- Not every mHealth app is well-suited to increase patient engagement for every patient population, but one new tool out of the University of Southern California (USC) has proven effective for the charitable-minded.
The tool, detailed in a recent post in the New England Journal of Medicine Catalyst, leveraged different components to make it appealing to multiple patient demographics.
First, the tool has a fitness tracker embedded in an individual’s prescription eyeglasses, measuring step counts, calories, distance traveled, and activity time. This helps eliminate barriers to using a traditional fitness tracker, such as a step counter bracelet or app in a patient’s phone, said the researchers from USC’s Center for Body Computing.
“Qualitative analyses of the reasons include forgetting to wear the device, discomfort during exercise, lack of aesthetic appeal, and loss of interest. In some cases, users report they have met their fitness goals and no longer rely on the device,” the group wrote in NEJM Catalyst.
The glasses served as an effective solution for those barriers because patients rarely forget to wear their glasses, or decide they just don’t want to wear the glasses anymore. Per previous findings from the group, the prevalence of visual impairment and blindness is set to double by 2050, opening a vast market for the wearable.
Second, the glasses used a philanthropy component to motivate patient engagement and use. When patients hit their step count goals 50 times, the glasses development company VSP Global donated a free eye exam and pair of glasses to the users’ choice of vulnerable population: school children, the elderly, veterans, or homeless individuals.
Third, the glasses recorded wellness data in participants’ smartphones. That data was also shared on a social media platform only available to device users. Social network users had the ability to connect with each other, comment, and “like” each other’s wellness progress reports.
That social component supplemented the fourth factor within the app: periodic, automated motivational messages. These were meant to reinforce positive behavior change and motivate patients who were not active to increase their activity.
Together, these app features were set to test three areas over a 15-week study:
- How can patient personality traits predict user engagement?
- How do motivational prompts and social networking supports patient motivation?
- How does embedded and easy-to-use hardware lead to better user interaction with the sensor?
A personality assessment that the study participants completed prior to the study’s start showed that certain patients were more motivated by the tool than others. Older patients with higher levels of life satisfaction were deemed likely to regularly engage with the app. Additionally, patients with a high propensity for charitable giving and social relationships were more likely to stick with the app.
For example, patients who received more “likes” and comments on their progress posts usually had higher step counts than others. Patients deemed likely for charitable giving walked on average 700 more steps than other participants.
The digital health coaching and automated motivational messages also improved the likelihood that a patient would take more steps. Patients who did receive motivational messages walked on average 7,389 steps daily, while patients without coaching only walked about 5,924 steps daily.
Embedding the step counting sensor into patients’ eyeglasses was deemed an extremely valuable decision, the researchers said. Patients reported that this element was the most effective part of the mHealth intervention and make it easier to incorporate the wearable into their daily lives.
Despite those proclamations, patients still abandoned the wearable intervention at about the same rate as patients do in other studies. This phenomenon is likely because the eyeglasses sensors still had the same hardware problems traditional sensors have – hindered ability to connect with apps, for example.
Although not all study participants stuck with the intervention, the researchers maintained that the study still gleaned valuable insights.
"While we cannot say we've cracked the code for long-term motivation of physical activity, we still learned a tremendous amount: digital prompts, social support, philanthropy, older age, and life satisfaction created the most impact in motivating our participants," researcher Glenn Fox, PhD, Head of Design, Strategy and Outreach at the USC Performance Science Institute, said in a statement. "We now know these are all keys to increased engagement with fitness trackers and deserve further investigation."
The study identified which patients might be more apt to use certain mHealth apps, and negated the idea of a one-size-fits-all mHealth intervention. Patients with a high likelihood for charitable giving or with a positive life outlook should be introduced to tools similar to the one discussed in this study, the researchers said, while other patients should use different tools.
Finding the right mHealth intervention for certain patients is critical, lead researcher Leslie Saxon, MD, said in a statement. Healthcare professionals are increasingly recognizing the effectiveness of these tools in improving patient health, and it will be important for clinicians to have a diverse array of interventions to fit patient motivation needs as more patients fall into high-risk populations.
"One in every five Americans wears a health tracker but there was no research that took a look at what motivates engagement, until now," Saxon concluded.
"Since the average study participant fell into a group considered overweight—which can lead to increasing health issues such as diabetes and heart disease—it was illuminating to find digital coaching via the app and an altruistic connection helped these participants maintain their engagement or even increase their activity in some areas."