Mobile health: Make it personal
CHICAGO—When it comes to mobile health, “technologies must meet people where they are at and respond to who they are,” said David Gustafson, PhD, research professor of industrial and systems engineering and director of the Center for Health Enhancement Systems Studies at the University of Wisconsin-Madison, speaking at the 2014 Healthcare Leadership Forum on Sept. 29.
He suggested four pillars of a successful smartphone app intervention: monitor and respond just in time; set aside theory-get dirty; be obsessed with understanding customers; and don’t play God.
A smartphone application designed by researchers at the University of Wisconsin called ACHESS—which was used to support recovery from alcoholism—encapsulated these concepts. Its features included motivation reminders, private messaging and chat groups—and the app continuously requested users to answer questions about their state of mind and progress.
Clinicians used ACHESS to check on their patients, and if certain thresholds were met, patients would receive an email that an intervention was needed. Also, if patients were in the proximity of high-risk locations (i.e. bars), the system could determine that a video call with a counselor was warranted.
“The system was designed as you’re moving from inpatient care to continual care in the field,” he said. Before being discharged from a healthcare setting, the patient would be trained to use it.
In a randomized trial with 350 alcoholics, those utilizing ACHESS had 57 percent fewer heavy drinking days during the eight-month pilot. This success occurred even for participants who also used opioids.
The success continued even after the smartphone was taken from the patients, he said. “Over time, even after we removed technology, the difference between the control group and the intervention group went up. It’s encouraging as it shows the system has an effect.”
As effective as ACHESS was, Gustafson stressed that it was “just one part of the package.” The app intervention was bundled with medication-assisted treatment and behavioral interventions, which contributed to its success, he said.
ACHESS not only is effective for patients, but families of those struggling with addiction. In a small pilot study, he said when given to adults of alcohols, ACHESS was correlated with an increase in attendance at support meetings for friends and family of alcoholics.
Looking at the importance of mobile health, social support and family member involvement are crucial to its success. Also, Gustafson said that the use of sensors to monitor patients is promising, given that privacy concerns are addressed.
“The potential, if used properly, is so incredibly exciting,” he said.