Presentation made at the American Public Health Association Meeting, San Francisco, CA. 30 October 2012. This presentation includes images from the PSFK 'Future of Health' report; content developed from the mHealth Evidence Workshop convened at the National Institutes of Health [16 October 2011]; and mHealth marketing recommendations from Lefebvre RC. Integrating cell phones and mobile technologies into public health practice: A social marketing perspective. Health Promotion Practice, 2009; 10:490-494.

1. Creating the Evidence
Base for mHealth
Txt4Health: Using Mobile Technology in Public
Health Communication and Education Campaigns
American Public Health Association
San Francisco, 30 October 2012

2. Presenter Disclosures
R. Craig Lefebvre, aka chiefmaven
The following personal financial relationships with
commercial interests relevant to this presentation
existed during the past 12 months:
“No relationships to disclose”

3. Mobile Thoughts
When the expectations of
wireless experts are
realized everyone will
have his own pocket
telephone and may be
called wherever he
happens to be…When
that invention is
perfected, we shall have
a new series of daily
miracles (circa 1908).

4. It Took About 100 Years, But Then
It Went Mainstream - Fast.

5. The 7th Mass Media Channel
1 - first personal mass media
2 - permanently carried media
3 - always-on mass media
4 - built-in response
mechanisms
5 - at the point of creative
inspiration
6 - accurate audience
measurement
7 - captures the social context
Tomi T Ahomen. Communities
of people’s lives Dominate Brands blog, 2 May 2008.

14. mHealth Evidence
Challenges
• Create and evaluate scalable systems capable of
collecting unprecedented amounts of data
• Analyze and integrate that data with other health
information
• Field interventions—some in real time—while at
the same time providing value and protecting the
safety of participants.

15. mHealth Opportunities
• Contributes novel measurement methods and
processes
• Enable the design and delivery of novel
interventions that can be delivered remotely and in
real time
• Offers new methods of data collection and
analysis that can improve the speed and efficiency
of health research and evidence of an intervention
or treatment effect.

16. mHealth Research
Challenges
• Difficult to create controlled and reproducible
environments
• mHealth devices are frequently used by
individuals with little training that may affect their
reliability and validity
• Few gold standard measurements exist in the
mobile environment, self-report measures may be
the most accepted existing assessment
• Risks to privacy and security

17. Evidence Requirements
• Statistical Conclusion Validity - evidence of a
meaningful, causal effect
• Internal Validity - rule out confounders
• Construct Validity - validity of outcome measures
• External Validity - generalizability across
persons, settings, and times
• Ecological Validity – can be implemented in real-
world settings and integrated into life and work
flow

18. When are Randomized
Clinical Trials Indicated?
• Interventions have been shown to be feasible and
acceptable
• Whose efficacy has been demonstrated in quasi-
experimental designs
• There is the desire to demonstrate superiority to
exiting approaches to the same problem

19. Quasi-Experimental Designs
for mHealth
• Pretest-posttest (with and without comparison
conditions)
• N of 1 (with multiple crossover – ABABAB)
• Interrupted Times Series Design – (AAAAB, with
and without comparison groups)
• Stepped Wedge (or delayed treatment)

20. Other Research
Considerations
• Continuous Evaluation of Evolving Interventions
(CCEI) – new versions are added to original
protocol
• Adaptive Interventions - personal tailoring

21. Quality Considerations for
mHealth Interventions
• Selection of • Timing of
appropriate communication
technology
• Understanding of
• Privacy assurances priority group
• Linguistic and literacy • Long-term evaluation
competency
Gurman et al (2012). Effectiveness of
• 2-way mHealth behavior change
communication communication interventions in
developing countries: A systematic
• Targeting & tailoring
review of the literature. Journal of
content Health Communication; 17 (suppl 1):
82-104.

22. Marketing and
mHealth
How do I add
mHealth features
to my behavior
change
products, service
s and
programs??

23. Marketing and
mHealth
• How do I use these
technologies to
overcome
psychological and
social barriers
(costs)
• develop new
incentives and
reinforcers
• create new ways of
providing social
support to people
who are trying to
change behaviors?
social support to people who are trying to
change behaviors?

24. Marketing and
mHealth
How can I place-
shift; use SNS, co-
presence and
virtual worlds; and
add GPS to create
scalable behavior
change
programs??

25. Marketing and
mHealth
How do I facilitate
conversations
among
people, not aim
messages at
them?

26. Are we available when, where
and how people want us to be?

28. R. Craig Lefebvre, PhD
Lead Change Designer, RTI International
University of South Florida College of Public Health
socialShift, Sarasota, FL
social|design, marketing and media
On Social Marketing and Social Change
http://socialmarketing.blogs.com
http://twitter.com/chiefmaven