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The role of digital technology in changing patient behaviour

Applying an evidence-based approach to optimising digital solutions will increase your chances of success
With the combination of advances in digital technology and increasingly burdened healthcare systems, the pharmaceutical industry and healthcare providers could be forgiven for believing that the elusive answer to achieving optimal self-management and medicines adherence is just an app away!

Those leading the digital revolution clearly think the same. With Apple’s release of its Health app and HealthKit platform, the UK government’s backing of Proteus’ innovative ‘chip in a pill’ technology and a myriad of other competing and complementary technologies vying for evolutionary dominance and application in healthcare, it’s clear that we’re not short of options. But is this increased focus on technology really delivering value to all stakeholders and ultimately improving health outcomes? There’s some evidence to suggest not. In January 2012 Google retired its Health offering, saying it was “not having the broad impact that we hoped it would”. The company added: “There has been adoption among certain groups of users like tech-savvy patients and their caregivers, and more recently fitness and wellness enthusiasts. But we haven’t found a way to translate that limited usage into widespread adoption in the daily health routines of millions of people. That’s why we’ve made the difficult decision to discontinue the Google Health service.” More recently a white paper looking at the adoption of ‘wearables’, such as the Jawbone UP and Nike Fuelband, suggested that “more than half of US consumers who have owned a modern activity tracker no longer use it and a third of US consumers who have owned one stopped using the device within six months of receiving it”.

With such a wealth a digital applications designed to support positive health behaviours, why are so many failing to achieve their desired outcomes?

Changing behaviour
At the recent launch of the University College London (UCL) Centre for Behaviour Change, one of the plenary speakers highlighted that, “behaviour change isn’t rocket science, it’s much more complicated than that!”. And while the disciplines of behavioural medicine and health psychology have isolated many of the key determinants of sub-optimal illness self-management and medicines adherence, successful interventions in controlled, non-digital environments have met with limited success. Add to this the complexities of understanding and influencing digital health behaviours, it’s clear to see why most forays into the world of health have failed. Simply put, technology on its own is not enough. Why, because digital technology is only one component of the solution and is essentially just the delivery mechanism of the broader intervention. Assuming the delivery mechanism in isolation is enough to change patient behaviour will lead the project down a path to failure.

Achieving digital health goals
So what can we do to ensure that our digital health projects are designed to achieve both improvements in individual and population health and also add to the growing body of evidence within this field? Firstly, one must start by applying existing validated and evidence-based approaches. All too often, digital health projects start with the technology or channel within which they’ll be delivered, and fail to focus on the content that will be received or its context. One of the dominant factors as to why health-based portals and apps fail is due to poor adoption and lack of engagement by the users they were originally designed for. While the reasons for this are complex, it’s likely that much less attention was paid to user experience, content development and context of the solution itself. To improve the chance of success, every individual interaction needs to be personalised, manageable and perceived to be from a trusted source. But are technology-led, digital healthcare companies or the pharmaceutical industry best placed to understand the challenges of human health behaviours?

One must understand that no matter how technologically capable the solution is, this isn’t a determinant of adoption, engagement and retention. One size most definitely does not fit all and expectations, in terms of enrolment into any digitally-based solution, must be set. However, applying an evidence-based approach to optimising health-based digital solutions is much more likely to deliver success.

The content-context-channel model (see above), developed in 2012 by Rob Horne, professor of behavioural medicine at UCL and scientific director and co-founder of Spoonful of Sugar, is a good starting point. Taking these constructs one by one, this process can be instructive to ensure the right balance exists within a digital programme’s design.

Personalised communication, specific to the individual needs of each target patient, is essential in achieving any behavioural change goal. Tailoring information and education, based upon the predictors of illness self-management and adherence defined in any pre-development insight work, is possible utilising a range of validated profiling tools developed within academia. For example, each patient prescribed treatment for a long-term condition will have his own personal set of perceptual and practical barriers to achieving optimal adherence and these can be defined quite simply at the start of any programme using one such tool, the Beliefs About Medicines questionnaire, developed by Professor Horne in 1999 to help understand individual patient beliefs about treatment. Profiling patients within any digital solution is key to ensuring that only the most salient and pertinent information is delivered to the patient and the solution remains relevant and valued.

Many digital solutions are conceived, and often developed, in isolation of the specific end user and without full engagement with the community that will be essential in driving adoption and fostering advocacy for the solution. The assumption that the clinical community is waiting for health-based digital solutions to become part of its multidisciplinary team is a risky one. Specifically, we know that there is healthy scepticism in relation to industry-funded patient support and it’s unfortunate that we see far too many solutions that end up looking like a direct extension of a company’s marketing platforms. To truly engage patients with any solution, and remove the mistrust surrounding industry-funded support, solutions must be developed in conjunction with healthcare professionals, patient support groups and payers, and essentially handed over to the patient community. Only then will we see adoption levels increase and, paradoxically, an exponential increase on the return on investment.

And finally to take us back to where this article started. Of course, the benefits of utilising digital channels to communicate and educate patients is of tremendous value to healthcare, but without paying proper attention to the real determinants of illness and medicines-related behaviour, the success of these interventions will be limited at best. Relying solely on one channel, without engaging with individual patient preferences, motivations and beliefs, including those relating to how they wish to be contacted, will ensure these very obvious fault lines in modern healthcare communications continue to proliferate.

Digital technologists, healthcare providers, the pharmaceutical industry and patient support organisations are still in search of that ‘magic bullet’. One that will release pressure on healthcare services and improve health outcomes beyond the traditional healthcare setting. While this desire is critical in managing population health in the future, assuming that digital technology alone will be the solution is like assuming pharmacological treatments alone are the panacea to achieving healthier patients.

The author
Andrew Martello, managing director and co-founder of Spoonful of Sugar. For further information on how to optimise digital patient solutions email, follow @SoSAdherence on Twitter or watch the evidence-based adherence strategies webinar on May 28 here:

3rd June 2014



Company Details

Spoonful of Sugar

020 3714 5630

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45 King William Street

Latest content on this profile

The role of digital technology in changing patient behaviour
Applying an evidence-based approach to optimising digital solutions will increase your chances of success
Spoonful of Sugar
Evidence-Based Adherence Strategies: behavioural medicine and the patient’s perspective. Free webinar
On 28th May at 2:30pm (GMT), PMLiVE is partnering with Rob Horne (Professor of Behavioural Medicine at the UCL School of Pharmacy and internationally recognised expert in medicines-related behavior and adherence to medicines) and Spoonful of Sugar (a University College London Business spin-out company) in a unique, free-to-join webinar that promises to uncover the challenges and potential solutions in the development of patient-centred adherence strategies.
Spoonful of Sugar