Sep 2, 2013

Health Apps - Man, Machine and Medicine

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All over the world, a myriad health apps are being conceived, created and marketed to an 'app happy' culture of consumers, as well as to health professionals. In the USA, an interesting map has arisen, writes Gabriella Rosen Kellerman in The Atlantic: On the West Coast, the consumer-orientated developers are hard at work testing the apps and securing venture capital to get them onto phones and tablets, whereas on the East Coast, doctor-focused apps are being developed in partnership with government bodies, the pharmaceuticals industry, and insurance companies. Industrious app activity aside though, how will we really benefit in terms of health outcomes?

With today's obesity epidemic, and Britain the most obese nation in Europe, dieting and exercise apps should receive first attention, and it's no surprise that a recent report quoted in Female First suggests one in three Britons turn to their smartphone when dieting, with 81% of those surveyed saying they experience more successful weight loss by using apps than before they used them. Several reasons are given as to why, including the ability to check calorie content and receive help to stay motivated.

However, critics such as Sherry Pagoto, Ph.D. writing for Psychology Today argue that weightloss apps contain a major flaw in that they include only a very narrow range of behavioural strategies. She explains: "The vast majority of apps are tools for weight, diet, and activity tracking, and although apps do a great job here, these strategies represent a very small segment of a much larger body of effective behavioural strategies that are used to help people lose weight." Pagoto explains that a common problem she hears from patients is, 'I don't have time to exercise', making the valid point that a weight loss app does absolutely nothing to help someone work through such issues - issues that prevent people from reaching their weight loss goals. Indeed, Pagoto cites two studies that show dietary tracking using a smartphone is no more effective at helping people eat less than using paper-and-pencil diaries (Acharya et al 2011; Burke et al 2012). So, the question is, what differentiates a health app that only targets 'the lowest hanging fruit' from which has far wider, long-term benefits? What makes a good app? After all, with word of mouth recommendation and good communications, quality will out. Part of the answer would seem to lie with provision of advice that is precisely tailored to the user (based on the data they entered). Here lies the rub...

PUT THE DATA AWAY AND LET'S GET PERSONAL

Interestingly, mobile apps that connect users via social networks tend to be more effective than those which don't, assuming users utilize the social function. This was certainly the case regarding a weight loss programme ROAD launched just ahead of the proliferation of smart phones and apps: The programme's online chat forum was absolutely instrumental in motivating other users to keep up the effort, because it tapped into the human hardwired responses to share and care. Pagoto urges, "I would love to see apps do much more to link users. For example, users who have common interests and/or characteristics could be suggested to one another (just like Twitter does). Users tightly connected socially will not only use the app longer, but will probably lose more weight and keep it off longer." This brings to mind the endurable appeal of Weight Watchers, with its group settings and socialising function - much lambasted as the company was by the recent BBC series, The Men Who Made Us Fat.

Another solution was proffered in the fascinating Horizon documentary, Monitor Me, presented by Dr Kevin Fong: Fong waxed lyrical about the potential for mobile health apps to "switch the focus away from 'illness' and towards 'wellness' by mobilising self-harnessed health data". He also points out, "We have made real progress in being able to measure physical activity using GPS and accelerometers (movement sensors), but we remain 100% reliant on the user for diet tracking." The solution, he suggests, could lie with sensors to detect the mere act of eating, thus significantly advancing mobile technology for weight loss by providing opportunities to insert mini-interventions at the start of an eating episode. In other words, a 'catch them before they fall' facility.

WHERE MAN AND MACHINE MEET

Health app builders could seemingly take a lesson from telehealth pioneers who have used text messaging to target patients to improve adherence to medication or treatment. Dr Ruth Chambers, OBE, Clinical director for practice development and performance at Stoke-on-Trent CCG, describes in The Guardian Healthcare Network how 'Flo' - the NHS's simple telehealth app - is being used to target asthma, hypertension, smoking and weight within general practice, acute hospital, community and mental health settings. Interestingly, when patients were asked what they liked about Flo, they replied: Having a "friend"; feeling more supported in improving their health; feeling that the NHS cares about them.

The long term success of health apps would seem to lie in getting the right balance between 'man and machine,' 'listening' to what people's ultimate goals are, and addressing issues that concern education and motivation. Only then will behaviour change follow. Whilst robots can be built to 'look cute' it's a lot harder to teach them what it takes to 'be human'.