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mHealth Apps for Chronic Care Struggle to Solve the Motivation Issue

A new study finds that mHealth apps aren't being used by people with chronic conditions, either because they don't know about the apps or don't think they'll help.

Source: ThinkStock

By Eric Wicklund

- mHealth apps have the potential to help people with chronic conditions manage their health. Yet according to new research, that particular population isn’t taking advantage of those apps.

A team of researchers led by Rebecca Robbins, PhD, and Paul Krebs, PhD, of the NYU School of Medicine’s Department of Public Health, surveyed more than 1,600 mobile phone users on their mHealth use and preferences. The results, published last month in JMIR, indicate mHealth app users are predominantly wealthy and in good health.

Meanwhile, those with chronic conditions or who lack access to healthcare resources – who would benefit most from mHealth – aren’t using the apps.

“Results from this study suggest that individuals with poor self-reported health and low rates of physical activity, arguably those who stand to benefit most from health apps, were least likely to report download and use these health tools<’ they reported.

The challenge, once again, lies in engagement. Healthcare providers and mHealth app developers aren’t finding ways to convince those with chronic conditions or poor health outcomes to make use of mHealth apps.

READ MORE: Chronic Care mHealth Apps Benefit from Patient Feedback

Robbins and her team pointed out that some two-thirds of Americans now own a mobile phone, and most of them are capable of using mHealth apps – of which there are more than 300,000 now on the market, according to recent research.

Surprisingly, the study found no difference in health app use between those with chronic conditions and those in good health.

“Nevertheless, we found individuals with very good and excellent self-reported health to be more likely to report health app download than individuals with poor self-reported health,” the researchers reported. “We also found individuals with any report of regular physical activity (from 1 day per week to 5-7 days per week) to be more likely to report health app download than individuals without physical activity habits.”

According to the study, roughly one-third of those with a chronic health condition agreed that mHealth apps “have the ability to dramatically improve health.” Taken another way, this means that two-thirds of those who could benefit from using mHealth apps either don’t know they exist or aren’t convinced that they can be helpful.

“Interest in and use of these apps will likely remain low and that motivating download of these resources among high-risk populations remains a critical challenge for the field,” the study reported.

READ MORE: How Improvements to mHealth Apps Increase Patient Engagement

That task might be complicated by a prevalence of mHealth apps that don’t address the right motivations.

“(R)esearch has developed apps for assisting with specific disease management functions, such as improving medication adherence, and also for promoting healthy lifestyle choices among these populations,” the study reported. “According to our findings, although slight variations between conditions were identified, the most common reasons for health app download among individuals with chronic illness had to do with healthy lifestyle behaviors, such as tracking exercise, improving nutrition, and assisting with weight loss.”

“The nuance in responses between conditions could in part be explained by different treatments for each condition,” Robbins and her colleagues added. “For instance, just over one-third of individuals with obesity reported most use of health apps for exercise tracking, as this is consistent with treatment for their condition, yet depression management would not necessarily require regular tracking; thus, less than one-third reported use of health apps for this function. However, hypertension and cholesterol are conditions that are largely dependent on exercise and nutrition but fewer reported use of health apps for these functions, suggesting differences in characteristics of the apps they are using or less adherence in modifying these behaviors. It is interesting to note that these were also the most common uses of health apps among populations without chronic illness.”

The NYU study follows by one year a similar study on mHealth apps by researchers from, among others, the University of Michigan Medical School and partners Healthcare. That study, published in Health Affairs, analyzed 137 patient-facing apps on nine variables and found that the apps weren’t effective in reaching their targeted populations.

“(T)here is a large-scale proliferation of apps happening related to health, and people have made the switch over to smartphones,” that study reported. “But the question is, to what extent are apps serving the needs of patients with chronic diseases, and their caregivers, as opposed to generally healthy people seeking help with wellness.”

READ MORE: A Failed mHealth Program Offers Lessons Learned For Future Projects

Researchers call the issue the “inverse care law,” in which health interventions targeting populations help some people, but neglect more vulnerable groups that require different tools, thus increasing health disparities. For example, an mHealth app might help some people by providing basic information, but if it can’t compel or support behavior change, it won’t help the patients who need that intervention.

“Since many apps focus on a narrow set of functionalities, recommending the same apps to patients with different levels of engagement might not always be appropriate,” the study’s researchers wrote.

The NYU study, meanwhile, concludes that the primary users of health and wellness apps are those who are already living healthy lifestyles, and they’re using apps to augment or track their habits. The challenge here lies in finding the right way to motivate people with chronic conditions to use mHealth apps.

“There may be an opportunity to better market health apps toward chronically ill populations, or design tailored apps specifically for these groups,” Robbins and her colleagues concluded.

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