Everhealthier.org WomenManage health tasks for you & others through mobile web and SMSDevelopment TeamDamien Leri, MS Ed1Anne Teitelman, PhD, FNP-BC, FAANP, FAAN2Marilyn Stringer, PhD, CRNP, RDMS, FAAN2Ben Koditschek, BFA31Big Yellow Star, Inc.2Univ. of Pennsylvania, School of Nursing3Designer, Civil ServiceRationale•African-African women are more likely to die fromsome cancers*•Latina women are more likely to get cervicalcancer*•Asian women are less likely to access regular cancerscreenings*•Prevention is the best way to solve this problem•USPSTF, ACS, ACOG provide recommendationsbut many women do not access and adhere to them.There is “too much info” and most of us haveliteracy and/or health literacy limitations.•Prevention and health promotion should bestraightforward, almost as simple as your automotivemaintenance schedule.•Everhealthier.org Women is simple, engaging, and100% mobile *womenshealth.govHealth 2.0 Challenge, Feb 5 2013
Features & BenefitsAccess! Mobile web site works with any smartphone model. Alternative interface uses text messaging, and automated voice calls can beadded. All content in English and Spanish.More than just reminders: interactive SMS text messaging includes decision-tree branching conversations to collect data. These areinitiated according to any frequency -- daily, fortnightly, biannually, etc.Tailored recommendations (by age, gender, pregnancy status, smoking, et al.) are automatically applied to family members which can thenbe tracked and/or reminded over time. These recommendations are from the USPSTF, IOM, and other official sources.The full library of Healthfinder.gov articles (in two languages) is available for browsing, searching, starring as a favorite, and sharing byemail, text, or (coming soon) Twitter and Facebook.Tasks can be from the recommendation list or created custom. They can be shared (the same 4 channels as above) or exported to calendar(iCal .ics format which is standard).Screening and test results can be entered and maintained with this app. Reminders can encourage follow-up of positive test results. Thesecan be shared (same formats as above) for example with care managers or lay navigators. They can also be exported using the Blue Buttonformat popularized by the VA health system. This exported data can then be shared with a care team or entered into a PHR or EHR.Other relevant information and news is aggregated and available in mobile-optimized format right within the app. The nation-wide HRSAlist of clinics is included in geographic format. And relevant social news is embedded within the app, including the Twitter feed andFacebook posts of Healthfinder.gov.Used a co-design process involving multiple stages of user feedback on the features. Implemented using scalable technology: the app ispowered by jQuery Mobile, Ruby on Rails, MongoDB, Nginx, and Twilio. It is hosted in the cloud using Amazon Web Services (EC2).
How It WorksLogin with Facebook to preload a list of loved ones including name, gender, and age. Or login with a Twitter account, orcreate an Everhealthier specific account with only an email address and choice of password.Choose from the Facebook Friend list or add others by providing merely a nickname, age, and gender. Quickly switchamong people in this “healthy circle” at any time.Choose recommended actions from the official list, or create your own. Take ownership of these actions so you willperform them. Read the Healthfinder article for each task. Set reminders according to your preferences.When reminded about each task by text message, reply Done or Snooze. These reminders can also be sent directly tofamily members if desired.Manage the tasks for each person in your circle. View the past progress and future due dates, export to calendar, and sendlinks to share tasks and articles with others.Enter results from screening and other tests as you accomplish them. The system can remind you to follow up on positivelab results where appropriate. Data can be downloaded with the Blue Button approach at any time.On the Explore tab see the latest Twitter and Facebook posts from over two dozen curated channels of cancer preventioninformation - in English and Spanish. This content is available right within the app, and you can click on subscribe/followbuttons to leverage these popular mobile media and stay informed.Find local clinics: your phone geolocates you, but you can also enter a zip code or address. Click on the map to view thedistance from your current location and the clinic’s website. Click the phone number to call.
All images were captureddirectly from an iPhone.A Co-Designed SystemNumber of pilot users who gavefeedback: 10.Number of future features planned(mostly from user feedback): 14.Co-design material is available uponrequest.
Theoretical GroundingThe development of this app was based on our prior researchwith urban minority women, in which we identified barriers foraccessing preventive health services . Our research is theory-based and uses the Integrated Behavioral Model  to guideidentification of social -cognitive as well as contextualdeterminants of health behaviors.1. Teitelman, A.M., et al., Social cognitive and clinical factorsassociated with HPV vaccine initiation among urban,economically disadvantaged women. J Obstet Gynecol NeonatalNurs, 2011. 40(6): p. 691-701.2. Fishbein, M. and I. Ajzen, Predicting and ChangingBehavior: The Reasoned Action Approach. 2010, New York:Psychology Press: Taylor & Francis Group.