Three years of stagnant health app adoption

By: Brian Dolan | Nov 8, 2012        

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Brian Dolan, Editor, MobiHealthNewsAs has been tradition for some time now, every year around this time the digital health community gets a wake up call. The Pew Internet & American Life Project published its latest report on mobile health this morning and while it is filled to the brim with helpful, encouraging statistics related to mobile health adoptions, buried deep within is an outright discouraging one. Health app adoption has remained flat.

Since 2010 about 10 percent of American adults with mobile phones have had some kind of app on their phone that helps them track or manage their health, according to Pew’s survey. While the figure presented in Pew’s reports has ticked up or down one percentage point this year and last year, it’s within the survey’s margin of error.

Pew’s Associate Director Susannah Fox told MobiHealthNews that this year’s survey has a bit more of a focus on smartphone users, which have about twice the adoption rate for health apps when compared to the general population. About 19 percent of smartphone users have some kind of health app that helps them track or manage their health.

Of course, not all of the consumer health-related apps available today explicitly help people to “track” or “manage” their health, some simply provide helpful tips or reference materials. Pew’s question seems to hit on more interactive apps. Fox said that’s for a reason.

“When we wrote that survey question back in 2010 it was about wanting to find out about people’s engagement,” Fox said. “The Pew Internet Research Project studies the social impact of the internet and back in the year 2000 it was very much about people’s changing relationship with information. As the Internet evolved our project evolved to study not only how people access information but how they engage with information as well as with each other and instutions. That was the context of writing that question. This comes to the point again where we can examine what a survey question is good for and what it is not good for. We write a survey question in the hopes that just the general population can understand what we are talking about.”

The question also specifically asks about a “health app” and does not explicitly include fitness as part of the question. Even Apple makes a distinction between the two as demonstrated by the name of its AppStore category Health & Fitness. Still, of the survey respondents who said they used a health app to track or manage their health, the largest cohort said they used a fitness tracking app. Did other fitness app users say “no” because they didn’t consider their running app a “health” app?

Pew’s surveys are the gold standard for mobile and digital health metrics. Few would disagree with that sentiment. That said, Fox is open to improving this survey if possible. Any helpful suggestions for rewording or similar surveys that might inspire new questions are welcome, she said.

Assuming Pew’s survey results are correct and there still is a large portion of the population that would benefit from health apps, what might drive adoption moving forward? There has been a significant proliferation in the number of health apps available, but seemingly no increase in adoption.

“What is going to be the trigger for health app adoption given the fact that for three years running we have not seen significant growth?” Fox asked. “The trends that I am watching — I don’t make predictions — but [there are three] trends that I am watching. [The first is] smartphone adoption. If smartphone adoption continues increasing and we see continued engagement with smartphones users getting health apps, then looking for increased health app adoption among smartphone users seems to make sense.”

While there is something intuitive about the growing adoption of smartphones leading to a larger base for health apps, if you examine Pew’s data on overall health app adoption among all mobile phone users — not just smartphone users — you find flat adoption for three years, despite the significant gains in smartphone adoption that occurred between 2010 and 2012. Fox didn’t disagree with this but made clear that this isn’t the only trend worth watching, other factors are important, too.

“The other aspect is media portrayal of apps,” Fox said. “I perceive that there has been an increase in mainstream media coverage of health apps.”

This is without a doubt true. Big name newspapers and blogs of all stripes have been promoting suggested health app lists throughout 2012.

“The third aspect of this that I am watching for is clinical integration,” Fox said. “That is when your doctor prescribes an app. That is going to have a different effect on your interest in trying it, over you just downloading it, or it coming pre-installed on your phone. Those are the trends I’m watching — again, they are not predictions, just some of the trends I am keeping an eye on.”

Read the full Pew report here.

  • Edward Flaschner

    Doctors don’t have the time to independently evaluate so many apps. We need our academic centers to organize app evaluations which would guide us toward the most useful apps and sensors to incorporate into practice and recommend to patients.
    Edward Flaschner, M.D.

  • Jim_Bloedau

    Let’s Manage Our Expectations Instead of Expecting the “Consumer Miracle”
    “Consumers of healthcare…” You hear that a lot around mHealth, but aren’t mHealth apps a form of consuming health-care?  And with the exception of a very few of us, who likes consuming health-care or being reminded that they are sick or will be if…?  Even if a physician prescribed an app, we could take a hint from the compliance rates of pharmaceutical scripts about what the adoption might be: 50% of prescriptions are not fill by a pharmacy and 50% of those that are fulfilled aren’t really used beyond a couple of days – again, only a very few of us take our meds religiously, particularly for sever illnesses. On a whole we are passive consumers of healthcare and religate most of it to a third party-we just get tired of hearing about our “illness”…in tech they call this “user fatigue.”

  • Mark

    I use a fitness app called endomondo.  The most useless data I find are calories burned.  It’s useless because it doesn’t take into account effort.  For example, if I run seven miles in 56 minutes, it says I burned less calories than running seven miles in 70 minutes.  That’s not possible.  It takes a lot more oxygen to move 190 lbs seven miles in 56 minutes than in 70.  It is a fact, that moving the same weight at a faster pace requires more energy.  Additionally, within this app, there are contests, fastest, farthest and most calories burned.  If you want to win the most calories burned category, cycle-sport.  There is no other category that comes close.  I honestly don’t know if this is true.  In my experience, running burns more fat than cycling, swimming, hiking, walking, mountain biking, and cycling-transportation.  The question should be, “Do you believe your app is giving you reliable data?”  Here’s the best example of bad data.  I swam a 5K last summer with my phone in a waterproof box.  I swam on the surface, but my altitude changed by 73 feet.  The app also failed to track the actual route I swam.  What did I rely on?  The time swimming was accurate.  When I manually entered the route that was accurate.  The calories burned, who knows, but I know it isn’t accurate.  Distance?  Since the GPS showed me crossing the lake instead of swimming the perimeter, that was wrong and obviously the altitude gain and loss were off.  I’ve used several fitness apps.  They all seem to have the same problems, I settled with endomondo because it covers all my activities, the one I used before it dropped swimming in an update and after several weeks I changed.  The best apps are reliable, easy to use, and allow you to track what is important.  Calories burned has no significance.  I can tell I’m losing weight on a scale and by my pants when I’ve got to wear a belt on the tightest notch, to keep my pants up, I’m thinner.

  • MobiHealthNews

    Adherence to pills vs. adherence to apps is an interesting premise for a study or at least good fodder for discussion. One med adherence issue: Some medications cause side effects and make people feel physically worse in the short term, one reason for skipping a dose or stopping altogether. Not sure what the app parallel is there…

    Still, like you, I wonder how comparable the two adherence stories might be if apps were as easy to prescribe as other therapies.

  • MobiHealthNews

    Johns Hopkins is one such academic center that has taken that on:

  • Jimbloedau

    Agreed Brian: When we also think about the use of apps and the influx of game developer stratgies into the design of some healthcare apps, I think we should tease out the question of is it adherence or addiction…two very different drivers.

  • Paul Sonnier

    While not an academic institution, Happtique is also evaluating health apps:

  • MobiHealthNews

    Know of any other academic institutions evaluating health apps specifically, Paul?

  • Dlschermd

    Duke University Med School and Verizon have a partnership which might very well envelop mobile apps:

  • civisisus

    Why is health app adoption flat? Because most people, most of the time, are (or feel) healthy enough not to have to think about health care much, if at all.

    Sure, we here do: we’re invested in the subject. In a sense, we’re the ALREADY “adherent”.

    Stare at the Most Important Chart In US Health Care long enough, and the issue will become clearer:

  • Dlschermd

    I believe that the lack of clinical efficacy is the major common thread of many barriers to adoption.  Payers (governmental and commercial), providers, investors, and patients are all clamoring for “where’s the beef?” Clinical efficacy studies will be publicized in mainstream media as well as at professional and allied professional medical meetings and in journals.  This is how technologies still get adopted in healthcare.  Most providers use medical apps for reference information and are not familiar with patient management technologies, even the ones FDA approved. It’s time to have developers invest in studies, and start to consider them the price of success. Lack of clinical input at the time of development is hindering many of these technology companies. 

  • Charlie Murdock

    Hmmm…I’m a sales guy.  I believe this is all being ‘sold’ incorrectly.  Or said another way, “not how I’d go about it…in order for large scale adoption”.   Apps are generally a hope strategy;  hope folks find it, download it, and adhere to it.  I think you gotta’ sell a ‘solution’…etc.  Not being done…my opinion….for what it’s worth.

  • MobiHealthNews

    Not being done that way by anyone, Charlie?

  • Paul Sonnier

    Maybe UCSF? I don’t have a list, I’m afraid, Brian.

  • Charlie Murdock

    OK, kind of a stretch and painting with a big brush…I apologize.  I’m just a 20+ year IT sales guy and have seen some great technology/solutions never gain much traction…as sales force wasn’t selling and/or aligned correctly.  Just seems to be similar story…etc.

  • carolynthomas

    Not only is stagnant health app adoption “buried deep within” the latest Pew report, also buried (deep, deep, deep down) is the former Pew finding that only 5% of mobile phone applications – including health tracking apps – are still in use 30 days after downloading.

  • Susannah Fox

    Hi Carolyn,

    Thanks so much for giving us credit for that insight — wish we could claim it, but we can’t. We weren’t able to squeeze in any questions about usage to the Sept 2012 survey.

    However, my colleague Kristen Purcell wrote an earlier report about apps *in general* which contains some intriguing data. Here’s a link to the section entitled, “Do people use the apps they download?”