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Facilitating cross-talk in mHealth intervention development
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
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!
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
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
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
19.
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
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.
