Multiple tech interventions boost patient engagement

It's more or less conventional wisdom that technology has the potential to affect patient behavior and, by extension, improve outcomes, reduce readmissions, and lower healthcare costs. In a new study published in the Journal of Medical Internet Research, researchers sought to quantify the idea by measuring the impact of email and text messages on patient self-monitoring of activities and behaviors such as diet, exercise, and smoking.

Initiating and maintaining use of self-monitoring tools has been a challenge, they note in a report of the study results. And web-based programs have been "suboptimal."

There are plenty of online healthcare sites and scores of mobile apps that aim to engage patients in healthy behaviors. But challenges have include making online health and wellness programs "sticky"--not only getting patients to sign up for the programs but to keep them engaged in them long-term.

And using technology to engage patients in their health through technology can also boost patient loyalty, as FierceHealthIT recently reported.  

Patients do seem to want tech tools to keep them healthy, according to another recent study. But engaging patients who most need to improve their health--such as those with chronic conditions--is still a huge challenge.

An evaluation of the HealthPartners 10,000 Steps online program, for example, found that although 74 percent of participants tracked their behavior at least once, only 9 percent tracked their steps weekly throughout the 21-week intervention, according to a 2010 study.

The new study was led by the Center for Community-Based Research at the Dana-Farber Cancer Institute in Boston, and included researchers from a number of organizations, including Duke University in Durham, N.C. and the Harvard School of Public Health in Boston.

The researchers set out to determine whether email prompts or email plus telephone prompts increase self-monitoring of behaviors on a website created for a multiple cancer risk reduction program.

They tracked the frequency of daily self-monitoring on the study website. Participants who tracked at least one behavior three or more times during the first week went into a group that did not receive prompts. Participants who did not meet the threshold during the first were randomly assigned to either automated assistance (AA) or automated assistance and telephone calls (AAC).

Participants in the two latter groups received daily automated emails that encouraged tracking and two tailored self-monitoring reports that provided feedback on tracking frequency. Individuals in the AAC group also received two technical assistance calls from trained study staff. 

The results were pretty straight-forward: Self-monitoring rates increased during prompting and declined when prompting ceased.

Over the 16 weeks of observation, there was a significant between-group difference in the percentage who met the self-monitoring threshold each week, with better maintenance in the AAC than in the AA condition. Meanwhile, self-monitoring rates were greater in the observation-only group than in either the AA or AAC condition.

Although prompting can increase self-monitoring rates, the decrease in self-monitoring after the promoting period suggests that additional and online reminder prompts would be useful, the authors concluded. And the use of technical assistance calls appeared to have a greater effect in promoting self-monitoring at a therapeutic threshold than email reminders and the tailored self-monitoring reports alone.

To learn more:
- see the JMIR study report
- check out the 2010 study

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