- Physicians at Seattle Children’s Hospital are working to turn a web-based coping program for children with serious illnesses into an mHealth app.
Created roughly 10 years ago, the Promoting Resiliency in Stress Management (PRISM) program has helped young patients with health issues like cancer and type 1 diabetes – and their families – develop physical and emotional skills to better deal with the challenges that a chronic disease has thrown into their lives.
Now Dr. Abby Rosenberg, who created PRISM with Dr. Joyce Yi-Frazier, wants to scale up the program and make it more accessible. That means creating a platform for the program on mobile devices like the smartphone and tablet.
“This is the language that young people today speak,” she says. “We essentially need to translate what we have now into something that will live in the digital space.”
Rosenberg’s and Yi-Frazier’s mission summarizes the challenges faced by healthcare providers as they look to turn tried-and-true programs and treatments into connected health tools. Faced with a target patient population that wants access to care on mobile devices at the time and place of their choosing, they’re venturing into territory dominated by techies and gamers, not doctors and nurses.
“This is all new to me,” Rosenberg confesses.
The format may be new, but the treatment is familiar. According to Rosenberg, the PRISM program has helped teens and young adults for the past several years in developing skills to deal with chronic and sometimes terminal illnesses. It builds on the experiences of previous patients, offering guided interventions targeting stress management, goal-setting, cognitive reframing and meaning-making.
“People get through tough times by harnessing those resources,” she says.
In a study led by the two doctors and published in the Journal of Clinical Oncology, the program proved successful in improving these coping skills, boosting resilience, forward thinking and quality of life while reducing clinical depression and, consequently, the need for psychological intervention like therapy or medication.
But while the program works for those who access it, Rosenberg and Yi-Frazier want to make it easier to access. They want patients and their families to take advantage of the program when and where they need it, and in a format with which they’re familiar and comfortable.
Working with two Seattle-based tech design companies, Artefact and General UI, Rosenberg, Yi-Frazier and hospital staff set about translating the program into a mobile health app that personalizes the journey. They created an app that connects to a user profile, looks like an Instagram feed and includes gamification and animation.
They tested the app last summer on 50 randomly chosen hospital patients, and received positive feedback as well as suggestions on how to tweak certain features. This includes creating a more interactive platform, allowing for pushes and messages of support.
“The app won’t be effective by itself,” says Rosenberg, who sees the challenge ahead as “a compromise between the digital and in-person space.”
Rosenberg is quick to point out this isn’t a clinical app, meant to connect patients with providers. It’s a coping tool, recommended or perhaps prescribed by the care team but separate from the treatment program.
“This is a scripted intervention,” she says. “It’s not psychotherapy.”
As Seattle Children’s gets ready to pilot the app, Rosenberg says she’s expecting many more conversations about how the platform will work and how success or effectiveness will be measured. She wants to know how often patients access the app, how much time they spend on it, how much time they spend on each section, and how frequently they return. From there, they’ll work on metrics that define patient engagement, improvements in coping, decision-making and planning, and each user’s outlook on life.
“We don’t yet have a way of measuring in the app how these skills are being developed,” she says.
Rosenberg says she’s been surprised at “how much fun” the mHealth process has been, but also notes “it has been way more complicated than I realized.” That points to the importance of collaboration between clinicians, designers and engineers in the mHealth space.
She also wonders if it’ll take a few years to master the design of this app, or whether they should just put it out there in an app store and learn as they go along.
“I don’t know what to expect, but I’m willing to learn,” she says. “What I want to see is an app that engages these kids and really helps them learn these skills.”