By Eimear Morrissey and Gerry Molloy
This years European Health Psychology Society (EHPS) conference was held in sunny Limassol, Cyprus. Health psychologists from all over Europe flew in to attend the week long event. One of the hot topics of the week was mobile health or ‘mHealth’. This refers to an array of technologies that encompass wireless sensors, software and mobile phones, worn and accessed by caregivers, patients, and individuals interested in being engaged in their own health to facilitate collecting and communicating health-related data. It has the potential to revolutionalise the way we conduct research and also the impact of our field. For many years behavioural science research was one of the poor relations of medical science. One of the main reasons for this was that we did not have the opportunity to engage and collaborate with major industry partners like our medical colleagues. For example, the profit chasing pharmaceutical, medical device, diagnostic and biological industries have allowed many areas of medical research to flourish for many decades in the frenetic search for new health products to bring to market. With the recent advent of mHealth things might be about to change dramatically for behavioural science and in particular those of us that work in the area of health psychology.
‘mHealth for health related behaviour change’ was the focus of the Synergy ‘expert meeting’ – a two day pre-conference event. This meeting was facilitated by Professors Lucy Yardley from the University of Southampton, Susan Michie and Robert West from the University College London. One of the first things that the group acknowledged is that there are few if any ‘experts’ given the very recent emergence of mHealth. Mobile devices undeniably have great potential to influence and change health related behaviour. However, there is little we can say with confidence about the real impact of these technologies yet, as systematic reviews of the research literature show that evidence demonstrating the efficacy and effectiveness of mHealth interventions is in its infancy.
This shortage of evidence in relation to mHealth is simultaneously a note for caution and a signal for opportunity. The Synergy delegates from around the world shared their recent work in the mHealth field. It quickly became clear that there are a broad range of applications for many primary and secondary prevention health behaviours that health psychologists have studied for many years now. The continuous measurement capacity that mobile phones and wearable activity trackers provide for studying regular physical activity is perhaps one of the clearest ways in which measurement validity, reliability and sensitivity has been greatly enhanced by mHealth technology. Equally the continuous potential to intervene on this behaviour remotely from health care settings using prompting and self-monitoring behavioural change techniques is also a potentially game changing affordance of the technology.
Examples of this kind of research were presented in the ‘Embracing mHealth technologies for health behaviour’ change symposium. This symposium was held on the penultimate day of the conference and involved researchers from the mHealth research group at NUIG – Jane Walsh, Eimear Morrissey and Emma Carr – along with Felix Naughton from the University of Cambridge and the aforementioned Lucy Yardley. Jane, Eimear and Emma presented studies that had been conducted in Galway in the previous year. All involved the use of a smartphone app as an intervention to change behaviour. While one of these studies resulted in a significant change in behaviour (step count in this case), the other two did not. Lucy Yardley, in her role as discussant, highlighted these non-significant results as a particular strength of the symposium. In a relatively new area like mHealth, it is crucial to have transparency of results in order to build a strong foundation of what works and what doesn’t.
Felix’s presentation discussed one of the more sophisticated aspects of mHealth – geotracking interventions. His intervention involved delivering supportive messages to those attempting smoking cessation when the phone’s GPS system detected that users were in geographical locations where they were at risk of relapse. This early feasibility and pilot work shows that many participants found this kind of use of their data acceptable, particularly as the work was not carried out by a private corporation but by an organisation that was considered trustworthy, the University of Cambridge. This example of real-time intervention on behaviour in response to detected contextual risks might represent a major opportunity for technology and behavioural science to bring about major public health improvement.
While there was much enthusiasm for the potential for mHealth at the conference, there are several critical unanswered questions about the potential for mHealth to improve health at an individual and population health level. Not least of which is whether this kind of intervention strategy can bring about lasting changes in behaviour and whether mHealth has a wide enough reach to improve health for those with more socio-economic disadvantage. Equally it remains to be seen whether mHealth is largely a fleeting novelty for the worried well or a major game changing means for improving health for everyone.
Extracts from this piece appear in the 2015 October issue of the Irish Psychologist