Digital self-monitoring tools may promote positive behavioural changes, new study suggests

Digital self-monitoring tools may promote positive behavioural changes, new study suggests

Digital self-monitoring tools enables individuals to track meaningful data about themselves. This capability has encouraged healthcare providers to use these tools to personalise and scale treatment in a more cost-efficient way.

A recently published research paper titled “Self-monitoring utilisation patterns among individuals in an incentivized programme for healthy behaviours,” suggest that the use of digital self-monitoring tools could significantly improve a patient’s long-term health engagement.

According to the research paper, the 69% of Americans track regularly at least one indicator of health, including their weight, diet, exercise routine, or symptoms related to chronic disease.  Since there is a wide range of mHealth devices, there is a growing trend among the general population to measure, track, and make changes related to their health based on quantifiable data collected by oneself. Projections show that the number of everyday wearables, devices, and sensors will increase 5-fold by 2019 [1].

Although the effectiveness of these tools varies depending on the manufacturer, it is well-established that effective, digital self-monitoring tools can have profound health benefits. For example, among diabetics, blood glucose monitoring is a major component of disease management and provides individuals the ability to assess glycaemic targets and evaluate response to therapy. Additionally, blood pressure monitoring has been associated with improved short-term blood pressure control and medication adherence, and self-monitoring has also been shown to improve weight loss and short-term activity levels Importantly, monitoring programs, wearable devices, and other non-traditional healthcare resources can potentially facilitate healthy behaviour changes [1].

As non-traditional healthcare channels such as virtual care become more popular, there is a shift to value-based treatment. Together, these aspects have led to an interest in incorporating digital self-monitoring tools into chronic condition management, and the diagnosis of acute episodes. All these are important steps in incorporating digital technologies into routine patient care.

According to the research, after 20 weeks, 28.36% of registered users were still actively engaged in the program. Meanwhile, combined with the duration of program participation, the frequency of program participation over the first 20 weeks demonstrated some interesting trends. First, the average number of activities logged by users was 4.28 during the first week in the program. However, after excluding the roughly one-third of users who ceased recording activities after one week, the average number of activities logged by participating users increased to 7.53 by the second week. After four weeks, this number was 8.01 and remained relatively steady throughout the 20-week period examined [1].

Overall, the study demonstrated that while a large proportion of users stopped participating in the programme early on those that did continue to log activities did so at a fairly consistent level throughout their participation period [1].

Primary findings

Monitoring physiologic parameters, health activities, and health behaviours in a non-medical setting has the potential to enable alternative systems of health management that can be both more individualised and convenient for health consumers.

An understanding of home-based, self-tracking parameters can provide insights into optimising such programs in future health care models.

The results of the study suggest that incentives might work for connected and active participants in achieving healthy activities. The study showed consistent, extended results of how incentivised consumers track health behaviours and health data in a real-world setting with a large population.

 Long-term adherence to healthy behaviour programme and automated self-monitoring tool

According to the study 57% of all users that remained on the study after one month continued to participate for at least twenty weeks. However, it should be taken into consideration that engaging consumers initially and for prolonged lengths are important components of success.

There is still much to learn about long-term participation. However, the digital tools used, should be easy to use and they should incorporate proven behaviour change theories through the use of rewards or incentives. For example, useful tools to improve long-term, self-monitoring are mobile health-tracking technologies since they can collect, transmit, and aggregate health data.

In fact, a study looking for adherence to the protocol through mobile phone apps which compared website or paper diaries for weight loss also proved the advantage of mobile phone apps even when it was not a fully automated process [1].

 Web-based and mobile health self-monitoring is popular in the general population, and could play a critical role in the future of health management and wellness. Self-monitoring has been shown to improve health and management of chronic conditions. [1].

The Monsenso mHealth solution can be used as a digital self-monitoring tool by individuals with a mental illness. With the smartphone app, individuals can track their health and behavioural data, as well as their symptoms and medication compliance. Besides, all this information is also synchronised with the clinical web portal enabling healthcare professionals to offer a more personalised treatment.

Reference:

Self-Monitoring Utilization Patterns Among Individuals in an Incentivized Program for Healthy Behaviours. JMIR Publications. Ju Young Kim, MD, PhD; Nathan E Wineinger, PhD; Michael Taitel, PhD; Jennifer M Radin, MPH, PhD; Osayi Akinbosoye, PhD; Jenny Jiang, MS; Nima Nikzad, PhD; Gregory Orr, MBA; Eric Topol, MD; Steve Steinhubl, MD. 2016. http://www.jmir.org/2016/11/e292#Body

Empowering patients with digital technology

Empowering patients with digital technology

On the previous blog post, “Transforming health and social care with digital technology” connected health or technology-enabled care (TEC) was defined as the collective term used for telecare, telehealth, telemedicine, mHealth, digital health, and eHealth services. This type of technology can empower patients and carers by giving them more control over their health and social care needs. It can also help individuals to obtain more information regarding their health.

In broad terms, TEC can:

  • Improve self-management through remote monitoring, education, and treatment adherence
  • Tackle areas of unmet needs that traditional treatment struggles to address, such as mental health
  • Supports the development of online patient portals and patient communities
  • Transforms the relationship between patients, carers and healthcare providers to focus on co-creation

Enables self-management

Nowadays, patients and their carers use technology to research information online, identify treatment options, rate providers, and share their experiences. Healthcare needs to acknowledge that emerging technologies offer a tremendous opportunity to transform the way people engage with their health.

Besides connecting patients and providers, digital technology leads to better outcomes and a more personalised service by educating patients in regards to their health-related issues, enabling remote monitoring, and supporting treatment adherence.

Informs and educates patients and carers

It is estimated that 75% of the UK population goes online for health information. Websites, apps, videos, texts and free online courses are being used to educate and provide information to patients and their family caregivers [1].

Figure 1 displays the most common category of mobile apps: fitness, medical reference and wellness apps, which provide information with other very limited functionalities.

Figure 1. Digital health app category, percentage share in 2014.


Figure 1

The use of digital technology to educate patients and carers is a crucial driver of patient engagement. Surveys suggest that patients are more likely to make better choices and be engaged in their health if they can access information quickly.

Digital technology connects patients and providers, leading to better health outcomes and a more convenient and personalised service, through informing/educating, two-way remote monitoring, and supporting treatment adherence [2].

TEC can help carers understand and support those they care for by:

  • Providing psychological reassurance
  • Enabling carers to co-ordinate their work-life-care balance through supporting flexible hours and remote working patterns (approximately 2.3 million people have had to give up work to become carers and three million have reduced their hours)
  • Delivering peer-to-peer support

Facilitates remote patient monitoring (RPM)

Remote monitoring uses technology to monitor changes in patients’ health status outside conventional clinical settings.

Historically, it allows a patient to use a device to perform a routine test and send the test data to a healthcare provider. Initially, it depended on a healthcare provider recommending its use to patients. However, digital technology has increased the potential for remote monitoring and, with the advent of apps and wearables, patients are increasingly bringing the innovation to doctors [3].

New advances in the development of biosensing wearables are spreading their capability beyond simply tracking activity. New devices can monitor a broad range of physiology (from posture to brain activity) and convert this information into outputs, through advanced connectivity and computing power.

Biosensing wearables can support people with chronic conditions, automating monitoring and detecting real time changes in an individual’s health status. Data from biosensing wearables can be uploaded to an Electronic Patient Record (EPR) and this information can be used to display an overview of a patient’s medical history in real-time, supporting early diagnoses and early intervention.

If a negative change occurs, patients, family caregivers and healthcare providers can be alerted quickly, preventing emergency admissions.

Increases treatment adherence

In bad cases, failure to follow treatment can cause a patient’s condition to deteriorate, leading to an increased likelihood of hospital admission, permanent disability, or death. Electronic reminders and alerts, via text SMS or apps, can remind patients to follow their treatment regimens, thus improving health outcomes.

The World Health Organisation has calculated that adherence to long-term therapies in developed countries is around 50%, and is even lower in developing countries [4].

In the UK, between one-third and half of all medicines prescribed for long-term conditions are not taken as recommended. It is estimated that the cost of unused or unwanted medicine is around 100 million GBP per annum [5].

Improved adherence allows healthcare providers and pharmaceutical companies to obtain a better understanding of the impact of drugs, including any complications or drug interactions, providing useful data for research. An increasing number of pharmaceutical companies are investing in digital TEC projects to increase patient adherence to the drugs they produce. Likewise, patients and carers are increasingly using digital health software to register and monitor medication intake [6].

References:

[1] Valuing Carers 2011: calculating the value of carers’ support, Carers UK and academics at the University of Leeds, May 2011.
http://circle.leeds.ac.uk/files/2012/08/110512-circle-carers-uk-valuing-carers.pdf

[2] Putting patients first. The NHS England business plan for 2013/14 and 2015/16. https://www.england.nhs.uk/wp-content/uploads/2013/04/ppf-1314-1516.pdf

[3] Primary care working differently: Telehealth and telecare –a game changer for health and social care, Deloitte UK Centre for Health Solutions, December 2012. http://www2.deloitte.com/content/dam/Deloitte/uk/Documents/life-sciences-health-care/deloitte-uk-telehealth-telecare.pdf

[4] Medication Adherence: WHO Cares? Mayo Clinic 2011. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068890/

[5] Aston Medication Adherence Study, Aston University. See also: http://www.aston.ac.uk/lhs/research/health/pharmacy/adherence/

[6] Mobile apps, fighting for patient adherence, Mobile health global, December 2014. See also http://www.mobilehealthglobal.com/in-the-news/news/109/mobile-apps-fighting-for-patient-adherence

[7] Psychological Therapies, Annual Report on the use of IAPT services: England – 2013/14 Experimental Statistics, Health and Social Care Information Centre, September 2014. http://www.hscic.gov.uk/catalogue/PUB14899/psyc-ther-ann-rep-2013-14.pdf