A large body of peer-reviewed published research has shown us that demographcis/sociecomics account for about 5% to 6% of variation in activation scores. Well educated or not, high income vs. low income — we find these characteristics in all levels of activation. This is encouraging given that we can not alter these characteristics, any more easily than providing new jobs for the individuals/patients we support.

The thinking around the role of providers was this — the lower activated (and those who can benefit the most from Mhealth) are heavily influenced by physicians. So the idea of ‘prescribing’ Mhealth for those with chronic conditions feels important. These same clinicians also play a very important role in the feedback loop — helping a patient learn and respond to insight gained from a mobile health application. My other thought concerns the cost of some of these applications — will payors (employers, health plans, govt) require a prescription for some important applications? If so, physician engagement is important. But I agree with your point, either way these products must be designed with the end user in mind!

I enjoyed your comments. Thank you.

Putting aside the limitations of the Harris study – it’s pretty much a waste of time to survey people on technologies they haven’t yet experienced in any significant way — the heart of the issue is still valid: how can we significantly increase adherence and self-care, and how can mobile technologies help?

You correctly note the importance of understanding underlying causes. As the Whitehall II study, in the UK, has shown, the work environment, notably the cultural environment at work, has a huge impact on health. In that study, the person’s job level was the most accurate indicator of health (the lower on the organization ladder, the worse the health). The person, the employee, has very little control over this major factor on their health. (This is very much in contradiction to the diagram on your company’s “About Insignia Health” page.) Our mobile health technology, will probably not do much about these underlying causes.

In addition, the increased busyness of modern life — ever more demands on our time, ever more interruptions, ever more responsibilities placed on the individual — makes it ever harder to be adherent to a health regimen. The daily logistics of self-care for those with chronic illnesses is an almost impossible task. Here at least, mobile health technologies could play an important role. Your point about the importance of addressing competencies hits the nail on the head. We must first ensure that people are *able* to carry out a health regimen, within the context of their already very busy life. Today’s “patient-oriented” technologies too often are designed from the perspective of the healthcare providers rather than from the people (the patients) themselves, too often focused on the little task than the entirety of the health regimen in context.

Brian wrote that your advice is to “find the doctors with patients that can benefit from these products.” This I believe is the wrong approach. Don’t start with the doctors. Start with the people. Understand their needs, their wants, and design products that truly make a difference in their lives. Treat this like any other consumer product — make products that are truly appealing, that truly make life better/easier/more joyful, and adoption will be far, far more likely than products designed the way someone else thinks people should use.

I am actually very optimistic. I believe that people do prefer to be healthier (just so they can get on with whatever else in life gives them pleasure), and that mobile technologies can make self-care much easier for most people, But, it won’t come from incremental changes to existing approaches — not mere email/SMS reminders and more tele-monitoring, not from disease-specific widgets (not another glucose & insulin tracking product!) that don’t acknowledge the entirety of a person’s health regimen. Rather it will come from products that fundamentally understands and addresses the person’s, not the doctor’s, needs.

“Glucophone is an example of a product that looks AMAZING on paper (speaking as a diabetic myself) BUT IS TOTALLY UNSUCCESSFUL AND WILL NEVER HAVE ANY SUCCESS…”

I’d be happy to discuss more via email mtendler@glucosebuddy.com

1) “It has lots of research and clinical trials and has spent plenty of money figuring out just what diabetics want”

Unfortunately the US healthcare system is not just driven by what patients want. The needs of Distributors/Retailers, Doctors, Pharma and Insurers also need to be served.

2) “It logs blood glucose results and can send them directly to your doctor”

Does your Doctor have the ability to receive these and the tools to manage them? Would this extra work be reimbursed? etc etc

3) “490 unique visitors last month”

I have no idea how this statistic is supposed to make me think. With millions of diabetics in the USA it’s not a particularly revealing statistic.

I am not, in any way, suggesting that Nike+ is the answer to any of our Mobile Health prayers.

The purpose of using Nike+ as an example is to provide a product that has taken the right steps to engage people who never wanted to exercise, to begin exercising. After all, this article is entitled, “Those who need it most, aren’t interested.” Nike+ does indeed interest people who need it.

I could not disagree more with your statement, “We need to bring [health] functionality to standard phones (eg. preinstalled or made available as a downloadable application) before there is a good chance of it catching on well with the low activated.”

I believe, we need to look forward instead of backwards. Standard phones are clearly a dying breed as a) smartphone hardware becomes cheaper and more widely adopted across all demographics and b) OS’s like Android (with their Android Market) offer attractive options for manufacturers to ’sexy’ their phones up on the cheap. Every day, App Stores become more and more popular. Landing that big Verizon or AT&T deal isn’t as important as it used to be.

Your miCoach example is precisely the reason I believe so many mobile health companies will fail: It’s not just about the details of devices, it’s about the entire experience and it’s about accessibility. It’s about asking sick people to take the least amount of steps as possible to change their not-so-healthy lifestyles. It’s about connecting with peers, not just doctors, who are going through the same things as you are. It’s about recognizing that society as a whole, especially low activated, more likely to purchase an Us Weekly or People magazine than a novel. We need to embrace the paradigm shifts if we want Mobile Health to prosper across low and high activated, not fight it.

Here’s an example of a product that looks AMAZING on paper (speaking as a diabetic myself):
This product has substantial hardware advantages for diabetics.
It has lots of research and clinical trials and has spent plenty of money figuring out just what diabetics want.
It logs blood glucose results and can send them directly to your doctor.
It can send reminders and alerts.
It’s FDA approved.
It has a free web portal, too.
AND its website has 490 unique visitors last month. Why do you think that is?
https://my.glucophone.com/runscript.cfm?page=home.cfm

To my mind the devil is in the detail and in my personal experience there are far too many barriers to adoption with the Nike+ system that would make it unfeasible for Doctors or Payors. Not least among these are the costs, hardware required and IT proficiency.

I have been involved in the development of a mobile health solution that has already been launched and it has several advantages over the Apple system. The project involved a collaboration between Adidas and Samsung and you can find out full information on it at http://www.micoach.com

An important lesson I have learnt is that we need to bring this functionality to standard phones (eg. preinstalled or made available as a downloadable application) before there is a good chance of it catching on well with the low activated. Mobile operators (carriers) have an important role to play in this and it would be a very good idea for them to work with health system payors as there is lots of value they can add (eg. making the apps available in the first place and white listing the connectivity for the app so customers are encouraged to try it out).

The simple question here is “HOW DO WE GET SOMEONE WHO DOESN’T CARE ENOUGH, TO CARE ENOUGH?”

I am suggesting that bringing this sort of NIKE+ platform will help both low and high activated patients.

Level 1 and Level 2 individuals tend to be passive with regard to managing their health, and may fail to see the connection between their own behaviors and health outcomes.

“Nike+ does something very different. Nike+ is about creating, and then meeting, a psychological need. ”

“For a lot of people, there’s something excruciating about exercise—it’s right up there with balancing your checkbook, visiting your in-laws, and flossing your teeth. That was the case with Rick Law.
‘I used to complain about how inactive I was and wish there was an interesting way to become more physically active,’ says Law… In 2007, Law’s wife gave him a Nike+ system for Christmas, hoping it would motivate him…By tracking his effort—enhancing an analog experience with digital technology—Law found that running could be as interesting as his work… Law got feedback as he ran and enjoyed the sense of accomplishment that came from charting his progress as he got more and more fit.”

I’d be interested in hearing your thoughts on why this sort of system if applied to mobile health self-management and covered by payors and promoted by doctors, would not catch on well with the low activated.