mHealth Insight: With early adopter phase for mHealth over, finding what is effective is next challenge

A study underway by the North Carolina-based Research Triangle Institute will investigate how an app can potentially decrease HIV risk among women in the state living in low-resource communities.

The five-year trial, according to Wendee Wechsberg, Ph.D., principal investor and director for RTI's Substance Use, Gender and Research Program, will also address other life issues faced by women ages 18 to 25 who have not recently been tested for HIV.

The study is being funded by the U.S. National Institute on Drug Abuse and is an adaptation of a women-focused HIV intervention program developed by Wechsberg in the later 1990s, called Women's CoOp.

FierceMobileHealthcare reached out to Wechsberg to get greater insight on the study, as well as her views on emerging mHealth and its role in research.

FierceMobileHealthcare: What is the status of the app at this point and what features and functionalities are included?

Wendee Wechsberg: The plan for the app and full study is to start this coming August after pre-testing all the systems. The intervention asks participants to engage in sessions that will teach them about risks around substance use; pregnancy and substance abuse; ways to reduce substance use and the importance of treatment; concerns about and differences between treatable and curable STIs; HIV risk and sexuality; and skills to reduce sexual risk. It also addresses communication and problem solving, violence and violence prevention.

Taped stories from young African American women who have participated in studies are also part of the curriculum. Feedback about these vignettes have been extremely important to ground this intervention in real-world stories. Functions on the mHealth app including being able to slide through the curriculum and it has features such as pop ups.

FMH: Tell me about RTI's other mobile health efforts.

Wechsberg: RTI has developed a variety of mHealth apps for research efforts that address health topics such as substance abuse intervention, mindful meditation for post-traumatic stress, monitoring outcomes for change in Fragile X syndrome in children, and reducing risk factors for cardiovascular disease in children, among others. RTI is currently developing apps for preconception health education, mindful meditation for pain management and cardiovascular wellness for college students. These projects are facilitated by the use of a common development framework and reusable resource library, RTI's Personal Health Intervention Toolkit.

FMH: How do you reach populations that may not be technology savvy or have the means to acquire mobile devices?

Wechsberg: We agree some may not be tech-savvy and may not have the same kind of technology, so we decided to buy small tablets for everyone in the study and each participant will be taught how to use it.  

FMH: What promise does mHealth hold for research?

Wechsberg: The early adopter phase for mHealth apps is about over. The mobile revolution has produced a multitude of apps with lots of new ideas and quality, however few have an evidence base. The challenge is to determine what is effective in mobile technology, particularly to affect behavior change and improve health. This will take time and be more evolutionary.

Eventually we will see qualified, evidence-based apps being prescribed to work in concert with traditional interventions. One feature of mobile technology is that it is always with us, and so it can be used to assess health factors and behaviors at any time and place. Both body-worn and smartphone-embedded sensors can facilities this process through autonomous measurement and contextual analyses, such as recommending a nearby park for taking a walk. Such capabilities can revolutionize how we improve wellness through behavior change and behavior encouragement; however, they in themselves can become burdensome and eventually users will tune out and turn off the devices and reminders.

Research is needed in understanding this new mobile human-device interactivity, and how it can be optimized to help meet the promise of improving health and healthcare.

FMH: What do you view as some of the hurdles with mobile healthcare at this point?

Wechsberg: Rapid technology change causes early obsolescence of devices and lack of support. For example, most wrist monitors and smartwatches measure acceleration. However, each product uses a proprietary algorithm to product a proprietary measure. This lack of standardization and interoperability, and rapid obsolescence, presents a challenge in evaluating the long-term benefits and fairness monitoring, let alone understanding how to generalize the best use such devices in healthcare.

Editor's note: This interview has been condensed for clarity and content.