mHealth: Texting and Tweeting for Health
Over 90 percent of Americans now use cell phones, a fact that may soon change the way health professionals help their patients make healthier choices.
As mobile technologies have become relatively inexpensive, easy to use and ubiquitous, they have emerged as potentially powerful tools for health professionals. Mobile phones can provide a way to remind and reinforce behaviors that can lower cancer risk and other chronic diseases. The field of “mobile health” is young, but recent mobile-phone based interventions focusing on nutrition and fitness-related goals show promising findings.
The Road to mHealth
Mobile health, or mHealth, involves the use of mobile and wireless technologies applied to improve health-related behavior. In June 2011, the World Health Organization released their first report devoted to mHealth, stating that over 85 percent of the world’s population now has access to a commercial wireless telephone signal.
In the US, the mHealth market is only at its beginning, according to a recent report from research2guidance, a market research firm. An estimated 247 million mobile users will have downloaded a smartphone mHealth application at least once in 2012, the report found, a near doubling of users from 2011. mHealth now has its own annual conferences and an increasing number of studies are investigating its benefits and applications.
“Mobile phones are everywhere, and now information is being shared across the developed and developing world,” said Heather Cole-Lewis, MPH, at the Department of Epidemiology and Public Health at Yale University. The technology works for two reasons, she says: familiarity and low cost.
Mobile phone interventions are addressing a gamut of health issues from tracking the success of weight loss to diabetes self-management. mHealth interventions in diabetes management, for example, may involve a patient logging her blood glucose readings into a phone that are then reported to a health professional who can provide guidance in real-time. “It’s a very dynamic process that can provide loads and loads of data health professionals may not have had access to before,” said Cole-Lewis.
“Our review supports the idea that mobile phones are a useful tool for interventions seeking improvement in health outcomes, and that text messaging is a useful tool for behavior change.” — Heather Cole-Lewis
Texting to Better Health
Last year, Cole-Lewis led a review to assess one of the most commonly used – and studied – mHealth applications for behavior change in disease prevention and management: text messaging. After evaluating all relevant studies published between 2005 and 2009, Cole-Lewis found that the majority provided evidence of a short-term effect for improved behavior changes. The interventions included in her review related to weight loss, smoking cessation and diabetes management, which share many behaviors related to reducing cancer risk.
“Our review supports the idea that mobile phones are a useful tool for interventions seeking improvement in health outcomes, and that text messaging is a useful tool for behavior change.”
At the University of California, San Francisco, pilot studies by Yoshimi Fukuoka, PhD, RN, have shown promising findings in how mobile interventions can increase physical activity. In one three-week pilot study, Fukuoka, Associate Professor, Institute for Health and Aging at the University of California, San Francisco, found that study participants increased their average daily total steps by 15 percent when the participants responded to daily text prompts and used a physical activity diary on the phone. As a follow-up to this study, Fukuoka is currently conducting a randomized controlled trial to assess the efficacy of a three-month mobile text-based program to increase physical activity in 200 inactive women.
“The growth in mobile technology in the past decade has changed how we communicate with each other and how physicians communicate with their patients,” said Fukuoka. “Now, the focus of the field is moving into efficacy trials to explore the feasibility, usability and acceptability of mHealth interventions.”
Mobile Technologies for Research
For researchers studying the diet-cancer link, relying on participants to accurately report their usual food intake has its challenges. Faulty memories, underreporting, and confusing questionnaires can all lead to inaccurate estimates of dietary intake.
With recent advances in technology, cell phones are now one of latest tools that have the potential to improve dietary estimates and ultimately, the research, says Amy Subar, PhD, MPH, RD, a nutritionist at the National Cancer Institute and an expert on dietary assessment and nutritional epidemiology.
Instead of asking study participants to remember then write down what they ate, the new cell phone technologies are trying to get people to record the day as they go using image technology,” says Subar, who spoke at AICR’s 2011 Annual Research Conference.
Images technology involves participants photographing their meal before and after they eat. The image is sent to a server programmed to identify the food and portion size by recognizing its color, shape, texture, volume, and other unique characteristics.
The technology currently has several challenges, notes Subar. For example, it can’t distinguish between diet cola and regular cola, and it’s hard to identify each food in a mixed dish. There are also situations where people cannot take pictures, such as while driving.
Other technologies striving to capture dietary intake aim to minimize human input even more. A wearable miniature camera which comes in the form of a pin, snaps a continuous stream of photos, capture all foods/beverages consumed. But all these new technologies cannot overcome inherent biases that come with reporting food intake, says Subar. “The food record method is by nature reactive. When people keep them, no matter how well they do them they might eat differently…. If someone eats a hot fudge sundae almost daily, their reaction to having to record it could be not to eat it that day. That’s just a reality.”
Excerpted from ScienceNow.