Digital Strategies for
Course overview and structure
Health Communication
Mobile Health Design
Dates: May 23-June 20, no class May 28
Times: 5:30-8:30pm ET + team meetings
What to do if missing all or part of class?
Meet in person: for class session, separately, or not at all?
Twitter and other social media
Social media survey
Online course feedback: you are not guinea pigs!
Questions:
Lisa Gualtieri, PhD, ScM
Tufts University School of Medicine
lisa.gualtieri@tufts.edu
July 18, 2013
l.gualtieri@tufts.edu, cell: 781-330-9456
dickie.wallace@tufts.edu, cell 413-335-3803
1
Mobile is only part of digital landscape
2
Cell phone use in US
• 82% of adults in the US own a cell phone
• Unlike the internet, which has been associated
with a large digital divide, mobile phones are
being used by people in
– All geographic settings
– Across all age and racial/ethnic groups
– Pew Research Center 2011
3
Smartphone owners by age
• Smartphone
adoption
has grown
more than
54% in the
past year to
82.2
subscribers
(9/11/11)
• 36.1% of
Americans
13+ use
smartphone
4
Smartphone growth is across all ages
5
Android Phones and iPhones
Dominating App Downloads in US
• 83% of app
downloaders
(in past 30
days) use
iPhone or
Android
smartphones
• Which is best
choice?
6
Health search, apps, devices
7
Past, present, and future of health
information seeking behavior
?
“Democratization
of location”
Future?
Democratization
of medical
information
Present: Look it
up on mobile
Past: Look device in waiting
it up at
room, elevator,
work or at car, walking, etc.
Distant past: home
Literature,
family, friends
8
Before looking at mobile health search,
need to ask if people use mobile devices
• 321.7M wireless subscribers in US at end of 2011
– Penetration of 101%
• Smartphones outnumber feature phones in the US
• 1 in 8 internet page views are on smartphone or
tablet, doubling in just a year
– Comscore 9/12
• Almost impossible to focus only on laptops and
desktops when considering health information
seeking
Not only are mobile devices used but
they may eradicate the “digital divide”
• Smartphone ownership in US
– 49% of Hispanics
– 47% of African Americans
– 42% of whites
– Pew Internet & American Life Project 9/12
Some people are only using mobile devices
• 34% of US household are wireless only
– Stephen J. Blumberg, Julian V. Luke, Wireless
Substitution: Early release of estimates from the
National Health Interview Survey, July-December
2011, National Center for Health Statistics, 2012,
http://www.cdc.gov/nchs/data/nhsr/nhsr061.pdf
• But one device or many?
Some people are using
lots of mobile devices
• 40% of US households have 3 or more mobile
devices in addition to their PCs & TVs
• Differences in
– Where mobile phones and tablets are used
– Frequency of use
Where are mobile phones and tablets used?
Note that doctor’s office isn’t listed!
56%
Living room
53%
Bedroom
Work
42%
12%
Restaurant/coffee shop
32%
Kitchen
34%
Hotel
30%
30%
29%
Bathroom
Airport/airplane
Events
26%
9%
Train/subway/bus
School
Library
6%
6%
6%
51%
44%
41%
mobile
28%
14%
Home office
Church or place of worship
41%
39%
32%
36%
Other room in my house
Bank
45%
29%
Stores
Other
48%
31%
Car
79%
49%
35%
Outdoors
88%
35%
tablet*
18%
18%
15%
17%
15%
15%
16%
13%
Base: 2,116 US online adults who own a mobile phone; Base: 549 US online adults who own a tablet
Source: North American Technographics Telecom And Devices Online Recontact Survey, Q3 2011 (US)
Tablets are used more frequently than smartphones with the exception of
daily health content users
24%
25%
Smartphone
Tablet
20%
16%
15%
13%
13%
11%
9%
10%
5%
5%
8% 8%
6%
0%
Daily
Source: comScore Custom Research – Jan/Feb 2010 Total n=1191 and Jan 2012 Total n=1033
How often do you use your device for health purposes?
5-6x per 2-4x per
Week
Week
Once a Less than
week
1x per
week
Mobile access to health information
• 2/3 of mobile users used browsers instead of apps
to find health information
15
Search
to apps
16
Who uses
health apps?
• Individuals with varying
–
–
–
–
–
–
–
–
Demographics
Health literacy skills
Health needs
Medical knowledge and
experience
Skills
Disabilities
Cultural and language
differences
Economic situations
17
Consumer Health Apps
18
Having smartphone = having apps
• Easy to find out about pre-loaded and
downloaded
• Harder to find out about use
• Having apps and using them are not synonymous
– 26% who download health apps use them only once
– Pamela Culver, Yahoo! News, 3/21/11
19
Mobile design is the entire
experience
• Having a need and/or learning
about an app
• Deciding to download
• Deciding to try - initial use
• Sustained or ongoing use
• Can an app be successful with only
initial or sporadic use?
20
Design rules apply – even more so
• Make first experience positive
• Make subsequent experiences helpful and
compelling
• Consistency between screens
• Similar metaphors to other apps, as appropriate
• Well-written text
• Judicious use of imagery
• Name and branding
• Creative use of mobile capabilities!
21
Applying user experience design
to apps – and the app store!
• Appeal
– Immediate reaction
– Recommend to friend
– Rate or review
• Usability
– Easy to accomplish tasks
and know capabilities
• Effectiveness
– Accomplish goals
– Sustain use
22
What do mobile devices
provide health seekers?
•
•
•
•
Immediacy and access
Affinity
Multiple methods of input/output
Context
Immediacy and access
• 85% of respondents had cell phones
– 53% of these, or 45% of US adults, had smartphones
– Cell phone owners
• 31% look for health or medical information
• 11% have health apps
• 9% receive text updates or alerts from doctor or pharmacist
– Pew 9/12 via Susannah Fox
• Mobile devices may be used immediately after leaving doctor’s
office, especially with a new diagnosis or prescription
– Impact on health literacy especially recall and retention
– Impact on patient-physician communication
• Could patients listen or ask questions differently due to reliance on search?
What do mobile devices
provide health seekers?
•
•
•
•
Immediacy and access
Affinity
Multiple methods of input/output
Context
More lovable
when they’re
cute and little
Affinity
• People relate to computers differently than people
– What about smartphones? Tablets?
• Mobile users have an ongoing intimate and
personalized relationship with their “digital
appendage” or “cognitive prosthetic device”
• Do people seek information differently?
– Searches on mobile devices tend to be about
private/sensitive conditions: sexually transmitted
diseases, mental health
• How is use changing?
– Greater online community use
Top 10 health searches 2011
Web
Mobile
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
1. Cancer
2. Diabetes
3. Symptom
4. Pain
5. Weight
6. Infection
7. Virus
8. Diet
9. Thyroid
10. Sleep
• Healthline Networks
1. Chlamydia
2. Bipolar disorder
3. Depression
4. Smoking/quit smoking
5. Herpes
6. Gout
7. Scabies
8. Multiple Sclerosis
9. Pregnancy
10. Vitamin A
Online research is up in every category with the greatest growth
in community support
64%
65%
2010
64%
55%
54%
47%
2012
53%
Largest shift: more people
were seeking online
communities!
52%
45%
41%
39%
33%
32%
22%
15%
10%
Source: comScore Custom Research – Jan/Feb 2010 Total n=1191 and Jan 2012 Total n=1033
What types of health-related information have you looked for online in the last 6 months?
What do mobile devices
provide health seekers?
•
•
•
•
Immediacy and access
Affinity
Multiple methods of input/output
Context
Methods of input/output
• Input: less typing, fewer spelling mistakes
– Text: Autocomplete, word suggestions, etc.
– Voice: “Siri, what is…”
– QR codes
• Search: many types of mobile search: app and browser
–
–
–
–
In mobile browser
On mobile website
In app store
In an app
• Output: limitations are screen size and location/privacy
– Text
– Images
– Video
14,000
Thousands
12,000
52%
More Mobile Health Access
through Browser than App
10,000
59%
8,000
6,000
4,000
2,000
-
Mar-11
Apr-11 May-11
Jun-11
Jul-11
Aug-11
Accessed health information [Application]

Sep-11
Oct-11
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
Accessed health information [Browser ]
SOURCE: COMSCORE MOBIL LENS, 3 MOS ENDING MARCH 2012
Number of search results viewed on
smartphone versus computer
What do mobile devices
provide health seekers?
•
•
•
•
Immediacy and access
Affinity
Multiple methods of input/output
Context
Context
• People are exposed to a wealth of contextual
information: what they see, hear, feel, remember
– How do people act on it using their mobile device?
• Multiple devices monitor and record contextual
information, including sensors and GPS
– How do weather, location, time of day, blood
pressure, etc. impact personalization and tailoring?
• Big data and predictive analytics
Mobile First
• Designing for mobile first instead of retrofitting
existing practices into mobile format
• Is what is best for people what is most successful
in the marketplace?
– Evaluation and market research only go so far
– My apps were mobile first
35
App challenges
36
My app design
• Business travelers
have increased rates
of poor health and
health risk factors,
including obesity
and high blood
pressure
• Many apps help
locate restaurants
based on cost,
location, and
ethnicity
37
Videos on Mobile Health Design
38
Accelerators and Incubators
• HealthBox
• TheraVid (Kim)
Sensor and devices
• The newest “sensor” that transmits data
– Smaller than a vitamin, easy to swallow
– Used for space travel and my athletes, expanded uses
– Ex: CorTemp Ingestible Core Body Temperature Sensor
• Don’t want people to overheat
– Ex: Proteus Digital Health
• Body is power source – magnesium and copper on each side
generates electricity from stomach acids - so no battery
• Used to monitor vital signs
• FDA approved
• Next…
Google Glass
Nike Fuelband
• Terabytes of data from wearers
– Average run duration
• 35 minutes
– Active cities
• New Yorkers move more than Angelenos
“Fuel”
• How is Fuel calculated?
• What are the advantages to a secret algorithm?
How can they…
• Increase use and loyalty with current owners?
• Increase sales?
• Compete with Fitbit, Jawbone, and newcomers?
– What should Apple do?
– What should Google do?
Nike Accelerator: 3 month “boot camp”
• $20K and mentorship to 10 startups
• GeoPalz
– Track kid’s efforts; points traded for gifts
– CEO sold shoe charm business to Crocs
• GoRecess
– Find nearby workout classes
– Select based on Fuel
• My submissions
1. Fuelband covers bundled: sequins for dancing
2. Fueling classes to maximize Fuel (think spinning)
My challenge
• Up to 3 months
• Up to $20,000 seed money for design +
development
• What would you do?
Near future
• Design for mobile first instead of retrofitting
health websites into mobile format
• Make smarter smartphones and better integrate
sensor data
• Learn from strategies used by well-funded retail
– Use of big data and predictive analytics to provide
accurate and timely health information