Robyn Whittaker National Institute for Health Innovation University of Auckland (Wednesday, mHealth Workshop)

1. Mobile health: clinical aspects
Dr Robyn Whittaker
Health Informatics & Technology, NIHI
Research & Innovation, Waitemata DHB
The National Institute
for Health Innovation

2. mHealth research & development
• Text messaging smoking cessation
• Video messaging smoking cessation
• Multimedia messaging depression
prevention in adolescents
• Text messaging & internet exercise
prescription & support for cardiac patients
• Text messaging weight loss programme
• Text messaging brief intervention for
problem alcohol drinking
• Smartphone applications for data collection
• Smartphone application linked to food
database for nutrient advice
• Tools & communication for people with
diabetes

3. mHealth programs can be
HEALTHY
BEHAVIOR
• integrated into daily life
CHANGE • proactive
• there at the ‘right’ times
• personal/ised
CHRONIC
DISEASE • interactive
MANAGEMENT
• on-going
• providing social support

4. STOMP implemented nationally
4

5. Txt2stop United Kingdom

7. “Spot, Sort, Do”
Reality TV or
‘Youtube’ style
Set challenges
Video clips
youth and celebs
‘Brotown’ Short catchy key
style message in txt
Animated 2 messages/day Educational
cartoons for 2 months messages
Access for
mobile
12 months website
Contacts & summary

8. MEMO „teens‟

9. MEMO celebs

10. MEMO Animations

11. Conclusions
It is possible to convert
CBT into mobile phone
messages, feasible to
deliver such a
programme, and
acceptable to NZ teens
The majority liked it and
said they found it helpful

12. Objective depression scores
Unable to prove that MEMO works
to prevent onset of depression
• Our control programme
or study processes
(interviews with lovely
RAs) worked as well
• The group were
Worsening scores
uniformly ‘happy’
anyway and can’t
improve much on that
• The ‘dose’ was not
sufficient to show an
effect

13. Heart Exercise and Remote
Technologies (HEART):
A Randomized Controlled Trial
ISO 9001 Registered

14. Intervention
• Fully automated program of SMS
via mobile phones
– Exercise prescription
– Behavior change strategies
• Role model video messages
accessed via secure website
• Self-efficacy theory
– Task
– Barrier
– Scheduling

15. RCT
• 170 participants with CVD
• Primary outcome change in VO2max
• Secondary outcomes
– 6 min walk test
– Self-reported PA
– HRQoL
– Cost-effectiveness
• Recruitment finished

16. Approach to development
- Whittaker 2012, Journal of Health Communication
– Start with the problem
– Conceptualisation
• Experts and target audience
• Use evidence & theory
– End-users involved through-out
– Consider implementation from
start
– Pre-test & refine
– Test in high quality research
studies
– Publish/make publicly available

17. People with diabetes
• Regular blood glucose monitoring & frequent
contact with health providers improves control
of diabetes
• Better control delays or prevents costly &
debilitating consequences
– Blindness, lower limb amputations, kidney disease,
heart disease
• Growing evidence that mHealth solutions can
enhance self-management & improve control

18. mHealth interventions
• Reminder text messages for monitoring
• Diary functions to collect data on
insulin/glucose/diet/activities
– Education & practical tips on how to
manage diabetes
– Individualised automated advice based on
readings
– Enhancing self-efficacy for control
– Integrating with providers

19. End-user input
• Expert Advisors/clinical teams
• Maori Advisory Group
• Focus groups
• Interviews
• Demonstrating existing tools
– Identifying needs and barriers to self-management

20. Guiding principles
• Theory eg. Social cognitive - enhancing self-
efficacy
• Illness perceptions
• Behaviour change techniques
– short term goals, motivation, positive
reinforcement, reminders/scheduling, self-monitoring &
feedback, role modelling/observational learning, social
support
• User-friendly options

21. Implementation
• Integration into clinical practice and health
information systems
• Shared Care Plan platform
– Primary care, secondary care, community, patient and
caregivers
– Graphical visualisation of patient-reported data

22. Portal Overview

24. Other DHB work
• Text messaging integrated into DHB systems
for clinical and non-clinical uses
• Trial of smartphone-based paging system
• Systems to support community-based
ambulatory workers
• Clinical apps

26. Issues with mHealth in
clinical practice
• Privacy of personal health information
• Health information security, hosting
• Infrastructure: wifi & 3G access in hospitals
• BYOD: registration of devices, health
information on devices, evidence-based
apps
• Clinical: integrated models of care,
understanding of potential value
• Patient engagement

27. Overall lessons
• Make sure mobile is the right tool and if so
optimize the benefits of using mobile
• Decide on guiding principles & logistics
• Involve target audience in development &
use their input/feedback
• Do it well!

28. Acknowledgements
Thank you
r.whittaker@nihi.auckland.ac.nz
#rawegd