For improving health, 'there's an app for that' ...But do they actually work?October 7, 2016
Remember the ThighMaster? And what about those plastic sweat suits that (supposedly) helped burn fat? And then of course there was the grapefruit diet and the werewolf diet (when you fast according to the lunar calendar). Are today’s new health apps and devices simply the high-tech versions of these long-gone fads? Should they be relegated to the realm of late-night TV infomercials or do they actually work to improve health—and are they here to stay and grow? With so many burning questions, of course the inquiring minds at GSC had to know. Here’s what we discovered…
Wild and wonderful?
Often when people think of health apps and devices, they think “wearables” like the Fitbit—that colourful wristband that helps people track activity, exercise, food, weight, and sleep. And no wonder, since the health-wearables market is dominated by fitness activity trackers.
However, not only do health apps and devices go way beyond just trackers, they also go way beyond just wearables. In fact, most of today’s health apps and devices are a mashup of different applications and different health issues that involve not only the user’s conscious behaviour but also their physiology and psychology. For example, a clip-on sensor tracks activity while also assessing the user’s state of mind by monitoring breathing patterns. If it detects stress or anxiety, it vibrates or sends a smartphone notification alerting the user to take a breath.
From helping with important health conditions—like apps for diabetics to monitor glucose levels—to working on specific prevention or lifestyle issues like learning to be mindful—now there’s an app for that. And health apps and devices are getting more interesting every day.
How about shocking yourself—literally—into stopping an unwanted behaviour? Every time you do the unwanted behaviour—
like smoking, eating chips, biting your nails—a wrist device can give you a shock. That’s right, an electric shock. Based on aversion therapy, the idea is that this negative association with the electric shock should help deter the unwanted behaviour. You may be relieved to hear that it’s up to you to decide the strength of the shock—you can set it to be a strong vibration at 50 volts up to more of a real sting at 450 volts. (FYI, a police Taser is about 50,000 volts.)¹
…And what about the range of high-tech apps now available for calorie counting. Is taking photos of everything we eat just filling our seemingly insatiable obsession with documenting everything, or can these apps accurately count calories based on photos? This brings us to the crux of the mystique swirling around today’s health apps and devices. Although they are certainly getting wilder, are they actually both wild and wonderful—do they actually work?
It’s not enough that they just “work” in terms of their features, like a wearable technology that fits well, looks good, and is easy to use or an online program that works the way it’s supposed to. Ultimately, the technology also has to work in terms of actually improving the health issues it promises to improve. To see if today’s health apps and devices are making a difference, our first stop, as always, was to check out the scientific evidence…
The jury is still out
So far the body of scientific evidence specifically around the effectiveness of health apps and devices doesn’t lead to a definitive
“yes” or “no” regarding whether they improve health outcomes. As usual, where health is concerned, it’s complicated.
- Suppliers producing or distributing the technology are often also conducting the research; however, that means their bias could creep in.
- In the academic world, although less risk of bias exists, to date the studies are very focused, so in most cases, the results are not overly generalizable.
- There is a lot of anecdotal feedback from health app and device users in cyberspace, which is interesting, but not reliable because it has no scientific rigour.
With so much uncertainty, it seems that all we know for now is there is a solid body of evidence around behaviour change and behavioural economics. Accordingly, driven by logic (of course!), what we can say is that health technologies that incorporate principles like goal setting, feedback, gaming, and rewards have more potential to make an impact than technology that does not.
But why not check with an expert? We contacted Amos Adler, the founder and president of MEMOTEXT Corporation, which was the IT platform and methodology behind GSC’s original Stick2It medication adherence program. Amos established MEMOTEXT as a texting reminder messaging service; however, it turned out that 87% of MEMOTEXT users were using the platform specifically for medication adherence. As a result, today MEMOTEXT focuses on improving health outcomes for patients—and the bottom line for health care stakeholders—by ensuring patients adhere to their medications.
As Amos explains,
"We ‘action’ our users’ data by using it to personalize and integrate behaviour change into their everyday lives. And we do this based on scientific principles that shift away from the idea of ‘getting people to do things’ toward figuring out why people do things. Health technologies have a better chance of engaging users and ultimately, helping them change behaviour by focusing on why. For example, it’s not enough to just remind people to take their medications, we need to figure out why they are non-adherent in the first place.”
Amos elaborates, “To do this, health technology suppliers need to think of their technologies as having a digital conversation with their users. Not only does the technology allow users to be heard, it also provides the supplier with a chance to make the digital conversation more effective. The supplier needs to really understand the power of the user-generated data, as well as data from stakeholders, to scale behaviour change and improve health while decreasing costs.”
Amos provides the example of chatbots, the new, cool trend in private messaging. Chatbots are computer programs that use artificial intelligence to help the user to find information in a more conversational and natural way, rather than by having to input
a series of key words and gradually piece together the information. For example, instead of browsing a website, you could have a text-based conversation via a chatbot and essentially interact with the chatbot as if it were a real person who is helping you. One health care chatbot allows parents to discuss their children’s symptoms—like fever, cough, headache, rash, vomiting, sore throat—and the chatbot helps them determine whether the symptoms warrant a call to the doctor.
“How people interact with their phone, how they interact with content on social media, all of this user-generated data can not only improve consumer engagement but also identify lack of engagement,” explains Amos. “In fact, the user-generated data can be used in a range of important ways, like helping triage care priorities to support decision-making around diagnosis and treatment, and it can flag risks. For instance, current research includes studies that analyze Twitter logs to identify individuals who may be at high risk for suicide.”
One size doesn’t necessarily fit all
To shed light on what’s going on, new research
surveyed 193 people who had abandoned Fitbits or financial trackers.5 Many study participants experienced no real difference in their lives after ditching it, whereas others felt guilt over abandoning it or relief because they no longer had to keep using it.
The researchers also found that people threw in the towel for different reasons: “Some don’t like what their Fitbit or financial tracking tools
reveal, others find collecting data a hassle, don’t quite know how to use the information, or simply learn what they need to know about their habits and move on.”6
Digging deeper, the researchers also specifically focused on the 141 people who stopped using Fitbit.7 They showed them seven different visual designs and ways of framing previously collected data to see if
new and interesting approaches would help
The results reveal that most people preferred social comparisons that made them look better than their peers. For instance, “you walked more than 70% of people,” versus negative framing like “30% of people walked
more than you.”8 Overall, the researchers conclude that a design approach that is one-size-fits-all misses opportunities to support different types of users.
Beyond just shiny objects?
On Christmas Day in 2015, the Fitbit app was the top downloaded app in the Apple App Store.² However, in 2016 Fitbit’s stock has been described as “on the struggle bus.”³ And in terms of smartwatches, Apple shipped 55% fewer watches in the second quarter of 2016 than it did a year ago.4 What’s going on here?
So what is Amos’s take?
"There are a lot of what could be referred to as ‘shiny objects’ out there right now. Many are a case of a lot of flash and essentially very little substance. The technologies that will be winners in the long run will be the ones that are based on proven methodologies like cognitive behavioural therapy and motivational interviewing. The technologies that will endure will use traditional methodologies that have been around for decades, but use them in new ways. I like to think of it as not reinventing the wheel, but attaching a high-tech engine to the wheel of the existing science.”
As always seems to be the case where technology is concerned, the future seems wide open. However, as far as we can tell, the future is likely to hold health technologies that continue the trend of linking with the physical world—and in ever-expanding ways. For example, technologies that detect changes in physiological states will increasingly trigger events in the user’s environment—like tracking sleep patterns and then turning on the coffee maker when the user wakes up in the morning.
Virtual reality (VR) is also set to go well beyond just fun and games with more VR related to health and medicine. There’s an exercise bike that is essentially a game controller complete with joysticks and access to a range of games and software. The user also needs a VR headset and computer but then is ready to ride—like ride a virtual Pegasus to take the monotony out of cardio training.
Amos comments, “Technologies coming down the pike will become more integrated into each user’s specific environment, which affects their health and lifestyle. For instance, given that most health care happens outside the doctor’s office, we will see more technologies that extend care into people’s lives, like robots that help people with mobility. Technologies will identify what risks are in people’s everyday lives and environment and then design solutions that work for people in their natural habits at home, at work, in the community.”
The future is also sure to include an ever-expanding range of health conditions that can be assisted through technology. For instance, Amos feels that as technologies improve in their abilty to personalize interactions and engage people, they may be especially effective in helping people with mental health conditions. MEMOTEXT is currently working with the Centre for Addiction and Mental Health (CAMH) to develop a technology to help people with schizophrenia self-manage their illness.
Overall, Amos believes that ongoing technological development will result in a more empowered and involved patient. “This will mean that health care providers and processes will have to adjust to work with the patient rather than work on the patient.”
Solid category of technology
The good news is that health technologies that are evidence-based will not simply represent a high-tech version of wacky health trends as in the past—like the cookie diet (come on!) and those shoes that promised to tone your leg and butt muscles without ever having to break a sweat. Quite the opposite, they have the potential to represent a solid category of technology that can help transform people’s health—and the possibilities are limitless. Those that work to actually impact health will not just be a bundle of desirable features, but will be based on science. As Steve Jobs once said, “Design is not just what it looks like and
feels like. Design is how it works.”9
1“A Shocking Way (Really) to Break Bad Habits,” The New York Times, Wired Well, Jennifer Jolly, May 2, 2016. Retrieved September 2016: http://well.blogs.nytimes.com/2016/05/02/a-shocking-way-really-to-break-bad-habits/
2 “Shares of Fitbit rise on signs its fitness trackers were hot sellers for Christmas,” CTV News, Joseph Pisani, December 28, 2015. Retrieved September 2016:
3,4 “Fitness Bands and Smartwatches: Where are they now?” Toronto Star Touch, Jennifer Van Grove, August 21, 2016. Retrieved September 2016: http://startouch.thestar.com/screens/7c64642a-fb80-4803-a9de-f834750b5c9c%7C_0.html
5, 6, 7, 8 “Life after Fitbit: Appealing to those who feel guilty vs. free,” University of Washington website, News and Information, Jennifer Langston, September 8, 2016. Retrieved September 2016: http://www.washington.edu/news/2016/09/08/life-after-fitbit-appealing-to-those-who-feel-guilty-vs-free/
9 Brainy Quote, Steve Jobs Quotes. Retrieved September 2016: http://www.brainyquote.com/quotes/quotes/s/stevejobs169129.html