Catching up on my reading…as this American Heart Association (@American_Heart) Scientific Statement was published in 2015, however it’s very exhaustive. And even more skeptical than I am about these things.
Remember when email came out and everyone thought that would revolutionize health? Then the Web came out and everyone thought that would revolutionize health? And then mobile devices….
Our review included a total of 69 studies that investigated the use of mobile technologies to reduce CVD risk behaviors, which included 10 RCTs targeting weight loss, 14 on increasing physical activity, 14 aiming to improve smoking cessation, 15 on blood glucose management, 13 on hypertension management, and only 3 targeting lipid management. The majority were RCTs.
A great part of the scientific statement and is resourcefulness is that in every area above, a good characterization of the problem is documented, with references. And then it goes into detail about what mobile health applications have been tested, what the results were, and what the gaps are.
There are a lot of gaps
Current commercially available mobile apps for smoking cessation have generally failed to deliver empirically supported interventions or to make optimal use of the capabilities of mobile phones. A series of studies by Abroms and colleagues have shown that most commercially available smoking cessation apps do not adhere to practice guidelines for smoking cessation.
This is in addition to the fact that there’s a significant publication lag – most of the studies published are not of actual mobile phone interventions, but of Internet/Web based ones.
Another theme running through what is known from the literature is that mobile health interventions don’t work on their own. They usually require a program surrounding them, or a system that leverages them.
This is sort of not new news, as I wrote about in this post in 2012: Now Reading: Does mobile technology support behavior change? Does it support weight loss?.
Looking more closely at hypertension (high blood pressure)
In the section on hypertension management, it’s interesting that 2 of these three successful trials mentioned:
All 3 of these studies provided some combination of patient educational resources, timely delivery of BP data to providers, and personalized messages to patients. The positive results of the 3 trials may suggest that a combination of such strategies or modes of intervention delivery may be needed to engage patients.
…were done in integrated health systems (Group Health Cooperative, Kaiser Permanente). I was an advisor on one of the studies and I have visited team that produced the second study (see: Day 3, Population Care, KP Colorado : Care gaps are the currency (and we want to go broke)).
In addition, they were done in places where high blood pressure control is higher than the national average.
The national average for blood pressure control is cited in the statement as a dismal/embarassing < 50%.
At Kaiser Permanente, it’s a health promoting/pride invoking > 90% (Yes, that is a 90% Hypertension Control Rate). Therefore the value of understanding mobile health interventions may be more ideal because a place where the system is working and mobile health can make it work more efficiently may show more promise than using mobile health to fix a broken system.
Other general issues cited
Many(most) published studies…
- tend to not have control groups and enroll the willing/interested (the 10% problem)
- are not long enough to show benefit for conditions that have to be managed for a lifetime (diabetes)
- don’t follow established guidelines or make incorrect assumptions about what works in prevention (Education by itself doesn’t work)
- are intervening around the wrong things – lipid management being a prime example – fortunately/unfortunately not much is being done in this area anyway (“The paucity of well-controlled trials for the use of mHealth interventions specifically for lipid disorders is remarkable, considering the prevalence of dyslipidemia in the general population.”)
The future, since 2010 – There’s still promise, I promise 🙂
I am aware that I wrote an oft-cited blog piece exuberantly promoting the promise of Mobile Health in 2010, in an cute listicle (6 Reasons why mHealth is different than eHealth).
I re-read the post it and I still agree with most of what it says (except the part where I say “piece of cake” – today it would be “piece of kale”).
mHealth is different than eHealth, which didn’t revolutionize health but evolved it, especially in places where health was part of the mission in the first place.
Where I work, for example, the accesses to our patient portal via mobile device have far surpassed accesses via desktop computers, since early 2015. I remember when just 20% mobile access was a huge deal. People are getting smarter about using evidence and modeling long term effects of shorter term interventions (I think and hope). And, especially in the nutrition/weight/lipid space, good questions are being asked around whether any intervention program should exist at all, and instead the current less-than-healthy program should be dismantled.
As I alluded to in my post reviewing the Apple Watch Series 2 (Review of Apple Watch Nike+, Fitness Tracking, and Heart Rate Variability), the penetration of mobile health applications in shaping and improving our health may be a combination of
- The burning ambition of organizations making large investments (e.g. Apple)
- High performing health systems who are already achieving health outcomes through system-ness and collaboration
- Entrepreneurs and optimist-idealists stimulating all of the above
- Listening to the people we serve
On the last bullet, this is still the decade of the patient, and the most important app of this decade is listening, which is sometimes in short supply, but getting better in my opinion.
On that note, don’t forget:
- “Mantra: The Patient Is Not Like Me.”
- Diversity allows the human species to survive
..it matters here as much as it does anywhere in health.