Facilitating cross-talk: How to bridge the

interdisciplinary divides in mHealth intervention

developmentMegan L. Ranney MD MPH

Department of Emergency MedicineAlpert Medical School, Brown University

@meganranney

The value of mHealth…

@meganranney

Percent of Emergency Department patients with cellphones

@meganranneyRanney Annals of EM 2012

According to @PewResearch 2012 Data

@meganranneyhttp://www.pewinternet.org/Reports/2012/Mobile-Health/Key-Findings.aspx

What isn’t working with mHealth?

• < 30% of apps downloaded more than 50 times

• < 10% used more than once

• Few are evidence-based or linked to the healthcare system

@meganranney

http://www.imshealth.com/deployedfiles/imshealth/Global/Content/Corporate/IMS%20Health%20Institute/Reports/Patient_Apps/IIHI_Patient_Apps_Report.pdf

Where is the evidence?

Are they safe and private for my patient?

How do I know they’re good?

Do they exist for my OS?

Do they exist for my disease?

She doesn’t even look at my data!

@meganranney

Why do the researchers insist on testing this a gazillion times?

They’re asking for the impossible!

I need to deploy this quicker.

My investors need ROI!

@meganranney

“If knowledge and feedback was all it took to change unhealthy behaviors,

psychologists would be superfluous in the world” (Leslie Schover)

@meganranneyhttp://thehealthcareblog.com/blog/2013/10/11/healthcares-tech-disconnect-why-arent-we-building-the-products-patients-really-need/

Thank you!

@meganranney

Creating Technology

Interventions that are

Useful and UsedRochelle K. Rosen, PhD

Beth Bock, PhD

Centers for Behavioral & Preventive Medicine

Brown Medical School & The Miriam Hospital

Outline Behavioral theory for mHealth interventions

What’s been missing:• Deficiencies in current applications of behavioral theory to

mHealth design

Filling that gap• Efficient steps based on behavioral & social science • ACTIONABLE data• Role of qualitative inquiry

Example

Why use Behavioral Theory? Provides framework upon which to build an

intervention Provides a testable model for how variables relate

to one another Behavioral Theory for mHealth

Understand when, how and why people change their behavior

Whether they maintain those changes? user experience? & App design

Behavioral Theory guides intervention:

Content Ex: Self-Efficacy Theory

Initiation of program Ex: Stages of Change model

Interaction between the user & the device/app Ex: Systems Contingency Approach

Amount, frequency & type of communication Ex: social-ecological model

What’s been lacking• Most mHealth interventions have been one-step (receive

data –> provide output)– But are increasingly becoming interactive

• Most have no theoretical basis underlying the intervention– So if it works, we don’t know ‘why’

• Current theory may be inadequate as interventions become more interactive and dynamic– Suggests the need for new approaches and strategies

User Analytics doesn’t tell us about :

Meaning

Qualitative Research methods for mHealth

• Focus Group Discussions (FGD)– Series of groups, each with 6-8 people– 5 key topic areas– Information: breadth and trends

• Individual In-depth interviews (IDI)– 10-30 individual interviews– 5-8 key topic areas– Information: depth and personalization

• Ethnography– Watch and understand user interaction with

technology– In natural setting of use

Recent research and resources• Dennison et al. 2013

– Opportunities and Challenges for Smartphone Applications in Supporting Health Behavior Change: Qualitative Study. Journal of Medical Internet Research 15(4)

• Palmier-Claus et al 2013– Integrating mobile-phone based assessment for psychosis into people’s

everyday lives and clinical care: A qualitative study BMC Psychiatry 34(1)

• Hingle, Nichter et al 2013– Texting for health: the use of participatory methods to devleop healthy

lifestyle messages for teens. Journal of Nutrition Education and Behavior 45(1)

• Special issues on mHealth– Translational Behavioral Medicine September 2013– Journal of Substance Abuse Treatment September 2013

• Technology-based interventions for the treatments and recovery management of substance use disorders

Planned approach: focus groups• Show design ideas to target population • Get feedback• Adjust delivery & design• Conduct pilot study

Initial Design• Enroll in TMAP to learn safer drinking strategies• Complete a survey for personalized text messages. • Receive text messages for 6 weeks

Initial approach…

Behavioral strategies• Still thirsty? Switch to water. You’ll thank yourself tomorrow!

Tips & Suggestions• Eat foods with lots of protein and fat, like cheese and nuts, before

drinking.

Factual messages• It takes the body 60-90 minutes to feel the effects of alcohol on a

full stomach. Drink slowly.

Planned text messages

• Linguistic Theory: McWhorter “Text as fingered speech”

• Advisory panel with representative population– Weekly meetings– Texts generated during the meetings (in vivo)– on topics drawn from focus group results AND– They texted us sample texts daily during the week

(ecologically valid)– Produced “library” of over 300 texts

• RCT (2014)

Advisory Panel

• Using behavioral theory to design interventions

• Using technology in an ecologically valid way

• Incorporating qualitative methods early in

development to produce– A product that is desired by the target audience

– That will be used by the target audience

– That they find useful and that will change behavior

• Avoid the *wow factor* running the science

The Challenges for mHealth

Thank You!