Editor Donna muses on the link in the telecare chain where it can all fall down – the person who is expected to use the device.
“If you build it, they will come”–misattributed to the film Field of Dreams, 1989
We can get telehealth and mhealth into the home care or healthcare provider, payer, ‘app store’ or ‘ecosystem’ (the ‘push’), but you cannot force the client or patient to use it.
The buzz may be about how slick a system or app is, how to sell it to the C-suite or even the Four Big Questions, but have we forgotten someone? We assume that end users/clients/patients will be delighted to use our wonderful devices, in the way they should be used–consistently, correctly, continuously until they… expire. Step back and think about human behavior, however, and you realize…that cannot be true.
Can any reader of this article disprove this proposition: Many prime candidates for telehealth don’t want to admit they have a chronic condition, and moreover, don’t want to be bothered to manage it using buttons to push, manipulating devices, wearing things, etc.
How many end user studies of telehealth have you seen that really get into these factors? We do know more about health-related smartphone apps and their low adoption/high dropout rates–26% being used only once and 74% being discontinued by the tenth use (Consumer Health Information Corporation online survey, N=395, April 2011). Are we afraid of what we might find that doesn’t match the hype? Even passive telemonitoring – which requires the end user to wear and do nothing except live their daily life–can be rejected by users as invasion of privacy (a familiar refrain from my early days that hasn’t changed much in six years.)
Stan Newman’s presentation at the King’s Fund (sign up required to view) delves into why a significant population in the WSD turned down the opportunity to have telehealth in their homes.
- They preferred what they have–happy with face-to-face care management or caregiver
- Technology and ‘pushing buttons’ was ‘not for me’
- The fear that the technology would make them more–not less–dependent (a surprise)
- Suspicious that telehealth was being used to (eventually) take something away from them, coinciding with a time of economic austerity. These persons believe that their services will change, and not for the better.
So back we are to a marketing problem. Let’s first brace ourselves with Stan Newman’s blunt admission: telehealth is not applicable to everyone. But for those whom it is, the problem centers on how to present telehealth the right way, to damp down natural suspicions and create appeal in the mind of the user, both for adoption and for long term use.
Right off the top, I would rate high on the list these factors:
- Ease of use and low complexity
- A form factor which is as non-disruptive to routine as possible
- Positive and personal reinforcement from authoritative caregivers (nurses, doctors, care manager, family, neighbors)
- Positive reinforcement via the device, if design permits
- Knowing someone or personally experiencing a “save” situation (avoiding a hospitalization, bad drug reaction, fall–but not at a ‘deer in the headlights’ level which creates inaction)
- A social or community overlay of support and positivity
While I am not a huge fan of nationalized health (to the contrary), to this Yank the local councils/NHS in the UK have done a far better job of integrating telehealth, particularly for older people, into community services and life than we have. Yet they struggle with usage and cost factors too (see all that Steve has written on the WSD).
How do we make m/eHealth and telehealth the cool thing to do for the average person? How do we fit it into a person’s life, like taking a vitamin?
This is not Field of Dreams-ville--the ‘quantified life’ that plays well to early adopters, the obsessives, the “gearheads”, the hypesters and the m/eHealth cocktail party circuit.
How do we make self-monitoring a ‘given’ or ‘routine’ appealing to anyone–in other words, a no-brainer?
(And we should also admit that telehealth is not, and never is going to be, for everybody.)
Your opinions please
Related Reading and hat tip to: Do Consumers want smartphone health apps? MC ThinkCamp–mHealth