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mHealth App Studies Focus on Engagement Over Accuracy

Researchers and providers are finding that mHealth apps need to be easy to use first, to support sustainability. Making the data reliable comes later.

By Eric Wicklund

- With a survey pointing out that many popular mHealth apps are too complicated to sustain users’ interest, studies that struggle with patient engagement are putting more emphasis on user design and less on the accuracy of data.

In simple terms, it’s more important right now to convince people to use mHealth apps consistently.

An ongoing Boston University School of Medicine project, for instance, relies on a smartphone app that combines the popular DASH (Dietary Approaches to Stopping Hypertension) diet with a simple user interface for people dealing with high blood pressure. And instead of compelling users to go it alone, the app schedules twice-monthly phone conversations with a registered dietician.

“We’re using the app for all the things a computer is good for, and using a human for all the things a human is good for, which is listening and responding and building rapport,” Lisa Quintiliani, a registered dietician and assistant professor of internal medicine at the BU School of Medicine (MED), said in a story issued by the university.

The 24-participant study, which researchers hope to conclude soon, is actually a few years in the making. It’s the brainchild of Devin Mann, a former MED associate professor of medicine and former associate chief medical information officer for innovation and population health at Boston Medical Center, who says he saw the opportunity for an app after attending an mHealth conference in 2012.

The project draws on the DASH diet, developed in 1992 by a team from MED, supported by the National Institutes for Health and introduced to the university in 2010, and places heavy emphasis on user design.

“Blood pressure is obviously a highly prevalent condition, and we thought (the DASH diet) lent itself well to enhanced implementation with mobile health tools,” said Mann, who recently accepted a position at Yale. “It’s truly evidence-based; it’s very clear cut what you need to do for it.” 

Mann and his team designed the app to enable users to record what they ate at each meal by tapping on one of eight tiles, each pertaining to a food group, rather than looking up specific foods or dietary information online.

The interface “was a big piece of it, because diet tracking is one of the hardest things,” Mann said in the BU story. Other apps “ask you to look up this food and the calories and all that stuff. We made a very conscious decision to say, listen, we will sacrifice accuracy for usability.”

That strategy is becoming quite popular in mHealth circles, as healthcare providers and researchers look for ways to make apps and mobile platforms more engaging, and thus more sustainable. In studies that use consumer-facing wearables and activity trackers, for instance, researchers have said they don’t rely on accurate physiological data from the devices, but focus more on data trends supported by continued engagement.

Likewise, Mann said it was important to use the app to link users to a live support network, rather than having them rely on impersonal prompts or messages.

“We still feel human coaching is important, but setting up appointments is not easy to do,” he said. Added Quintiliani: “(It’s important) having a counselor contact the participant to see where they are in terms of their readiness to change.”

As mHealth and digital health platforms struggle for sustainability, the focus now has to be on design – creating a platform that a user will feel comfortable using, and one that the user will continue to use over longer and longer periods of time. Once that pattern is established, researchers can then think about refining the technology to make data accuracy a priority.

That’s what Mann is thinking as well. He said he’s not interested at present in marketing the app to consumers, but wants to explore how it can fit into a clinical environment. That means working with clinicians to determine how they’d fit this into their workflows.

“What we want to be able to say is that we’re confident in the approach, and then find the best way to scale that,” he said. After all, “It’s not really about blood pressure; it’s about the approach.”

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