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mHealth Programs For Adolescents Need to Focus on Patient Engagement

An mHealth or telehealth program designed for adults won't necessarily work for adolescents, who have different habits and attitudes toward mobile devices and social media.

Source: ThinkStock

By Eric Wicklund

- mHealth and telehealth treatments aren’t being designed for the adolescent patient living with a chronic condition, a group of pediatric health experts say.  As a result, America’s healthcare system is missing out on a golden opportunity to improve health outcomes for children and teens.

That’s the gist of an opinion piece posted this month in JMIR mHealth and uHealth by experts from the Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University’s Feinberg School of Medicine and Zagazig University Medical School in Egypt. They argue that adolescents use and react to mobile devices much differently than other age groups, yet healthcare hasn’t done enough to take advantage of that in chronic care coordination.

While that observation might seem obvious to any parent whose child possesses a smartphone, it has taken longer to catch on in healthcare, where a majority of mHealth and telehealth treatments pay little attention to the patient’s age.

Yet lead author Sherif M. Badawy, MD, MS, of Lurie Children’s Hospital’s Division of Hematology, Oncology and Stem Cell Transplant, says healthcare providers should pay more attention to how adolescents interact with their smartphones and platforms like social media.

“The use of personal and widely available technology-based approaches (in particular text-messaging, mobile apps, and mobile social media) to improve adherence behavior and other health outcomes in adolescents has shown overall acceptability and feasibility, with modest evidence for efficacy,” she wrote. “Nevertheless, the long-term health benefits, cost-effectiveness, and sustainability of patient engagement through technology-based approaches remain unclear. Additionally, text messaging delivery methods often lack innovative features targeted to adolescents.”

READ MORE: Chronic Care mHealth Apps Benefit from Patient Feedback

“Furthermore, methods to quantify patient fatigue, which is assumed to occur among adults with frequent text messaging, and the sustainability of patient engagement may apply differently to adolescents, representing a challenge for researchers,” they added. “Therefore, while the evidence to date is encouraging and promising, further study of technology-based interventions for adolescent self-management and medication adherence, with rigorous study designs and across a wide range of CHCs, are needed.”

That difference in target audience also affects patient engagement.

Badaway and his colleagues further argue that pediatric mHealth and telehealth programs that rely on observations from parents or other caregivers may be missing out on important observations that an adolescent could offer. That, in turn, could hinder the program’s effectiveness.

Some programs are using mHealth and telehealth to connect with younger patient populations. In one such example, researchers at Cincinnati Children’s Hospital Medical center and Ohio State University’s Wexner Medical Center are using an mHealth app with social gaming techniques to better engage with teens recovering from a concussion.

"We found that mobile apps incorporating social game mechanics and a heroic narrative can complement medical care to improve health among teenagers with unresolved concussion symptoms,” Lise Worthen-Chaudhari, a physical rehabilitation specialist who studies movement at Ohio State's Wexner Medical Center's Neurological Institute and lead author of the study, said.

READ MORE: mHealth Games Offer a ‘Fun’ Way to Boost Patient Engagement

"Teens who've had a concussion are told not to use media or screens, and we wanted to test if it was possible for them to use screens just a little bit each day, and get the bang for the buck with that," she added. "The app rewrites things you might be frustrated about as a personal, heroic narrative. So you might start out feeling 'I'm frustrated. I can't get rid of this headache,' and then the app helps reframe that frustration to 'I battled the headache bad guy today. And I feel good about that hard work.'"

Hospitals are also using connected mHealth devices and messaging platforms to collaborate with young patients on sensitive health issues, such as obesity and weight management.  

In their article, Badaway and his colleagues suggest that providers plan out their adolescent-based mHealth and telehealth programs with the patient in mind, and seek their opinions on how such a program should be developed.

“Adolescents are frequent users of technology and engaging adolescents with chronic illnesses in their self-management could be invaluable for improving long-term outcomes,” they concluded. “The use of technology-based interventions to improve medication adherence has shown promising results, and seeking adolescents’ perspectives could enhance uptake and long-term engagement, and minimize patient fatigue. Following guidelines for reporting results of technology-based interventions, and validating adolescent-specific adherence assessment instruments, would enhance further comparative research across studies.”

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