Making digital health personal

The World Health Organization estimates that between 30-50% of medications for long-term conditions are not taken as prescribed. Non-adherence can have negative consequences for both treatment outcomes and healthcare costs

To tackle this problem, digitally-led behaviour-change solutions aimed at patients are increasingly popular and appropriate. They can be effective at positively changing patients’ health behaviours and improving health outcomes. However, they can only be effective if they are properly designed, developed and, ultimately, used by patients.

Patients have competing motivations and considerations when it comes to managing their health. These must be properly considered to ensure that programmes are appropriately designed to fulfil patient needs. A recent research paper on this topic provides the example of a tailored online intervention to promote heart health. Despite nearly 90,000 visitors registering to use the tool, only 6% (just under 550 people) revisited the intervention after completing a single module³. Simply putting some information on to a website or giving people ‘another’ app is not enough. Behaviour change is still a complex phenomenon and digital health solutions have to work hard if they are going to deliver the desired outcomes.

What is needed is an established process and infrastructure to design, implement and measure digital tools, as increasing the personal relevance of these tools may lead to improved health outcomes through the promotion of behaviour change.

So, what makes a good digital behaviour-change solution? Studies suggest that there are two factors that emerge as being important for both retention and behaviour change. They are personalisation (making the experience feel more relevant to the users) and progress tracking (helping the users to track their progress). These two factors are discussed below in more detail, along with case study examples.

Personalisation

Digital behaviour-change solutions that are personalised to a patient’s needs are associated with both a high retention of patients and behaviour change. Digital media and sophisticated patient relationship management (PRM) systems can move beyond patient segmentation to personalise on multiple variables, creating a vast array of patient experiences and journeys.

Personalisation of digital tools can include:

• Ensuring that patients’ journeys are personalised to factors that drive their behaviour (eg a perceived need for treatment as a driver of non-adherence)
• Surfacing content on the patients’ homepages that directly relates to the challenges they face. For example, if the patients don’t perceive the need for treatment, promoting content that up-skills and educates them around this factor is important
• Motivational messages to maintain momentum based on users’ engagement and behaviour eg adherence
• Stacking content in a prioritised order, which can be re-ordered to stay relevant as the patient journey progresses
• Giving patients the option of ‘pinning’ content to their homepage that they have found useful, or that they might want to refer to again in the future.

Personalisation: A case study

This case study is of a digital health support programme that improved persistence of people with ulcerative colitis. The reasons for non-adherence among patients entering the programme were captured at enrolment via a patient survey (eg concerns about potential side effects, difficulties with routines). These insights were then leveraged to personalise the content of the digital health intervention, ie scheduling behaviour-change calls, SMS, emails and interactive e-learning modules over a six-month period. The programme received good uptake with 95% of patients completing the programme, and was effective as measured by a 34% higher treatment persistence rate at six months for those on the programme compared with baseline data.

Progress tracking

Patient self-monitoring and providing feedback are accepted behaviour-change techniques, which are effective in digital behaviour-change interventions. In addition, allowing participants to track their progress is associated with high participant retention in digital programmes.

Where it is not possible to track patients’ behaviour, common gamification techniques such as badges for achievement, levels and leader boards can be used to help patients log their progress through a programme, eg, by completing e-learning modules.

The prospect of encouraging patient self-monitoring and feedback will always be a potential cause for concern within legal and pharmacovigilance departments. However, it is possible to carefully navigate the regulatory environment to provide helpful patient tools. As with all support tactics, it’s important to undertake research with the patient population to identify their needs, rather than assuming that tracking and interventions will be perceived to be beneficial by all patients.

Progress tracking: A case study

This case study looks at a native app developed in the US market for a local pharma client that allows patients to plan their medication schedule; it also offers the ability to track adherence and symptoms over time. This data can then be shared with a doctor during a consultation to allow for any necessary dose adjustments. Another native app developed for a global client directly tackles adherence, both to medication and to a food-restriction window around medication, through addressing the underlying reasons driving non-adherence. It delivers motivational, behaviour-targeted messages based on each patient’s adherence and app usage behaviour. Patients can set the time when they routinely wish to take their medication and receive reminders on when to start or stop eating and take medication. Patients record their adherence within the app or via a one-touch medication usage log from the lock screen. Patients can view their overall adherence score and longitudinal adherence data. The app, which was initially launched in Germany, has been endorsed by global healthcare experts and is due to be rolled-out across additional markets in the near future. Results from patients using the programme are expected soon.

An opportunity

Digital health interventions have enormous potential as scalable tools to improve health and healthcare delivery; however they must be carefully designed and delivered with patient needs in mind. By increasing the personal relevance of digital interventions and implementing tried and tested behaviour change techniques such as increasing personalisation and incorporating patient self-monitoring and feedback tools, pharma can successfully promote patient behaviour change. Through doing so, there is an opportunity to improve health outcomes and prove value-based care.

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