Everhealthier.org Women is a mobile web and text messaging tool designed to help women manage their health tasks and cancer screenings. It provides personalized recommendations and reminders tailored to a woman's age, gender, health factors and family members. Women can track tasks, test results, and share information with care teams. The tool was co-designed with users and is based on behavioral research to address barriers to preventive healthcare access, especially among minority women. It aims to make health promotion simple and straightforward through a mobile interface.

1. Everhealthier.org Women
Manage health tasks for you & others through mobile web and SMS
Rationale
•African-African women are more likely to die from
Development Team some cancers*
Damien Leri, MS Ed1
•Latina women are more likely to get cervical
Anne Teitelman, PhD, FNP-BC, FAANP, FAAN2 cancer*
Marilyn Stringer, PhD, CRNP, RDMS, FAAN2
Ben Koditschek, BFA3 •Asian women are less likely to access regular cancer
1Big
screenings*
Yellow Star, Inc.
2Univ. of Pennsylvania, School of Nursing •Prevention is the best way to solve this problem
3Designer, Civil Service
•USPSTF, ACS, ACOG provide recommendations
but many women do not access and adhere to them.
There is “too much info” and most of us have
literacy and/or health literacy limitations.
•Prevention and health promotion should be
straightforward, almost as simple as your automotive
maintenance schedule.
•Everhealthier.org Women is simple, engaging, and
100% mobile *womenshealth.gov
Health 2.0 Challenge, Feb 5 2013

2. Features & Benefits
Access! Mobile web site works with any smartphone model. Alternative interface uses text messaging, and automated voice calls can be
added. All content in English and Spanish.
More than just reminders: interactive SMS text messaging includes decision-tree branching conversations to collect data. These are
initiated 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 then
be 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 by
email, 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. These
can be shared (same formats as above) for example with care managers or lay navigators. They can also be exported using the Blue Button
format 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 HRSA
list of clinics is included in geographic format. And relevant social news is embedded within the app, including the Twitter feed and
Facebook posts of Healthfinder.gov.
Used a co-design process involving multiple stages of user feedback on the features. Implemented using scalable technology: the app is
powered by jQuery Mobile, Ruby on Rails, MongoDB, Nginx, and Twilio. It is hosted in the cloud using Amazon Web Services (EC2).

3. How It Works
Login with Facebook to preload a list of loved ones including name, gender, and age. Or login with a Twitter account, or
create 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 switch
among 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 will
perform 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 to
family members if desired.
Manage the tasks for each person in your circle. View the past progress and future due dates, export to calendar, and send
links 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 positive
lab 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 prevention
information - in English and Spanish. This content is available right within the app, and you can click on subscribe/follow
buttons 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 the
distance from your current location and the clinic’s website. Click the phone number to call.

4. A Co-Designed System
Number of pilot users who gave
feedback: 10.
Number of future features planned
(mostly from user feedback): 14.
Co-design material is available upon
request.
All images were captured
directly from an iPhone.

5. Theoretical Grounding
The development of this app was based on our prior research
with urban minority women, in which we identified barriers for
accessing preventive health services [1]. Our research is theory-
based and uses the Integrated Behavioral Model [2] to guide
identification of social -cognitive as well as contextual
determinants of health behaviors.
1. Teitelman, A.M., et al., Social cognitive and clinical factors
associated with HPV vaccine initiation among urban,
economically disadvantaged women. J Obstet Gynecol Neonatal
Nurs, 2011. 40(6): p. 691-701.
2. Fishbein, M. and I. Ajzen, Predicting and Changing
Behavior: The Reasoned Action Approach. 2010, New York:
Psychology Press: Taylor & Francis Group.