Creating the Evidence Base for

mHealth

Txt4Health: Using Mobile Technology in Public Health Communication and

Education Campaigns

American Public Health Association San Francisco, 30 October 2012

Presenter Disclosures

The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

R. Craig Lefebvre, aka chiefmaven

“No relationships to disclose”

Mobile ThoughtsWhen the expectations of wireless experts are realized everyone will have his own pocket telephone and may be called wherever he happens to be…When that invention is perfected, we shall have a new series of daily miracles (circa 1908).

It Took About 100 Years, But Then It Went Mainstream - Fast.

The 7th Mass Media Channel

1 - first personal mass media

2 - permanently carried media

3 - always-on mass media

4 - built-in response mechanisms

5 - at the point of creative inspiration

6 - accurate audience

measurement

7 - captures the social context of people’s lives

Tomi T Ahomen. CommunitiesDominate Brands blog, 2 May 2008.

mHealth Evidence Challenges

• Create and evaluate scalable systems capable of collecting unprecedented amounts of data

• Analyze and integrate that data with other health information

• Field interventions—some in real time—while at the same time providing value and protecting the safety of participants.

mHealth Opportunities

• Contributes novel measurement methods and processes

• Enable the design and delivery of novel interventions that can be delivered remotely and in real time

• Offers new methods of data collection and analysis that can improve the speed and efficiency of health research and evidence of an intervention or treatment effect.

mHealth Research Challenges

• Difficult to create controlled and reproducible environments

• mHealth devices are frequently used by individuals with little training that may affect their reliability and validity

• Few gold standard measurements exist in the mobile environment, self-report measures may be the most accepted existing assessment

• Risks to privacy and security

Evidence Requirements

• Statistical Conclusion Validity - evidence of a meaningful, causal effect

• Internal Validity - rule out confounders

• Construct Validity - validity of outcome measures

• External Validity - generalizability across persons, settings, and times

• Ecological Validity – can be implemented in real-world settings and integrated into life and work flow

When are Randomized Clinical Trials Indicated?

• Interventions have been shown to be feasible and acceptable

• Whose efficacy has been demonstrated in quasi-experimental designs

• There is the desire to demonstrate superiority to exiting approaches to the same problem

Quasi-Experimental Designs for mHealth

• Pretest-posttest (with and without comparison conditions)

• N of 1 (with multiple crossover – ABABAB)

• Interrupted Times Series Design – (AAAAB, with and without comparison groups)

• Stepped Wedge (or delayed treatment)

Other Research Considerations

• Continuous Evaluation of Evolving Interventions (CCEI) – new versions are added to original protocol

• Adaptive Interventions - personal tailoring

Quality Considerations for mHealth Interventions

• Selection of appropriate technology

• Privacy assurances

• Linguistic and literacy competency• 2-way

communication• Targeting & tailoring

content

• Timing of communication

• Understanding of priority group

• Long-term evaluationGurman et al (2012).

Effectiveness of mHealth behavior change communication interventions in developing countries: A systematic review of the literature. Journal of Health Communication; 17 (suppl 1): 82-104.

Marketing and mHealth

How do I add mHealth features to my behavior change products, services and programs??

Marketing and mHealth• How do I use these

technologies to overcome psychological and social barriers (costs)

• develop new incentives and reinforcers

• create new ways of providing social support to people who are trying to change behaviors?

social support to people who are trying to change behaviors?

Marketing and mHealth

How can I place-shift; use SNS, co-presence and virtual worlds; and add GPS to create scalable behavior change programs??

Marketing and mHealth

How do I facilitate conversations among people, not aim messages at them?

Are we available when, where and how people want us to be?

R. Craig Lefebvre, PhD

Lead Change Designer, RTI InternationalUniversity of South Florida College of Public Health

socialShift, Sarasota, FLsocial|design, marketing and media

On Social Marketing and Social Changehttp://socialmarketing.blogs.com

http://twitter.com/chiefmaven