mHealth use in the UK – an update:
In the Guardian, recently, the NHS has decided to provide patients with free mobile apps and devices to aid in the management of their chronic diseases and promoting their overall initiative to increase self-care interventions as part of their drive towards personalised, precise, predictive and preventative medicine.
For instance, according to Simon Stevens the chief executive of NHS England, there will be a new device which would be attached to the back of smartphones, which would help monitor heart rhythms and detect any form of abnormality in it.
These will be given to millions of the UK’s patients in a year’s time, offering incentives and an increased ease of production to designers of the apps, as well as to promote the uptake with healthcare organisations by providing incentives there too. With the possibility of reducing healthcare costs – say for atrial fibrillation alone – down from £2.2bn, such an initiative may create a lot of benefits to patients and NHS coiffeurs alike.
However, according to the Journal of the America Medical Informatics Association in a report published in January 2016 regarding mHealth, device adherence figures seemed to show that only 16% of those with chronic illnesses continued to use them on a weekly basis as opposed to 76% of healthy participants. This may be attributed to the lack of user contribution to the design of such apps and perhaps also due to device fatigue.
Added to this, there are statistics that declare that 20% of people who download an app only look at it once and after 1 week, the numbers plummet further. It’s a sobering thought. It seems pertinent, that extra incentives and reasons for repeated use of these devices/apps need to be incorporated to keep them engaged.
The WHO reviewed mobile device adherence in 2011 and found that “increasing adherence may have a greater effect on health than improvements in specific medical therapy”, indicating that this is one of the most important aspects that the NHS England initiative will have to take into consideration if they are to ensure that the users of these millions of free apps and devices will actually make use of them.
Companies and mobile app designers need to ensure they work to increase usage and pay attention to ways to increase user motivation. Perhaps designing a whole system as part of a larger supporting community would help. For instance, Weight-watchers works because of the many levels of user support including social media/support groups and regular “weigh ins” and sharing of goals. A balance of face-to-face and digital tools.
Wellness programs combined with ongoing app reinforced support may be a beneficial way forward as it would help to build on both this face-to-face, social support and self-care all together, which would be required to produce and sustain behaviour change. These are the underlying issues involved when discussing the theory behind sustained self-care measures.
As there needs to be regulatory due diligence to ensure that these apps are safe to issue for self-management purposes, NHS England will verify their safety by allowing a panel of 10-15 experts to heuristically test and check them before issuing them to patients next year. In addition to this Stevens is determined to encourage healthcare staff to take on board and promote these mobile tools with their patients. To this aim, he used the device: AliveCor – a heart monitor that produced ECG readings within 30 seconds, so potentially benefiting the 100,000 people who suffer from sudden cardiac death in the UK, as an example to present the power of how timely diagnostics could save lives.
NHS England have piloted a COPD app in Portsmouth called MyCOPD to help patients with chronic obstructive airways diseases such as emphysema and chronic bronchitis to help manage and support their conditions and this has had some good results.
As long as the designer involves the healthcare staff, patients and other important stakeholders in designing the devices and apps, and use a wide variety of approaches to engage and motivate them once in use, there is then an increased possibility of adherence and no reason why Stevens’ bold move towards the use of mHealth in the NHS could “transform people’s lives”.