A clinical trial in Kenya confirmed that human kindness is the secret ingredient to health and mobile phones are an ideal delivery system. Well, that’s my interpretation.
Here’s the gist:
Taking your meds is essential to maintaining your health when you live with a chronic condition. People know this, but they need help doing it. They tend to tune out reminders — constant texts become more of a nag than a boost, studies show. Instead, people respond to empathy — in this study, a single word, texted once a week: “Mambo?” which means “How are you?” People who texted back that they were not feeling well received follow-up phone calls to see if clinicians could help them get back on track.
And the results? I’ll quote the study:
Patients who received SMS support had significantly improved ART adherence and rates of viral suppression compared with the control individuals. Mobile phones might be effective tools to improve patient outcome in resource-limited settings.
This research, conducted in 2008 and published in 2010, reminds me of others of a similar vintage.
In working with teens living with serious, chronic conditions, Project HealthDesign researchers found that technology is a comfort, especially if it is portable, like an ipod or cell phone. They also found that teens are less likely to take their meds if they are feeling sad. So the researchers came up with a tool that tracks the teens’ moods, monitoring the songs they listen to and the words they use in text messages to friends and family. If a teen’s mood seemed to dip, the tool sent an auto-generated medication reminder. Crucially, the teens agreed to surveillance by their clinicians because they were willing to trade privacy for better health and independence from their parents.
Sadly, it was only a pilot project. but did show how a mobile device can serve to deliver just-in-time, clinically-guided medication reminders in the context of people’s lives. Or, as I like to call such things: health care (with an emphasis on care).
What if this idea could be expanded beyond the clinical setting? What if we could break open the box that contains all the support that friends, family members, peer patients and caregivers beam to each other every day?
PatientsLikeMe demonstrates the power of peer education and support in HIV, epilepsy, and other condition communities. People who are able to connect with others who share their same condition are more likely to be able to manage their own care, including taking their meds on time and with regularity, understanding that a “treatment holiday” is not a good idea.
QuitNet is another community of people who are working together to stay well by not doing something (smoking). Members who are successful stick around to help newcomers because they want to give back what they received.
Neither of those powerful examples of peer-to-peer health care involve text messaging, but what if they did? What if we could marry the power of peer support with the ubiquity of cell phones?
It’s also not lost on me that these studies date back 5+ years in some cases. And yet we are still debating both concepts: text messaging for health and peer-to-peer health care. On the one hand, pioneer clinicians, patients, and caregivers are using these techniques to good effect. On the other hand, the annual mHealth summit is growing to Hulk-like proportions. But what will it take to bring these ideas to the massive middle, the mainstream, so more “real people” can benefit?
I’d love to hear what you think — please share your ideas and observations in the comments.
Meantime, if you want to geek out, I’ve included some background readings. Please add to the list of studies and resources in the comments (and remember, self-promotion is OK if you think it’s relevant!):
Segmenting Mobile Health, by Boone (Healthcare Standards, 2013)
Trial to Examine Text-message Based mHealth in Emergency Department Patients With Diabetes (TExT-MED) (PDF), by Arora, et al (Annals of Emergency Medicine, 2013)
Ask, Don’t Tell — Mobile Phones to Improve HIV Care, by Lester (NEJM, 2013)
Text messaging best practices emerge, by Rowe (Healthcare IT News, 2013)
A text message programme designed to modify patients’ illness and treatment beliefs improves self-reported adherence to asthma preventer, by Weinman et al (International Journal of Integrated Care, 2012)
Sharing health data for better outcomes on PatientsLikeMe, by Wicks et al (JMIR, 2010)
3 stories related to diabetes: Texting & Diabetes Management: Launchpad to ‘mHealth’, by Dyer (Diabetes Mine, 2010); Texting improves Type 1 diabetes adherence, by Dolan (MobiHealthNews, 2010); and an NBC story on the program.
Related posts by me:
All posts related to text-messaging (also known as SMS)
All posts related to peer-to-peer health care