- mHealth apps are used by both providers and patients to improve communication, promote health, and foster better self-management behaviors.
Apps accessible from smartphones, tablets, and other devices have the potential to expand access to care and offer enhanced monitoring tools to patients. However, even though apps are intended to promote health behavior changes and improve the health of patients, most mHealth applications do not deliver as they should.
In order to effectively influence health behaviors such as self-management, awareness, and goal setting, mHealth apps need to include four major features. Applications that receive high marks on ease-of-use, positive reinforcement, social support and interactivity, and provider support with assisted intervention are more likely to produce positive behavioral changes and clinical improvements.
A high degree of usability
A Brigham Young University (BYU) study published in the Journal of Medical Internet Research studied the relationship between behavioral theories and weight loss mHealth apps to see what features objectively promote positive health behaviors. The team studied the responses from 217 potential users of a diet/nutritional mHealth app to gauge favorability.
The research team found that 62.9 percent of diet and nutrition apps were easy to use which is important to curbing a regular barrier to health behavior adherence, complex and burdensome user experience
“Health apps have the potential to decrease some barriers to traditional prescriptions for behavior change, including expense, patient burden, and variable adherence,” the team said. “Specifically, how engaging, convenient, and easy to use the app is can be a mechanism for reducing barriers and increasing adherence.”
Easy-to-use apps can also increase engagement with the health system as a whole. At NewYork-Presbyterian (NYP), patients can access a consumer-facing app that lets users find a physician, navigate to their care facilities with turn-by-turn navigation, pay their bills, and access a live NYP news feed through simple frameworks without clunky interfaces.
“We want to make it as simple as possible for patients to navigate,” said Peter Fleischut, NYP’s Chief Innovation Officer. “It surprises me how basic information is very, very important to our patients – and to our providers,” he said . “And that type of approach is amazingly effective.”
Positive reinforcement for healthy behaviors
In the BYU study, a majority of the majority of participants strongly agreed that using diet/nutrition apps motivated them to develop behaviors that benefited their health.
Approximately 60 percent strongly agreed that the use of diet/nutrition apps increased their motivation to eat a healthy diet, and an additional 36.8 percent generally agreed with the same statement. In total, 66.4 percent of respondents said they felt they received positive feedback for eating a healthy diet.
“Participants in this study reported increased motivation, desire, and ability to improve their dietary intake with app use,” the study authors said. “Likewise, participants indicated an increase in their ability to establish and achieve dietary goals.”
Apps that promote good positive reinforcement can curb some of the most detrimental health habits and behaviors.
Through the use of patient-centered “missions” that encouraged smoking cessation, an mHealth app called Clickotine helped to increase smoking abstinence for adults. Other personalization, messaging, and motivational tools helped to get smokers to lower the amount they smoked as well as quit smoking altogether.
Interfaces in the app also allowed the users to quit at their own pace, so that goals could be continually set and completed without outside pressure from other stakeholders.
“The results of this initial evaluation suggest that Clickotine participants engaged with the app and appeared to remain engaged with the app for a majority of the study duration on average, and that Clickotine use may be associated with cessation outcomes,” said a research group from Mount Sinai who studied the potential of Clickotine.
Social media and user interactivity
Connecting patients to friends and families through social media features can be a powerful method for enhancing user health behaviors.
In the BYU study, 58 percent of participants felt the apps increased social support for improving their dietary habits. Fifty-six percent of users found that the app increased their belief that other people wanted them to eat a healthy diet, and 57 percent said they believed that other people were eating healthy diets as well.
“Self-efficacy is a key component of SCT and is widely considered to be a powerful predictor of health behavior and appears to be a key mechanism by which health apps facilitate behavior change,” the BYU team said.
Building features in an app that allow patients to connect with family, friends, and caregivers/providers has proven extremely useful and can “gamify” adherence to health behaviors.
In the Clickotine smoking cessation app, users could record their stats, progress, and other details of their goals to compare with family members and other supporters. This is called “gamification,” or the process of using a score-driven, or other gaming framework, to promote positive health behaviors.
Social tools such sharing and connectivity can loop close family and friends into the process of positive health behavior change. Experts on mHealth gamification say that having app features for the purpose of “scoring” and stat-tracking can trigger parts of the brain that link emotional investment and gratification to improving healthy lifestyles.
Provider interventions to encourage clinical improvement
Arguably the most important feature of an mHealth app is its ability to objectively improve a specific clinical metric, behavior, or condition. If mHealth apps fail to drive actionable health improvements, then they’re not meeting a patient’s need.
Of the total participants in the BYU study, 58.5 percent found that diet and nutrition apps helped reach their goal of eating a healthy diet. Fifty-seven percent said they increased their frequency of eating healthy foods, and 54.4 percent said they experienced higher consistency of eating healthy foods.
The BYU participants also found that the apps increased their health literacy on how poor diet leads to adverse health conditions. A total of 69.4 percent said that they increased their belief poor diet leads to disease and 72.1 percent said that the apps increased their belief that eating healthy can prevent disease.
“Diet- and nutrition-related mobile apps show promise as tools to successfully facilitate positive health behavior change,” the BYU researchers said. “The results of this study confirm that the use of diet/nutrition apps is associated with diet-related behavior change. Furthermore, apps that focus on improving motivation, desire, self-efficacy, attitudes, knowledge, and goal setting may be particularly useful.”
Adding provider-based interventions, coaching, check-ins, and other support can further increase positive behaviors and improve overall health.
In a trial of the Connect 4 Health app hosted by MassGeneral Hospital and Harvard Vanguard, for example, researchers found that increased coaching and provider intervention also improved weight, BMI, and obesity-related risk factors better than users of the Connect 4 app without coaching.
A team from UCSF also found that provider coaching could help to reduce weight and improve heart health in pediatric patients.
Children who used an app in conjunction with coaching delivered by phone, email, or video conferencing reduced their BMI more than those who only used the application.
“This [study] demonstrates that a mobile app-based coaching intervention can be an acceptable and effective means to achieving desired clinical results for overweight and obese individuals,” the UCSF team said.
“As mobile phones continue to penetrate the consumer market, digital health coaching may serve as a promising model to increase access to evidence-based behavioral coaching for obesity and related cardiovascular conditions.”
Effective mHealth apps need features that are motivational and inspire patients to make better health decisions. These motivational features need to work in unison towards objective health improvement.
“Moving forward, developers of diet/nutrition apps may consider design configurations that emphasize the provision of knowledge to shape attitudes and beliefs, followed by attempts to influence actual skill development in app users,” the BYU study authors concluded. “Elements of gamification or other such paradigms may be useful to maintain user motivation and the desire to be persistent in making weight loss efforts.”