 weeks. Determines intervention contentRECRUITMENT ASSESSMENT INTERVENTION ANALYTICS Depression screen Knowledge Test Anxiety/Distress Self Efficacy Scale Scale Stage Medicines of Literacy QoL SF36/12 Change Hx Self Depression Efficacy Condition Literacy
Speech, Social, Mobile. What is MEMOTEXT? Listen, guide, motivate. Phys. Lifestyle • Self-learning, multi-media trusted health Activity 10% 2% interventions tailored to customer Med Lit. 22% MI 30% segment and individual need. Diet Lit. CBT 25% Behavioral Economic 8% and Intervention Models: • Health Belief Model • Irrational Health Beliefs • Theory of Planned Behavior • Theory of Reasoned ActionRECRUITMENT ASSESSMENT INTERVENTION ANALYTICS - Medicines Education - Side Effect Information …integrating persuasive - Tailored Condition Literacy methods with individual patient - Inspirational/Motivational needs for - Automated Motivational education, incentives, interactive Interviewing coaching, motivation, reminder cues and stakeholder/peer support.
OutcomesI have not failed. Ive just found 10,000 waysthat wont work.~ Thomas A Edison
The numbers tell the story >20 ongoing programs/trials 3Years avg. duration of a program 85-95% program retention rates 67% average DAILY patient participation rate. Program Type Voice SMS Contraception 12% 88% (N.America) Multiple 64% 36% Sclerosis (Canada) Bone Health 36% 64% (US) T2 Diabetes 18% 82% (UK) Media selection is condition, demographic and geography specific.
Randomized Clinical Trial MEMOTEXT & JohnsHopkins University• Monitor • Poor • MEMOTEXT n= 428 Adherence Adherence group glaucoma • Good • Control group patients Adherence treated with once3 months Randomize 3 months daily Presented MHealth2011: therapy. What Really Works Stanford University MayJohns Hopkins University: is using the MEMOTEXT® platform to provide an 2011automated, customized and interactive adherence solution for glaucoma -a study entitled "The Impact of Automated Dosing Reminders on Presented at KaiserMedication Adherence using HealthVault". Permanente – Gallery of Innovation October 2011Launched: June 2009Recruitment Channel: JHU Research / Wilmer Eye Clinic March 2011 annual meetingScope: Reminders for Travatan of American Glaucoma Society.Results:Automated reminders linked to a personal health record are a practical This project receivedoption to improve adherence funding from the MicrosoftSignificantly improve adherence with daily medications: Intervention HealthVault Be Wellgroup increase adherence from 51% to 67% adherence p. 0.003 Fund.(Electronic Monitoring of Dosing)Control 49-50% p 0.83 11
The numbers tell the story 79% of patients rate programs very highly 17% + change in patients rating confidence in self management (over 18 months) Effect on Medication Average Change in Possession Ratios 3X daily Total Number of 76% of patient self-report feeling regimen medications Dispensed Records % better, healthier and happier since starting a T2 Diabetes program (over 18 High Medication Possession Rate + 1.5 - 3% months) (MPR) >80% Medium MPR 33% to 80% +20%-25% Low MPR <33% +50%
Best Practices 1. Everyone is different 2. Different conditions require different behavioral interventions. Commonalities are emerging though. 3. People change over time, they learn, they ebb, they flow 4. The most appropriate technology for the user. Fit the solution to the problem, not the other way around. 5. Relevant, intense, interactive guided dialogues throughout the course of treatment can positively modify behavior. 6. Health Belief Model and other health The Health Belief Model communication models help create emphasises that health personalization. behaviours are influenced by i) perception of the 7. Personalization creates RELEVANCE. individual’s susceptibility to a Relevance keeps the conversation going. health problem, ii) perception of the severity 8. Evidence based personalization is required for or seriousness white-coat credibility. iii) perception of the effectiveness and tolerability of the treatment iv) cues to take action.
MEMOTEXT Methodology – Stakeholder buy-in No silver bullet – just plain old hard work Analysis & What works: Stakeholder Visioning • Distribute and situate recruitment • multipoint/multichannel Intervention • Cross-organizational buy-in Validation • front-line champions • Internal communications rigour Design • Measure, monitor, pivot • Time to measure results • Ability to iterate Deploy • Stakeholder Communications Planning mHealth to MEMOTEXT means: Iterate • Organizational change • Systems thinking • Medical Science • Behavioral Science & Behavioral Economics • Informatics • Technology = 30%RECRUITMENT ASSESSMENT INTERVENTION ANALYTICS
The challenges • The biggest challenges in mHealth are not necessarily intervention efficacy. • Although – Current evidence is stronger for texting than apps in improving clinical outcomes/QOL indicators, but numerous studies are underway • The biggest challenge we have seen is not:
Although…Bad “Most technology needs to go to finishing school”Design ~ David Rose
Lessons learnedThe biggest challenge is: Behavior Change Ground ZERORECRUITMENT/ADOPTION We Want YOU to: - Comply - Download our app - Like our page - Sign up to our program - Buy more stuff - Give us your data - Admit that you need help!
- Competing for MindShare with - Professional Marketing - Overwhelmed and overloaded by apps and technology
RECRUITMENT/ADOPTION hierarchy Despite best efforts to enrol patients in mobile/text programs, patients get defensive when approached. Perceived as medical advice by the patient “I think you should consider this support program - try it1:5 recruitment ratio by Physican/Clinician out ” Perceived “I think you should as “what are1:20 recruitment ratio by Pharmacist consider this support program - you trying to sell me?” try it out ”
Evidence based personalization andgamification of healthcare interactions.Call me firstname.lastname@example.orgTwitter: @MEMOTEXTwww.memotext.com1.877.Memo.txt