Posted on July 18, 2017 by Bobby Gheorghiu
Infoway recently launched a digital health myths busting campaign, and as part of the campaign, we asked you to submit myths you’d like us to bust. One myth you asked us to debunks was, “Digital health apps are not evidence-based and do not work.” In order to tackle this myth, I enlisted the help of a clinician and researcher in the digital health space, who eagerly provided me with his insight. Dr. Kendall Ho is a professor at the Department of Emergency Medicine at the UBC Faculty of Medicine. He was the Faculty’s eHealth Strategy Office Director and his research focuses on digital technologies for innovative clinical practices: telehealth, wearables, health apps, social media, and patient engagement.
Me: Dr. Ho, I understand that you have prescribed digital health apps for your patients. Have they worked?
Dr. Ho: Digital health apps in general are prescribed for several purposes: 1) to build knowledge; 2) to change behaviour; and 3) to document changes. One of the theories about what causes behavioural change is the social theory of learning developed by Canadian psychologist Albert Bandura. He suggests that changing behaviour requires goal setting, behaviour modification, measurement and tracking changes, and resetting of goals and further behavioural modifications. Given this cycle of change, if an app is designed with a behavioural theory that underpins it, and that each component is well designed, then most likely it will work.
Me: That makes intuitive sense; however, don’t you need a solid evidence base before you can confidently prescribe an app to your patients?
Dr. Ho: The challenge about an evidence-based approach to apps is that, when someone does a randomized control trial on an app, and then publishes it in one to two years (this is very optimistic), the app may have become obsolete or significantly updated to add new features. Witness the publications related to the Pokemon Go app (last year): very popular in July, but by September, no one talked about it anymore. Publications about the app started to come out in late September and one in December. Already fast by publication standards, yet, not fast enough to truly apply the evidence-based cycle to app implementation.
Me: Are there any particular examples of apps that you have prescribed in the past with positive results?
Dr. Ho: Yes, the Sleep Time app: several people really enjoyed knowing how long they need to sleep to feel rested; Heart Rate: checking both pulse and rhythm for some people with intermittent palpitations; and Fitness Pal: many people feeling that this helped them with portion size of meals and weight control.
The same week that I was preparing this blog entry, I also had the opportunity to attend the closing keynote address at eHealth Conference 2017 in Toronto by Dr. Joseph C. Kvedar, a dermatologist, Vice President, Connected Health Partners HealthCare, and author of “The Internet of Healthy Things.” His speech echoed many of the comments made by Dr. Ho regarding the benefits of digital health apps as well as the challenges in evaluating such a fast-moving space. You can view his presentation here (available free to conference attendees and for purchase for others).
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Bobby works with stakeholders in academia, private and public sectors to develop and monitor performance targets for initiatives such as PrescribeIT®, Canada’s national e-prescribing service, to ensure widespread adoption of technology and to demonstrate tangible benefits of investments in digital health. He holds an MHSc in Health Policy, Management, and Evaluation from the University of Toronto.