Reaching mHealth's Holy Grail: Behavior change

Health apps continue to hit the market in droves, promising your patients faster weight loss, reduced blood pressure, improved cardiac health. But the true Holy Grail of mobile health--getting patients to make healthier choices, stick to health regimens, etc.--remains elusive.

So I dug in to find some real strategies that hospitals and developers can use to truly engage patients in their own healthcare, and turn their mobile phones or tablets into actual instruments of health change.

Perhaps the most important starting point is to make the smartphone a friend, according to Margaret Morris, a clinical psychologist and senior researcher at Intel, in a recent paper. It may sound easy, as most people view their phones as an integral part of their daily lives now.

She likens it to the relationship between a patient and therapist, where the smartphone (and its apps) become a trusted, relied-upon partner in the patient's health. That means changing some of the language, and responses, that patients get from their apps when they make poor choices.

For example, Morris suggests using a cooperative message like "Let's figure out what might be causing the rise in your blood pressure" rather than the more disconnected "Your blood pressure is high; answer the questions below."

Developers also need to incorporate "stigma-free" language and images, so that the app keeps a positive, encouraging tone, rather than a negative, punitive one (the former being far more likely to encourage change than the latter). For example, she recommends using an image of a rising tide as a way to remind cardiac patients of the effects of too much weight gain due to water retention--rather than a picture of a swollen limb.

Never doubt it, the "nag" factor can even affect something as beloved as one's smartphone. "If an app becomes the source of unwelcome advice or beeps, or we feel intruded upon or our response to some app brings unwanted attention to us, we will have no problem circumventing it," says physician Jessie Gruman, blogging for

Once the smartphone is a trusted ally in the fight for better health, bring in the big guns--peer pressure. Messages should compare the users' exercise rates, eating habits or other choices to peer groups that the user values. For example, instead of berating a teen user for not exercising, the app can use locators, social network information, and other resources to prompt the teen with a message saying "4 p.m.: 80 percent of teens play sports after school. Join your 16 friends playing soccer in Washington Park."

And make use of new media to get the message across, Morris says. Videos or motivational messages from individuals of similar age or who are involved in similar social or activity circles can encourage the user to step up to difficult choices, as a way to be more like peers they admire.

I told you last month about the American Diabetes Association of Washington testing out this exact idea. With it's ADA/Numera Social app, the association will use Facebook to connect diabetic participants with their friends, family and others as they report their diet compliance, challenge each other to exercise goals, and the like.

If Morris is right, they just might be onto something. - Sara