Mobile Health: A Brave New World

November 26, 2013

 Andrew Isham and Dr. Bret Shaw, mobile health researchers at the Center for Health Enhancement Systems Studies (CHESS) and NIATx, have co-authored a chapter in a new book, Health Communication: Strategies for Developing Global Health Programs.

The chapter, titled “Developing and Testing Mobile Health Applications to Affect Behavior Change: Lessons from the Field,” focuses on how to design mobile (mHealth) applications that can be potentially powerful tools for behavior change. The authors are also part of the team that has developed A-CHESS, the mobile phone-based relapse-prevention system that offers support to alcohol and drug dependent people when and wherever it is needed.
In the Q&A that follows, Isham shares his experiences related to this rapidly expanding field of research.

Q: Who is the intended audience for Health Communication: Strategies for Developing Global Health programs?

A: The book is written for researchers and clinicians, but is really for anyone involved in or interested in the field of health communications. Health communication technology is exploding right now, and there’s a lot of hype, both positive and negative, about its possible impact on behavioral health. Some think that mHealth is the answer to many issues in behavioral health, from the treatment gap to treatment modalities. Others perceive mHealth as a passing fad, or worse, a threat to quality treatment. This book offers a balanced view that I think puts a check on the hype and addresses the concerns of those who are not entirely convinced of the potential benefits of mHealth.

Q: The chapter that you wrote with Dr. Shaw covers mobile health or "mHealth" applications. What is the definition of an  mHealth application? 

A:  Right now, most mHealth applications are software programs delivered through a mobile device such as a smartphone. These applications are being developed at an amazing rate, and the app stores (Apple’s iOS App Store, Google Play Store, the Amazon Appstore) offer thousands for people to purchase. These apps help people manage health issues ranging from diabetes and obesity to smoking cessation and medication adherence. 
While smartphones are currently offering the majority of mHealth applications, other devices on the market now or expected to be in the near future include wearable devices such as fitness trackers, smartwatches, and GoogleGlass. It won’t be long before we see a proliferation of other less conspicuous mHealth applications such as clothing that monitors vital signs, or algorithms for early diagnosis of mental health disorders using data that is already in the cloud.

Q: What are some of the benefits that mHealth offers the field of behavioral health?

A: The ability to unobtrusively capture lots of data that may be used to create individual behavioral models that predict key behavioral moments and provide custom intervention in real time. In this way, mHealth can help diagnosis and intervention to move from the clinic to the patient’s “in vivo” environment. In the current model, people receive treatment primarily in a clinic setting—but they recover out in the community. Mobile health gives people access to their treatment at all times. In a sense, they can carry their treatment with them. Or better yet, their treatment is with them at all times without them having to think about it. For example, A-CHESS, the application that I’m working on as part of the study team at CHESS (the Center for Health Enhancement Systems Studies at the UW-Madison) has a feature that allows a patient who is struggling with a trigger to access a peer support network or a counselor at any time. This aspect of mHealth can give clinicians more information—or perhaps more useful information—in a more timely fashion about what’s working and what’s not working in a patient’s treatment plan. It changes the definition of “in treatment” and allows clinicians to make adjustments tailored to the patient’s needs more quickly.

The data available from mHealth applications also allows for proactive rather than reactive treatment. A-CHESS, for example, has a weekly check-in feature that people use to make an inventory of their thoughts, feelings, and potential triggers, and how they react to them. In our first study of A-CHESS, this was a tool clinicians could use to react to a patient’s relapse. Now, it’s become a tool that alerts both the patient and the clinician to a possible relapse, and can prevent it: either A-CHESS will offer the patient a strategy for preventing relapse, something that’s proven effective for that patient in the past, or A-CHESS will engage a counselor to intervene. Mobile health also has the ability to promote integration of behavioral healthcare with primary care, or a movement from silo-ed to integrated care. We know that many people with substance use disorders also suffer medical problems related to their substance use—but care for the multiple issues is not connected. mHealth data may eventually lead to a deeper understanding of how behavioral health and primary care issues are interrelated, as well as provide opportunities to intervene in a manner that honors this systemic nature.

Q: What do you consider to be some of the drawbacks of mHealth applications?

A:  One of its great advantages—the access to timely data—also presents greater potential for abuse by payers, employers, and anyone who has a financial stake in healthcare.

All the hype surrounding mHealth right now presents a drawback, as it’s creating a polarization between those with opposing views about its benefits. Some techies consider mHealth an inevitable panacea, and some traditional practitioners consider it a threat to what really works. I think both are misguided. This polarization could slow down adoption of really useful applications.

Privacy is a big concern that is being addressed at research institutions that are developing mHealth apps, as well as government agencies such as the FDA. Again, all that data could be abused.

Another issue is quality. There are a lot of ways for an mHealth application to fail. A good idea could be crippled by a sloppy user interface. A well-designed and useful application might become obsolete if it’s not updated to keep up with improving operating systems. And no mHealth application is going to have long term effect unless the users (patients or clinicians) believe in it and are not burdened using it. Consumers and clinicians will need assistance in selecting quality applications that cover all the bases.

Q: In addition to the book, what are some other resources available now that people can turn to for more information on mHealth? 

In the ATTC Network, the National Frontier and Rural ATTC is doing a lot of work on telehealth to improve access to treatment.

To keep up with the latest in mHealth, check out mHealth News ( For a thought-provoking and balanced take on the future of mobile technologies, read Jaron Lanier’s books, You are Not a Gadget  and Who Owns the Future?

Andrew Isham, M.S., is a researcher at the Center for Health Enhancement Systems Studies, University of Wisconsin - Madison. Isham has a BS in mechanical engineering, a minor in psychology, and an M.S. in industrial engineering, with a specialization in health systems engineering. Isham is the director of development for the randomized clinical trial for Addiction-CHESS (A-CHESS), a smartphone application designed to help patients leaving inpatient addiction treatment avoid relapse. 

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