Go mobile

In 2008, I summarized Pew Internet’s health findings in 7 words of wisdom:

Recruit doctors. Let e-patients lead. Go mobile.*

Four years later, I’m banging the same drum, but with even more data to back it up. The market for mobile-ready health information continues to grow, even as health apps are just simmering along (in terms of consumer adoption, anyway).

Today’s report, “Mobile Health 2012,” is the first of a series based on a survey fielded by the Pew Internet Project and the California HealthCare Foundation. Our plan is to release one report every four weeks (or so), so stayed tuned to pewinternet.org (and apologies to anyone whose email I don’t return since I’ll be spending more time in my writing cave).

Here is a round-up of reactions I’ve seen to the new mobile health data — thanks to each one of the authors for taking the time to write about it:

Pew: 19 percent of smartphone users have health apps, by Jonah Comstock

Three years of stagnant health app adoption, by Brian Dolan

Pew Research launch Mobile Health 2012, by David Doherty

How smart phones help me be a better doctor, by Claire McCarthy, MD

Pew survey finds mobile health adoption growing, by Gus Sentementes

I can’t wait to participate in all the conversations that will stem from this research. I learn from each person who reaches out with a reaction, whether it’s on Twitter, Facebook, by email, in a blog post, or a mainstream media article. If you have thoughts to share — or see an article I missed — please post in the comments or find me online!

* I later updated it to reflect the fact that we need all health professionals to participate, so: “Recruit clinicians.”

12 thoughts on “Go mobile

  1. Susannah,

    Great piece of work as always!

    I wanted to put in a plug of the same kind that I’ve put in on your web research – when you ask “Do you get information about your health from your health professional” and “Do you get health information online” – they come across as mutually exclusive.

    I think you’ve changed this on the web side, would you consider having the same situation happen on the mobile side, i.e. “Do you get health information online FROM your health professional” – I think this will unmask the value in mobile health, since you’ve shown that health professionals are the #1 source of health information overall.

    I want to state this is not me being doctor-centric, and as I have discussed, I never imagined 10 years ago that the connection to the health professional would continue to be so strong in this era, but it has and it seems to be the wave to ride for this technology to help people be healthy.

    I presented my findings on this recently:

    http://www.tedeytan.com/2012/09/26/11645

    I wanted to offer help if you need it on crafting the right question based on our experience (4M people online, 18% now accessing via mobile), that you could then generalize to your audience. Let me/us know!

    Thanks for helping us excel,

    Ted

    • Thanks, Ted, as always.

      One of Pew Internet’s challenges is asking questions in a way that everyone can understand, from the smartphone-wielding 20-year-old who has to think for a minute about whether a certain conversation happened “online” or “offline” to the still-on-dial-up 60-year-old who isn’t quite sure what we mean by the word “smartphone.” And then there are still the small percentage of U.S. adults who don’t have internet access, nor a cell phone at all.

      We also have a challenge in capturing general activity vs. specific. There is a significant difference between “ever” questions and “yesterday” or “the last time” questions. Both types are useful, but for different aspects of the internet’s impact. One measures the question, “How many people know this activity exists and have done it?” and the other measures something closer to “How many people do this on a go-to or regular basis, like on a typical day or during a typical search?”

      Here’s the question that yielded the “31% of cell phone owners” stat:

      Please tell me if you ever use your cell phone to do any of the following things. Do you ever use your cell phone to [INSERT ITEMS; ALWAYS ASK a-b FIRST in order; RANDOMIZE c-f]? [Next, what about using your cell phone to… [INSERT NEXT ITEM]?]

      a. Send or receive email
      b. Send or receive text messages
      c. Take a picture
      d. Access the internet
      e. Look for health or medical information online
      f. Check your bank account balance or do any online banking

      And, for reference, here’s the question we ask which yields the stats about how health professionals are still the #1 source of health information for most U.S. adults:

      Thinking about the LAST time you had a serious health issue or experienced any significant change in your physical health… Did you get information, care or support from… [INSERT ITEM; RANDOMIZE]? [IF YES AND INTERNET USER: Did you interact with them ONLINE through the internet or email, OFFLINE by visiting them in person or talking on the phone, or BOTH online and offline?]

      a. A doctor or other health care professional
      b. Friends and family
      c. Others who have the same health condition

      CATEGORIES
      1 Yes, online
      2 Yes, offline
      3 Yes, both online and offline
      4 No, did not use this source

      In 2010, we found that:

      “When asked to think about the last time they had a health issue, 71% of adults in the U.S. say they received information, care, or support from a health professional. Fifty-five percent of adults say they received such help from friends and family. Twenty-one percent of adults say they turned to others who have the same health condition for information, care, or suppport. The vast majority of respondents say those interactions happened offline.”

      And I don’t mind sharing in advance the 2012 findings, in broad outline: not much changed.

      All of this is to say: Yes, I’d love help figuring out how to integrate mobile into our general internet survey questions.

      But I suspect that our respondents are way ahead of us, already answering “online” when, if we dug down, they might be able to tell us whether their online interaction with a health professional was via text, an email, a secure Web portal message, etc etc. To those who are living online, it all runs together. To those who are not, it’s a mystery anyway and they’d answer “offline.”

      We are in another transitional moment, as I told Jonah & Brian at MobiHealthNews, when most people understand what a smartphone is, but not everyone has one, and yet those who do are starting to see their online/mobile experience as seamless.

      Hope all of that makes sense! Let’s keep the conversation going. This is indeed why I value social media and why I hope more researchers jump in. Communications is not just for the communications department anymore.

  2. My clumsy phrasing of a couple of findings has resulted in some valid critiques (David, I’m looking at you with gratitude) and some misinterpretation. I checked in with Lee Rainie, my boss, and we are going to publish a revised report to reflect two specific changes:

    1) The first paragraph of the Key Findings section is not worded as clearly as the first paragraph of the Main Findings, so I’m going to cut & paste to make them identical. My mistake was to count on everyone reading both and therefore trying to be quick, while really I should just be clear.

    2) Few receive text updates about health or medical issues <– that is our finding, and again, my artistic license should be revoked for writing, “Texting is nearly universal, but not for health” and “Few are texting for health-related purposes.”

    Any other critiques? I’ll leave it open for this morning in case others would like to weigh in with community peer review comments. Thanks so much, everyone, for either contacting me directly or posting to Twitter so I can see your comments.

    • If you are interested in other examples of how SMS (aka texting) can be used in a health context, check out:

      http://occupysms.org/

      And I am still thinking about David Doherty’s point that if a sibling texts “is mum ok?” to another sibling who is caring her their mother, then that is a health-related text.

      I have now updated the report to reflect this — deleting “Few are texting for health-related purposes” and replacing it with “Few receive text alerts about health or medical issues.”

  3. Susannah:

    Thanks much for your continued fantastic work. I have an overall comment about the mobile health marketplace based on reactions I’ve seen to your research and some suggestions for further investigations that Pew might conduct in this area.

    Looking at your data (and similar data we’ve collected focusing on mhealth app use) suggests to me that while it’s important to focus on the overall adoption rate, it’s more critical to think carefully about how to develop mhealth applications that are actually usable, sustainable (meaning not here today, gone tomorrow) and have a real impact on health and wellbeing.

    Some have looked at your data and expressed despair that the overall mobile health app adoption rate is not higher and wondered what’s preventing people from getting on board. My thought on this is that with smartphone and tablet use rates skyrocketing it is only a matter of time before mhealth app adoption becomes more prevalent in the general population. (In our work, we’ve already seen that mhealth app use is higher in groups that are more focused on seeking health content online).

    What to do during this period before the demographic and adoption wave catches up with us? Well, one thought is to do more work to determine which health apps actually work from an outcomes perspective (Johns Hopkins and Haptique are already doing great research in this area.) Another is to get more information about what mhealth app consumers actually want from their apps and their perceptions on app quality and usefulnessl. Although this information would be provided in the aggregate, it would help to shape how those who are developing apps today and in the future go about their work.

    For a future Pew study, it might be useful to look at:

    1. The criteria people are using to select health apps
    2. The proportion of paid to free apps they use (this would help us understand what it takes to get them to fully invest in an app) and how casual this use is
    3. What makes app ‘sticky’ for users — i.e., they use them consistently
    4. Consumer perceptions on what quality health apps look like

    We’re planning on doing some work in this area in the near future, but I think Pew focusing on it (with its much larger reach) would be a great service to the mhealth community.

    Thanks again for all you do. I’m looking forward to seeing what you think about this idea.

    • Thanks, Fard!

      These are stellar ideas, but I’m not sure Pew Internet is the right organization to tackle them with a national phone survey. They speak to more qualitative methods, I think, which would allow respondents to shape the questions, not just their own answers. I look forward to reading your study on these issues!

      You probably know this, but just in case someone reading doesn’t, Pew Internet has a ton of research about mobile in general — this report on mobile health is a tiny slice. See, for a quick overview:

      Pew Internet: Mobile
      http://pewinternet.org/Commentary/2012/February/Pew-Internet-Mobile.aspx

      One report I find myself turning to more often than others is this one:

      Privacy and Data Management on Mobile Devices (Sept 2012)
      http://pewinternet.org/Reports/2012/Mobile-Privacy.aspx

      Another one I’d recommend is our 2011 apps update:
      http://pewinternet.org/Reports/2011/Apps-update.aspx

      I’ll look again at those two reports for ideas for how we might adapt questions to be more specific about health apps.

  4. Susannah…
    Superb work, as usual. Very much looking forward to your next data set publication!

    I firmly believe that the one of the most useful mHealth applications will (should) be a physician’s website!
    Sadly, however, we still have a long way to go. Only 50% of physicians have a website, and the majority of those were created as a template. This means that the information is static, not very timely and the goal of the website is most likely promotional in nature.
    We can change that, we need to change that! Patients are thirsty for relevant timely, up to date information on their disease states. The majority of people still trust their physicians as a source of health related information. They will likely turn to us first for that information. If we do not step up and provide them with that information they will continue to look to the multitude of online, patient driven communities which are popping up to make up for our lack of productivity and content production.

    The Web 2.0 and mobile compliant physician’s site can then serve as a hub for the next huge advance in mHealth … text messaging or applications that attempt to motivate or drive positive behavioral changes, medication or therapy adherence, etc. The world of text based reminders and behavioral modification apps is in its infancy, but will explode onto the scene over the next few years.
    My question for providers … Would you rather host that solution or sit and watch your competitors do so?

    Thanks again!
    Howard

  5. Some new clips about the mobile health report, each of which adds to the public conversation:

    InformationWeek: Health Info Takes Center Stage On Mobile Phones, by Ken Terry
    http://www.informationweek.com/healthcare/mobile-wireless/health-info-takes-center-stage-on-mobile/240124954

    eWeek: Half of Smartphone Users Research Health Information on Web: Pew, by Brian Horowitz
    http://www.eweek.com/mobile/half-of-smartphone-users-research-health-information-on-web-pew/

    If you haven’t checked in on the comments attached to Brian Dolan’s MobiHealthNews column, they are worth your time:
    http://mobihealthnews.com/18978/three-years-of-stagnant-health-app-adoption/

    And later today I’ll post a comment from Dave Clifford that is so epic that I asked permission to post it as a separate post. Thanks, all!

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