Slides presented as part of our presentation at mHealth Summit 2013

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. The value of mHealth…
@meganranney

3. Percent of Emergency Department
patients with cellphones
Ranney Annals of EM 2012
@meganranney

4. According to @PewResearch 2012
Data
http://www.pewinternet.org/Reports/2012/Mobile-Health/Key-Findings.aspx
@meganranney

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. 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. 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. @meganranney

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. Thank you!
@meganranney

11. Creating
Technology
Interventions that
are
UsefulRochelle K.Used
and Rosen, PhD
Beth Bock, PhD
Centers for Behavioral & Preventive
Medicine

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. 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. 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. 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. User Analytics doesn’t tell us
about :
Meaning

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. 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

20. 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

21. 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.

22. 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)

23. 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

24. Thank
You!