“If you build it, they will come.” That strategy worked for Kevin Costner’s Field of Dreams character Ray, a farmer who attracted ghosts of baseball greats to a ball diamond he constructed in an Iowa cornfield. If you have an idea for a nifty mHealth app, however, you can’t assume people will use it just because you build it. We wrote about NIH recognition of mHealth as a new discipline and an mHealth Summit in 2014. We’ve also reported on studies about attitudes and acceptance of mHealth. A recent study designed to evaluate the effectiveness of a commercial mHealth app faltered and refocused on what factors led to the trial’s failure.
Researchers at the Weitzman Institute, a Middletown, Connecticut-based community health research and innovation study organization, published a paper in the Journal of Medical Internet Research Human Factors, a peer-reviewed open access journal. The paper’s title, “Lack of Adoption of a Mobile App to Support Patient Self-Management of Diabetes and Hypertension in a Federally Qualified Health Center: Interview Analysis of Staff and Patients in a Failed Randomized Trial” tells most of the story. According to the paper’s authors, low enrollment and inconsistent use of the mHealth app in question led to the trial’s suspension. But the authors wondered why the study failed, so they shifted their efforts to look in that direction. Based on phone interviews with patients and staff, the researchers uncovered a list of implementation problems. Staff time for familiarizing patients with the app and for checking the app for data and messages was unreimbursed, therefore neither was performed consistently or well. Patients didn’t use the app correctly. The app didn’t integrate with the health center’s electronic health record (EHR) system; both patients and staff viewed the app as valueless busy work.
The greatest takeaway from the Weitzman Institute paper is you can’t just institute new health technology and expect it to work without adequate context. Whether the health tech is software, hardware, or both, if patients and staff don’t value the new technology, don’t understand how to use it, and staff time isn’t reimbursable, the best mHealth app may not have a chance to help anyone.