Moving mHealth beyond hype to real scientific value

While excitement abounds about the prospects of mHealth to improve health and reduce the cost of care, a recent report offers this reminder: Don’t forget the science.

New mHealth devices, apps and systems show promise in the areas of diabetes, asthma, obesity, smoking cessation, stress management and depression treatment, but research is needed to show when, where and for whom these technology and systems are effective, according to the report—“Mobile Health Technology Evaluation”—which will appear in the August issue of the Journal of Preventative Medicine.

The report’s findings culminate from an August 2011 workgroup, consisting of 50 researchers, policymakers, government and regulatory officials from around the world that studied this issue. The meeting was sponsored by the Robert Wood Johnson Foundation, the McKesson Foundation, the National Science Foundation, the Office of Behavioral and Social Sciences Research and the National Heart, Lung and Blood Institute.

“The reason we brought people together is that we saw the interest in mobile health just skyrocket, but we also saw that the science was not developing at the same speed,” Wendy Nilsen, PhD, report author and health scientist administrator at the National Institutes of Health (NIH), told Clinical Innovation + Technology. “People said this works and this is going to change everything, but yet the science base was not following. Being the country’s research agency, we were very concerned about that.”

While the gold standard is randomized control trials (RCTs), the report explores other research methodologies to determine the efficacy of emerging mHealth technologies. “When we are doing this science, what we want to find out is who does it work for, when does it work and for what situation. That’s really important,” she said.

The report notes that RCTs typically take 5.5 years, which in this rapidly evolving industry poses challenges to keep pace with innovation. Nilsen said the new mHealth technologies actually can speed up the process of a RCT as devices can collect more data with its ability to continuously stream it through instead of gathering it at specific single follow-up points. Such methodologies could reduce the burden on participants as well.  

Many new methodologies, including rolling experimental designs, are being pioneered by some of the best methodologists in the field, added Robert M. Kaplan, MD, director of NIH’s Office of Behavioral and Social Sciences Research.

Kaplan said mHealth technology developers need to take into account the latest scientific thinking.

“Many more of the applications need to be built on what we already know about behavior change. It’s not uncommon for people to develop an application without attention to the evidence-based literature on how we change peoples’ behavior over the course of time,” he said.

The researchers said that the scientific community and developers are embracing NIH’s efforts to inject science and evidence into mHealth.

“As the nation’s biomedical and behavioral research institute, we like the idea of accumulating evidence about the effects of these devices and applications on health outcomes because they have such a prominent role in healthcare delivery now. We want to see more and more evidence for that. It’s starting to accumulate, but we are at the beginning phases of it now,” Kaplan said.