Get happier, lose weight, be fitter–the efficacy of apps debated in studies present and future pilots

Do they really work to change behavior? Studies for the past seven or so years have debated efficacy; a quick search online will show you a wealth of articles with findings on both sides. We know healthcare-related (consumer behavior and professional apps) are growing like weeds after rain– over 320,000 mobile, wearable, and IoT health apps were available for use in 2017, with 200 added daily (Research2Guidance, IQVIA estimates). But qualitatively, the jury is out.

Three studies published in the last two months come somewhere in the middle.

Obesity and weight loss: A telemedicine-based 12 week study from California State University found that the combination of a secure mobile phone-based platform for data tracking and video conferencing with the research team, plus meeting with the medical doctor once per month, and weekly with a registered dietitian worked to clinical standards, ≥5% of initial body weight loss over six months, for 69 percent of the telemedicine participants (n=13) versus 8 percent in the control group (n=12). Note the substantial hands-on human support each of the 13 participants received. Journal of Telemedicine and Telecare, Clinical Innovation & Technology

Activity monitoring not effective unless users set goals: A 400-person study performed by researchers from the Oregon Health & Science University (OHSU) School of Medicine and their Knight Cardiovascular Institute found that when people used such monitors and apps without a specific goal in mind, their physical activity declined and their heart health did not improve, even if 57 percent thought it did. The subjects, primarily office workers at one site, wore a Basis Peak band for about five months. To gauge heart health, the researchers also tracked multiple indicators of cardiac risk: body mass index, cholesterol, blood pressure and HbA1C. Cardiac risk factors did not change. However, the corresponding author, Luke Burchill MD PhD, told EurekAlert (AAAS) that when paired with specific goals, the trackers could be powerful tools for increasing physical activity. The original study published in the British Journal of Sports Medicine doesn’t go quite that far. 

But it’s great for your morale, especially if you pay for it: A Brigham Young University study published in JMIR MHealth and UHealth (August) confirmed that physical activity app usage in the past 6 months resulted in a change in respondents attitudes, beliefs, perceptions, and motivation. This study’s purpose was to track engagement factors such as likeability, ease of engagement, push prompts, and surprisingly, price–that higher-priced apps had greater potential for behavior change. Possible reasons were that the apps provide additional features or have higher quality programming and functionality. (And user investment?)

One growing area for apps is mental health, where the metrics are solidly behavioral and the condition is chronic. The UK’s National Institute for Health and Care Excellence (NICE) has moved forward in favor of piloting them with NHS England. The latest is one from Germany, Deprexis, that uses texts, emails, questionnaires, and cognitive behavioral therapy to give feedback to users. It also has tools to relax users through audio and visual programs. NICE recommends therapist guidance for the trial. According to Digital Health News, NICE is recommending it should be trialed for up to two years in at least two of the specialist services that were set up to improve access to psychological therapies. Again, cost is a factor in rolling out but others are access to care and freeing up therapist time. The organization also plans to review up to 14 digital programs to treat anxiety and depression over the next three years.

Hat tip to Toni Bunting for much of the above

For further reference: The 2017 R2G mHealth App Developer Economics 2017 study has been released and is available for free download here. The 2017 study surveyed 2,400 mHealth developers and practitioners. (Disclosure: TTA was a media sponsor for the study.)

NHS, Public Health England testing multiple digital health devices for obesity, diabetes

NHS England, Public Health England, and Diabetes UK launched a pilot, announced on World Diabetes Day on 14 November, to test various digital health approaches to controlling obesity and Type 2 diabetes. Approximately 5,000 patients will be recruited for a test period of up to one year. Multiple apps, gadgets, wristbands, and other digital devices to measure their results against goals will be tested,  combined with health coaching and online support groups. NHS is also offering to some wearable devices which record activity levels and receive motivational messages and prompts. 

The test will use products and services from five companies and the patients will be recruited from eight areas of the country. The companies, programs, and tools are:

  • Hitachi – Smart Digital Diabetes Prevention program combines an online portal + coaching
  • Buddi Nujjer – a wristband which monitors the user’s activity, sleep patterns and eating frequency, paired with a smartphone application
  • Liva Healthcare – 12 months of a dedicated coach starting with a personal face-to-face meeting. The Liva platform and patient app supports the patient with smart goal setting and plans, lifestyle tracking, video communication, and online peer to peer support.
  • Oviva – An eight-week intensive lifestyle intervention with an experienced dietitian providing personalized advice and support.
  • OurPath – A six-week mobile and desktop digital program with structured education on healthy eating, sleep, exercise and stress management.

The pilot builds on Healthier You: The NHS Diabetes Prevention Programme, launched last year to support people who are at high risk of developing Type 2 diabetes. This adds digital tools to a coaching-intensive, educational, and activity-oriented program. Public Health England also has the Active 10 app, which encourages at least 10 minutes of daily brisk walking. NHS press release, Digital Health

Humana-Omada Health diabetes prevention program could cut $3 bn in Medicare expense: study

A study performed by insurer Humana using the Omada Health program for diabetes prevention effectively lowered weight, improved cholesterol, blood glucose and mood. 500 volunteer subjects from Humana’s Medicare Advantage program, enrolled during 2015, lost an average of 13 to 14 pounds over a year (7.5 to 8 percent). They also saw improvements in cholesterol levels, blood glucose levels and subjective measures of moods and self-care. Individuals were chosen from administrative medical claims based on metabolic syndrome diagnosis or a combination of three of four of the following diagnoses: prediabetes, hypertension, dyslipidemia, and obesity. Based on the researchers’ calculations, this type of prevention program among this group if widely implemented among overweight adults could reduce Medicare costs by $3 bn over 10 years, not only for diabetes but also heart disease and high blood pressure.

Omada Health’s program included an online small group support, personalized health coaching, digital tracking tools, and a weekly behavior change curriculum. These one-hour lessons focused on a single topic were delivered via laptop, tablet, or smartphone, and included interactive games or exercises, written reflections, and goal-setting activities. The content was approved by the CDC Diabetes Prevention Recognition Program. Data was gathered via wireless scale, pedometer for physical activity, online food intake logging and standard lab results. “In conclusion, this study demonstrated that older adults who agreed to participate in this program were able to engage meaningfully and gain important health and wellness benefits during a relatively short time frame.”

While the cost reduction estimate is exactly that, other studies directionally confirm health improvement and savings: the National Diabetes Prevention Program (NDPP) which is the model for the Omada program, the BMJ/Noom Health study, and the Fruit Street/VSee telehealth program being used by St. Jude Children’s Research Hospital, University of South Florida and University of Michigan. mHealth Intelligence, study (full text in Journal of Aging and Health/Sage Journals)

“A rose by any other name would smell as sweet” (UK telehealth)

60 Second GP today points to an article on what looks to be essentially a Simple Telehealth-type application, in this case a GP-led internet-based programme to encourage weight loss among obese patients in West Oxfordshire.  What makes it newsworthy is that it never mentions telehealth, yet extolls the benefits in a manner that any telehealth project or programme manager, eager for clinical acceptance will instantly recognise, such as:

  • “An internet-based programme can involve GPs in the weight loss of a large number of patients in a cost-effective manner.”
  • “The main benefit of the programme is that it dramatically reduces the cost of face-to-face time with patients, freeing up healthcare professionals for other activities.”

Does this mean that the good GPs of West Oxfordshire have taken onboard a previous Telecareaware post “When mHealth and telehealth become ‘just healthcare’” ?

I somehow doubt it – however the article is nevertheless recommended reading for anyone wanting to sell successfully a telehealth programme to clinicians without ever mentioning the ‘t’ word.

Also worth pointing out is that a feature of the programme was to introduce some gamification – in this case via a league table of weight losers, where anonymised patients reported changes in weight, so other could compare achievements.  Perhaps that’s why the authors, Professor David Brodie, Emma Doyle, Dr Jey Radhakrishnan and Dr David Shaw, report that “One of the most striking outcomes was the high number of men who lost weight (almost 90%), because men are often more reluctant to become involved in weight loss programmes”? (For another great example of gamification applied to weight loss, without the technology, see Fitfans in Hull.)

Sadly there is no information in the article on the size of the programme…and the implication seems to be that having been shown to be successful it was discontinued after 12 months.