Mobile Health 2011 – Mapping the Uncharted

Susannah Fox provided a powerful analogy for mobile health at the start of the Mobile Health 2011 conference last week at Stanford. She spoke of individuals moving between the kingdom of the healthy and the kingdom of the ill and when we find ourselves (or our loved ones) in that unfortunate second kingdom, we grasp on anything that helps us navigate through that alien land. Though our doctors are still the brightest beacon we look to for guidance, people increasingly turn to include the web, online social networks and the mobile devices that effectively tie these realms together to help guide them.

There is undoubtedly much uncharted territory for public health professionals, entrepreneurs and researchers when it comes to mobile technology and how it can help meet peoples needs for information and how it can effectively and demonstrably support efforts to change behavior. I doubt that there is anyone who attended the conference that is certain that the map charting this course is complete. However, there is legitimate cause for optimism as the outlines of the unknown become increasingly clear.

Capturing everything that was discussed at the meeting is well beyond my stamina and note taking ability but some of my main takeways from the meeting can be found below (and here is the conference program and the presentations..

  1. Mental health was conspicuously absent from the discussion Kendra Markle noted what I had been thinking in her recap of Day 1 – there was an absence of discussion around Mental Health issues during the meeting. Interestingly, Robert Furberg observedin his review of the research literature that there was evidence for a substantial number of behavioral health-related SMS projects at the less sophisticated end of the spectrum (but not much, if any, evidence for more sophisticated projects).
  2. Feedback loops present a real challenge that mobile can help solve Aza Raskin spoke very persuasively about rethinking how we frame the challenges we see before us and how the separation in time (between actions and consequences) for health-related behaviors can be a serious obstacle when trying to change behavior. Mobile may help provide the key to solving the feedback riddle.
  3. Behavior change may be primary goal for many mHealth initiatives but we need to ensure that we are consistently learning and improving our processes along the way R. Craig Lefebvre and Ida Sim highlighted how the tools that are available have tremendous capacity to help improve how we conduct our work (Open mHealth being a important, relevant piece to this)
  4. SMS and apps get lots of attention (and the bulk of the existing research) but mobile optimization is (and will continue to be) the best bang for the buck – Jeremy Vanderlain, as part of his work with AIDS.gov, highlighted the importance of making web content mobile friendly and the audience (in an informal poll) seemed to feel that the future looked brightest for mobile web (vs apps and SMS)
  5. Data is the engine that will drive innovation and improvement in mobile but (end) user experience needs to mask that layer to make it more engaging and appealing Arna Ionescu noted that most people’s lives do not revolve around managing data and that although some individuals might be content to do it for while, most people will lose interest over time if the interaction is not compelling.
  6. Designing projects with input from patients/ end users is not an option – it should be a requirement – Google’s Roni Zeiger (I think) reiterated several times that patients were a far too often underutilized resource.
  7. Do not underestimate or ignore emotions – It is critical that when messaging around behavior change is developed that consideration is not just given to the intellect (rider) but also to our emotions (elephant).
  8. Personalized and tailored messaging are powerful – Fred Muench provided some good information about the importance of tailoring messages and Katie Malbon talked about her personal involvement in teen texting outreach at Mt Sinai (NYC) and how her personal touch helps make her pilot successful.
  9. Simple, social and fun is a good recipe for success. BJ Fogg, the event host, made this one of the key themes of the conference, though it is clear that the path to simple, social and fun involves lots of work behind the scenes.
  10. Technology is important but compassion is key Jen Dyer made a great point that tools that solve problems and provide compassion are a powerful combination and that good relationships (including doctor-patient relationships) cannot be overlooked.

Other perspectives on the conference:

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Laura Bennett

Nice overview, I very much agree with number 6. Patients/end users are often an under utilized resource in terms of services development and product development.

Andrew Krzmarzick

Thanks for the summary of this event, Andrew.

One thing that is on my mind a lot lately – and it is particularly relevant to health issues where the poor and resource-strapped are often disproportionately affected: how / do these new technology solutions provide access to the hardest-to-reach citizens? Wondering if that was addressed and, if so, what were people saying?

Andrew Wilson

Andrew – thanks for the comment and apologies on the delay in getting back. The short answer is yes, people are thinking about this and talking about it. The reality, with some evidence presented at the meeting, is that for some traditionally underserved populations mobile is the the PRIMARY way that they access the Internet. Although lack of full functioned smart phones might argue against app development, phones can access the still access the Internet (& thus the string argument for mobile web development vs app development). Overall, I think the evidence is very strong that mobile is an effective tool for reaching (at least some of the populations you are referring to). As usual, Pew Internet has some good stats on this.

Andrew Krzmarzick

Thanks, Andrew. My interest in hard-to-reach populations comes from my past life as a grant writer / non-profit program designer responding to RFPs from HHS and SAMHSA, mostly targeting groups like: people with HIV/AIDS, people with substance abuse or mental health issues, folks living below the poverty level, citizens who lack access to reliable transportation, etc.

For many of the health clinics and public health departments and school districts where I provided services / technical assistance, tech was another one of those “lack access to” areas…so wondering if, similar to One Laptop Per Child, we might want to start providing low-cost (smart?) phones and basic data plans as part of a pilot project – both to push information to hard-to-reach populations and to encourage them to use the phones to share information regarding progress toward health action plans / outcomes…self-reporting that saves the support staff at non-profits time and allows them to develop and adapt interventions based on near real-time data.

Thoughts? Anything like that happening right now? Research to back up efficacy? Since joining GovLoop, I’ve been out of that world for a couple years…but would definitely be pushing non-profit clients (and the agencies that fund them!) toward considering those kinds of solutions.