3. How can mobile apps be leveraged to combat obesity-related health issues?
4. What apps are currently available to address prevention and remediation of obesity-related health problems? How comprehensive are they?
5.
6. How can A4G play a role in furthering the study of its constituents’ needs and the efficacy of targeted mobile app interventions?
7.
8. Detecon is a global consulting company which unites classic management consulting with a high level of information and telecommunication technology expertise.
9.
10.
11. Superior design and visualization techniques will also expand the appeal and potential benefits of mobile health apps to low literacy and numeracy populations.There is also an opportunity for A4G to broker collaborative efforts among researchers, nonprofits and corporations to develop, promote and distribute applications designed to impact health outcomes among low SES communities.
12. Contents 1 Obesity and Nutrition in America 2 Low SES Communities and Mobile Technology 3 Mobile Applications as a Health Enabler 4 Mobile Health Apps Overview 5 Preliminary Gap Analysis 6 Conclusions & Next Steps 7 Appendix
13.
14. In 1990, among states participating in the Behavioral Risk Factor Surveillance System, ten states had a prevalence of obesity less than 10% and no states had prevalence equal to or greater than 15%.
15. In 2009, only one state (Colorado) and the District of Columbia had a prevalence of obesity less than 20%. Thirty-three states had a prevalence equal to or greater than 25%; nine of these states had a prevalence of obesity equal to or greater than 30%.Source: Behavioral Risk Factor Surveillance System, CDC
16. Frame Template 1. Obesity and Nutrition in America The target audience for A4G anti-obesity initiatives are Americans of low SES. Higher obesity rates among this population are due to a variety of complex factors. US Obesity Rate by Income US Obesity Rate by Education US Poverty Rate by Ethnicity 33.8% 32.8% 25.8% 25.3% 31.8% 30.4% 29.6% 29.7% 29.5% 24.6% 21.5% 9.4% >$50k $35k-$50k $25k-$35k $15k-$25k <$15k Some college High school graduate only Did not graduate high school College grad African American White Hispanic Low-income individuals are less likely to have access to affordable, nutritious food. Lower levels of education are associated with both lower SES and poorer understanding of health and nutrition. Poverty is significantly more prevalent among African American and Hispanic communities. US Adult Obesity Rate by Ethnicity US Childhood Obesity Rate by Ethnicity African
American African
American 35.7% 23.9% Hispanic 28.7% Hispanic 23.4% White 23.7% White 13.0% Sources: US Census Bureau 2010; CDC 2011; JAMA 2010; The Trust for America's Health and the Robert Wood Johnson Foundation, 2011
19. As of June 2009, the average monthly benefit was $133.12 per person
20. As of May 2011, 44 million Americans get a portion of their meals using food stamps
21.
22. Food stamp usage is typically at supermarkets, superstores and convenience stores which partially impacts dietary quality.Sources: US Department of Agriculture, 2011; Diet Quality of Americans by Food Stamp Participants, July 2008; S.N.A.P. Benefit Redemption Division Annual Report 2010
23.
24. Hampden County is a mix of twenty-seven urban, suburban and rural cities and towns and approximately 50,000 SNAP households
25. Objective is to rigorously evaluate the impact of financial incentives provided at point-of-sale for the purchase of fruits, vegetables and other healthy foods on the diet of SNAP participants
26. Funded by a $20 million grant in the US Farm Bill of 2008
33. In 2008, all obesity-related medical expenses were estimated at $140 billion.Indiana 15.7% Delaware 13.8% Arizona 13.5% 12.9% Louisiana 12.9% Maryland New York 8.5% Wyoming 8.5% Alaska 8.2% All figures in million dollars (2003 dollars) Massachusetts 7.8% 7.7% Rhode Island Sources: RTI, CDC
34. Contents 1 Obesity and Nutrition in America 2 Low SES Communities and Mobile Technology 3 Mobile Applications as a Health Enabler 4 Mobile Health Apps Overview 5 Preliminary Gap Analysis 6 Conclusions & Next Steps 7 Appendix
35.
36. Smartphone penetration is growing rapidly and this year is estimated to grow by 4 percentage points.Sources: CTIA, eMarketer 2010 * estimates
37.
38.
39. The data demonstrated that minorities are comfortable using the mobile internet, making it a legitimate medium for health interventions.Source: Pew Research Center Mobile Access 2010
40.
41.
42. The probability of being a cell-only wireless internet user is higher among low SES communities.Source: Pew Research Center
43.
44. Android is a logical platform choice for developing applications intended to address the needs of low SES communities.Source: Pew Research Center, July 2011
45. Contents 1 Obesity and Nutrition in America 2 Low SES Communities and Mobile Technology 3 Mobile Applications as a Health Enabler 4 Mobile Health Apps Overview 5 Preliminary Gap Analysis 6 Conclusions & Next Steps 7 Appendix
46.
47.
48. “Behavioral Intervention for Overweight Women”, University of California – San Diego: Researchers assessed depressive symptoms in 401 participants in a randomized control trial of a 12-month primary care, phone and internet-based behavioral intervention for overweight women. Results showed that a 1-year primary care-based phone and internet diet and exercise intervention can improve depressive symptoms.Source: “Medication Adherence and m-Health“, George Washington University;“Behavioral Intervention for Overweight Women”, University of California – San Diego
52. Exercise: How to incorporate more exercise into your daily routine
53.
54.
55.
56.
57.
58. These apps tend to command a higher selling price than the average app.
59. Medical apps tend to be of higher quality than health & fitness apps, as rated by users.Sources: Detecon Analysis, July 2011; www.appbrain.com
60.
61. Relatively few enabling apps available (probably due to lack of appropriate or sufficient data) and relatively few intervening apps available (probably due to complexities of app design involving intervention time, manner etc.)Source: Detecon Analysis, July 2011
62.
63. The most popular obesity-relevant Android apps are informational in nature. However, they are simple and lack the more sophisticated personalization, social and gaming features necessary to motivate people to adopt long-term change.Source: Detecon Analysis, July 2011
64.
65. Based on this criteria, Detecon evaluated the availability and functionality of apps in the Android Market that target:
76. The chart below reflects the current distribution of Android Market apps relevant for obesity-related use cases.
77.
78. Contents 1 Obesity and Nutrition in America 2 Low SES Communities and Mobile Technology 3 Mobile Applications as a Health Enabler 4 Mobile Health Apps Overview 5 Preliminary Gap Analysis 6 Conclusions & Next Steps 7 Appendix
79.
80. Are there other or new strategies we might look to in the future?
81. How can A4G overcome the challenges of app discovery and increase awareness of relevant app resources among its target audience?
87. What types of app features will help improve health outcomes?
88. What types of app features are currently missing among available apps?
89. What considerations, specific to A4G‘s target population, must developers bear in mind?Detecon interviewed healthcare and information design researchers, as well as app developers, to explore the questions above and gain insight into needs, trends and potential solutions.
90. Frame Template 5. Preliminary Gap Analysis Apps targeting low SES communities and obesity consequences are notably missing from the market. Apps that act as enablers or intervention tools are also needed. App Availability by Functionality Intervening Educating Monitoring Enabling Comments Obesity Causes App Availability by Focus Area Obesity Consequences Low SES Groups Comments Source: Detecon Analysis, July 2011 Very few apps; Low quality Many apps; High quality
96. App usability must be designed to be inclusive of users with low literacy and numeracy.
97. Interventions must balance everyday realities: can users really afford to research, find and follow healthy recipes (from both a time and money perspective)? If not, what are the options?
98.
99. How can we predict when a patient is going to relapse?
100. How do you know when to prompt a patient? When is the optimal time for a reminder (for example, to exercise) to pop up so that the patient is most receptive to the message?
103. Accountability: patients enjoy receiving feedback and feeling accountable, but they want to control how/when the app interacts
104. Human touch: patients enjoy themselves and are more responsive if they believe there is a real person behind the communication.
105. Some programs sign all correspondence (even if the automated ones) with the name of the provider that the patient interacted with during the initial program set-up.
106. Timeliness: Technical interventions need to be a presence and resource for in-the-moment decision-makingEmerging Features for Health-Related Apps Questions for Further Investigation
107.
108. Combining principles of information design with those of persuasion design to better motivate users to adopt and sustain healthy habits. Leveraging:
111. It is important to offer users small ways to begin a program and ramp incrementally so they do not become overwhelmed and resort to excuses as to why they cannot take on such a daunting undertaking.
112. App usability must be designed to be inclusive of users with low literacy and numeracy.
113. It can be challenging to figure out what the right portion size & nutrient mix is, given the skills required to interpret & utilize label information
125. Consequences: use predictions of future health consequences to build awareness and motivate users to make changes nowEmerging Features for Health-Related Apps Questions for Further Investigation
140. Feedback loop: app store reviews, comments on community boards, and emails provide helpful sources of user feedback for developersEmerging Features for Health-Related Apps Questions for Further Investigation
148. A paid version of a freemium app has to offer more than just the same app absent advertising. There has to be real value offered to the consumer.
149. Successful apps are well-designed and look nice, in addition to offering valued functionality.
150. While developers have historically been fairly poor marketers, the ability to promote one’s app, stand out and garner attention from users has become increasingly critical to the success of an app.
151. The importance of frictionless payment options (such as carrier billing) is fast increasing.Emerging Features for Health-Related Apps Questions for Further Investigation
152. Contents 1 Obesity and Nutrition in America 2 Low SES Communities and Mobile Technology 3 Mobile Applications as a Health Enabler 4 Mobile Health Apps Overview 5 Preliminary Gap Analysis 6 Conclusions & Next Steps 7 Appendix
153.
154. Monitoring: There is also a need for high-quality monitoring apps that are user-friendly and sticky enough to motivate users to continue using them over long periods of time to maintain healthy regimens.
155. Intervening: Because mobile phones are in close proximity to users at all times, there is tremendous potential for apps to be used as intervening mechanisms to promote good habits and, potentially, discourage bad ones. (For example: reminders to take medication; prompts to exercise at regular intervals, etc) New sensor technologies embedded in phones may further enable the development of apps with targeted behavioral interventions.
156.
157. Initiate market research to better understand the specific challenges, needs, motivators and preferences of the low SES target segment.
158. Partner with developers of market-leading apps to add supplemental enabling functionality targeted to low SES communities.
159. Partner with developers to build new apps designed to meet the needs of low SES communities that offer enabling, monitoring and intervening functionality.Key Findings Next Steps for A4G
160.
161. Next generation apps will differentiate themselves and boost quality by integrating a host of features that will improve their value proposition, stickiness and effectiveness. For example:
164. Gaming to leverage users‘ competitiveness and increase fun factor, retention and motivation.
165. Goal-setting can be a powerful technique for behavior change. Apps that help users set realistic goals, develop plans and skills needed to reach those goals, and monitor progress along the way, are positioned to offer formidable tools for instilling healthy habits.
166. Robust apps that offer some of the most valuable tools for both education and behavioral change incorporate comprehensive databases which provide a rich source of information from which users can draw as they improve their own skills and decision-making.
167.
168. Expert knowledge of A4G’s target market preferences, behaviors and challenges will help A4G collaborate with developers to design appropriate solutions, user experiences and applications to drive positive behavioral change.
169. A4G might also consider sponsoring studies to research optimal tactics to overcome the challenges of low literacy and numeracy.
170. Usability and features designed with these users in mind will expand mobile app access to a broader population.Key Findings Next Steps for A4G
171.
172. App discovery is a significant challenge across the mobile ecosystem and even more acute for applications targeting a smaller, often-marginalized group of users.
179. The Beehive has a health section which is targeted to users of low SES. Market-leading and low SES-targeted apps could be promoted effectively via this outlet.
180. One Economy‘s partners in bringing broadband to underserved communities (particularly in public housing projects) could also be tapped to help promote awareness of leading health apps.
181. Additionally, A4G could create a ‘Featured Apps‘ page on its website and promote the page among target groups to boost awareness. This central clearinghouse could serve as a destination for A4G‘s target audience looking for a curated list of apps well-suited to their needs.
182. A4G could develop a list of marketing guidelines or best practices for developers seeking to serve A4G‘s constituents.
183. A4G could also develop partnerships with corporate entities (such as insurance, pharmaceutical and food companies) to develop co-marketing campaigns.Key Findings Next Steps for A4G
188. Health insurance companies might benefit from subsidizing app development and distribution costs if apps can help reduce other costs such as hospitalizations resulting from drug non-compliance or poor health conditions as a result of unhealthy (nutrition or exercise) choices.
189. Example: State Farm sponsored an app called On the Move that sends automatic text message replies while the user is driving. The company hopes the app will help users avoid distracted driving, thereby saving the company money by reducing the number of accident claims.Key Findings Next Steps for A4G
190. Contents 1 Obesity and Nutrition in America 2 Low SES Communities and Mobile Technology 3 Mobile Applications as a Health Enabler 4 Mobile Health Apps Overview 5 Preliminary Gap Analysis 6 Conclusions & Next Steps 7 Appendix
201. OnTrack helps diabetics manage their diabetes by tracking various items such as blood glucose, food, medication, blood pressure (BP), pulse, exercise and weight.
203. Add multiple entries simultaneously, for example add glucose and medication at one time quickly and easily & a variety of detailed graphs and reports
204. a detailed log book with tables and graphs suitable for sharing with your doctor
213. Rena Wing, PhDDirector, Weight Control & Diabetes Research Center at the Miriam Hospital, RIProfessor, Department of Psychiatry and Human Behavior, Brown University Medical School
![Frame Template Project Overview Applications for Good (A4G) asked Detecon to assess how mobile applications can be leveraged to alleviate obesity-related health issues in underserved communities. Overview Objective Evaluate how mobile applications can be leveraged to positively impact obesity-related health issues most acutely felt by low-income and minority communities. Approach Market Overview & Preliminary Gap Analysis ,[object Object]](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)