One of the most fascinating things about health apps is the process of selecting them: defining the need, determining how to search and which search terms to use, deciding which to consider, and deciding which to try. Having thought a lot about health app search, I was thrilled to have an opportunity to talk about the broader issue of mobile health search in a session at APHA12 on health information seeking. My presentation first argued that it is almost impossible to focus only on laptops and desktops when considering health information seeking given the preponderance of mobile devices. I then talked about what mobile devices provide health seekers: immediacy and access; affinity; multiple methods of input/output; and context. For instance, I spoke about the role of the contextual information people see, hear, feel, and remember and how that impacts search; and external information and data from sensors, such as weather, location, time of day, and blood pressure, impact personalization and tailoring. I also talked about how the impact could be huge if public health had the resources of retail for the use of big data and predictive analytics.

1. Mobile Advantage:
Context and Immediacy in
Health Information Seeking
Lisa Gualtieri, PhD, ScM
Assistant Professor
Dept. of Public Health and Community Medicine
Tufts University School of Medicine
Email: l.gualtieri@tufts.edu
Twitter: @lisagualtieri

2. Health search is everywhere
• Last night, in J.K. Rowling’s The
Casual Vacancy, I read…
– “She navigated away from the
Parish Council message board and
dropped into her favorite medical
website, where she painstakingly
entered the words "brain" and
"death" in the search box.
The suggestions were endless.
Shirley scrolled through the
possibilities…”

3. Agenda
• Past
• Present
– Focus on what
mobile devices
provide health
seekers
• Future
3

4. Past, present, and future of health
information seeking behavior
?
“Democratization
of location” Future?
Democratization
of medical Present: Look it
information up on mobile
Past: Look device in waiting
it up at room, elevator,
work or at car, walking, etc.
Distant past: home
Literature,
family, friends 4

5. Before looking at mobile health search,
need to ask if people use mobile devices
• 321.7M wireless subscribers in US at end of 2011
– Penetration of 101%
• Smartphones now outnumber feature phones for
the first time in the US
• 1 in 8 internet page views are on smartphone or
tablet, doubling in just a year
– Comscore 9/12
• Almost impossible to focus only on laptops and
desktops when considering health information
seeking

6. Not only are mobile devices used but
they may eradicate the “digital divide”
• Smartphone ownership in US
– 49% of Hispanics
– 47% of African Americans
– 42% of whites
– Pew Internet & American Life Project 9/12

7. Some people are only using mobile devices
• 34% of US household are wireless only
– Stephen J. Blumberg, Julian V. Luke, Wireless
Substitution: Early release of estimates from the
National Health Interview Survey, July-December
2011, National Center for Health Statistics, 2012,
http://www.cdc.gov/nchs/data/nhsr/nhsr061.pdf
• But one device or many?

8. Some people are using
lots of mobile devices
• 40% of US households have 3 or more mobile
devices in addition to their PCs & TVs
• Differences in
– Where mobile phones and tablets are used
– Frequency of use

9. Where are mobile phones and tablets used?
Note that doctor’s office isn’t listed! 56%
Living room 88%
Bedroom 53%
79%
Work 49%
35%
Outdoors 48%
31%
Car 45%
29%
Stores 42%
12%
Restaurant/coffee shop 41%
32%
Other room in my house 39%
32%
Kitchen 36%
51%
Hotel 34%
44%
Bathroom 30%
30%
Airport/airplane 29%
41%
Events 28% mobile
14%
Home office 26% tablet*
35%
Other 18%
9%
Train/subway/bus 18%
15%
School 17%
15%
Library 15%
16%
Bank 13%
6%
Church or place of worship 6%
6% Base: 2,116 US online adults who own a mobile phone; Base: 549 US online adults who own a tablet
Source: North American Technographics Telecom And Devices Online Recontact Survey, Q3 2011 (US)

10. Tablets are used more frequently than smartphones with the exception of
daily health content users
25% 24%
20% Smartphone
Tablet
16%
15%
13% 13%
11%
10% 9%
8% 8%
6%
5%
5%
0%
Daily 5-6x per 2-4x per Once a Less than
Week Week week 1x per
Source: comScore Custom Research – Jan/Feb 2010 Total n=1191 and Jan 2012 Total n=1033 week
How often do you use your device for health purposes?

11. What do mobile devices
provide health seekers?
• Immediacy and access
• Affinity
• Multiple methods of input/output
• Context

12. Immediacy and access
• 85% of respondents had cell phones
– 53% of these, or 45% of US adults, had smartphones
– Cell phone owners
• 31% look for health or medical information
• 11% have health apps
• 9% receive text updates or alerts from doctor or pharmacist
– Pew 9/12 via Susannah Fox
• Mobile devices may be used immediately after leaving doctor’s
office, especially with a new diagnosis or prescription
– Impact on health literacy especially recall and retention
– Impact on patient-physician communication
• Could patients listen or ask questions differently due to reliance on search?

13. What do mobile devices
provide health seekers?
• Immediacy and access
• Affinity
• Multiple methods of input/output
• Context
More lovable
when they’re
cute and little

14. Affinity
• People relate to computers differently than people
– What about smartphones? Tablets?
• Mobile users have an ongoing intimate and
personalized relationship with their “digital
appendage” or “cognitive prosthetic device”
• Do people seek information differently?
– Searches on mobile devices tend to be about
private/sensitive conditions: sexually transmitted
diseases, mental health
• How is use changing?
– Greater online community use

15. Top 10 health searches 2011
Web Mobile
• 1. Cancer • 1. Chlamydia
• 2. Diabetes • 2. Bipolar disorder
• 3. Symptom • 3. Depression
• 4. Pain • 4. Smoking/quit smoking
• 5. Weight • 5. Herpes
• 6. Infection • 6. Gout
• 7. Virus • 7. Scabies
• 8. Diet • 8. Multiple Sclerosis
• 9. Thyroid • 9. Pregnancy
• 10. Sleep • 10. Vitamin A
• Healthline Networks

16. Online research is up in every category with the greatest growth
in community support
64% 65% 64%
2010 2012 Largest shift: more people
were seeking online
55%
54%
communities!
53% 52%
47%
45%
41%
39%
33%
32%
22%
15%
10%
Source: comScore Custom Research – Jan/Feb 2010 Total n=1191 and Jan 2012 Total n=1033
What types of health-related information have you looked for online in the last 6 months?

17. What do mobile devices
provide health seekers?
• Immediacy and access
• Affinity
• Multiple methods of input/output
• Context

18. Methods of input/output
• Input: less typing, fewer spelling mistakes
– Text: Autocomplete, word suggestions, etc.
– Voice: “Siri, what is…”
– QR codes
• Search: many types of mobile search: app and browser
– In mobile browser
– On mobile website
– In app store
– In an app
• Output: limitations are screen size and location/privacy
– Text
– Images
– Video

19. 14,000
More Mobile Health Access
52%
12,000
through Browser than App
Thousands
10,000
59%
8,000
6,000
4,000
2,000
-
Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12
Accessed health information [Application] Accessed health information [Browser ]
 SOURCE: COMSCORE MOBIL LENS, 3 MOS ENDING MARCH 2012

20. Number of search results viewed on
smartphone versus computer

21. What do mobile devices
provide health seekers?
• Immediacy and access
• Affinity
• Multiple methods of input/output
• Context

22. Context
• People are exposed to a wealth of contextual
information: what they see, hear, feel, remember
– How do people act on it using their mobile device?
• Multiple devices monitor and record contextual
information, including sensors and GPS
– How do weather, location, time of day, blood
pressure, etc. impact personalization and tailoring?
• Big data and predictive analytics

23. Sometimes asking questions leads to
more questions: fighting the Hydra

24. Some of my questions…
• Do people conduct health searches differently
– On smartphones or tablets?
– In mobile browsers or mobile websites or app stores or apps?
– Using text or voice?
– Based on location?
• Are people more or less easily able to locate “helpful”
information?
• Are there different indicators of quality or reliability?
• How can mobile health search better help people to seek
information and achieve their health goals?

25. Near future
• Design for mobile first instead of retrofitting
health websites into mobile format
• Make smarter smartphones and better integrate
sensor data
• Learn from strategies used by well-funded retail
– Use of big data and predictive analytics to provide
accurate and timely health information

26. Future
• From digital appendages to… Google glasses
• The ultimate in seamless mobile health search?
• Stay in touch
– Email: l.gualtieri@tufts.edu
– Twitter: @lisagualtieri