Engaging with digital health interventions
- Published: Thursday, 07 June 2018 11:06
- Written by Ann Blandford
Digital health interventions offer great promise: from supporting people who are managing chronic conditions such as diabetes to encouraging people to quit smoking or manage their weight or sleep patterns.
At least in principle, they enable individuals to take more responsibility for their own health, to be better informed, to be “empowered”. They help to move health management (or “care”) away from clinical environments to the places where people live their lives. Such care can be delivered more cost-effectively, and can focus more on wellbeing and prevention, as well as treatment. Digital health interventions can support people in a variety of ways, including:
- Providing or giving access to validated information that helps the individual to make sense of the health issue in question and determine an appropriate course of action.
- Facilitating social support by enabling people to engage with “people like me” who are managing similar health conditions under comparable circumstances, in order to learn from peers, provide peer support, and discover a new “normal” when dealing with a health condition.
- Enabling people to more easily track key parameters relevant to their health, such as weight, mood, activities, diet, or blood glucose levels. Such tracking can help people to reflect on their behaviours, identify previously unrecognised correlations between parameters, or set targets for desirable outcomes.
- Delivering just-in-time adaptive interventions, providing encouragement, information or reminders for people that are appropriate to the circumstances (e.g., time, place, individual preferences) and that encourage positive behaviours – whether taking medication on time, taking exercise, or resisting a craving (e.g., for unhealthy food, a cigarette, or alcohol).
- Delivering therapies such as Cognitive Behavioural Therapy or mindfulness therapy at a time and place that fits with the individual’s lifestyle.
To date, the promise of digital health interventions is slow in being realised. There are many possible, overlapping reasons for this, including how people engage with both the digital intervention and the “real world” behaviour that the intervention is designed to support. Some digital interventions are designed for short-term engagement as the individual develops a new habit (or long-term behaviour change) or deals with an acute health condition. Others are designed for extended engagement – e.g., for managing a long-term condition such as diabetes or depression.
For any digital intervention, engagement has both short- and longer-term elements that can contribute to overall engagement and effects. Short-term effects relate closely to ideas of immersion from computer games: whether the individual is absorbed in the experience, living “in the moment” with the intervention. Longer-term effects relate to sustained use and behaviour change over time. The former is most commonly achieved through good user interaction design, often including gamification. The latter requires that the intervention has perceived long-term value: that the individual believes in their own ability to change their behaviour or manage their health (maybe with social and physical as well as technical support); that the intervention helps them in remaining motivated to manage their health; and that it fits with their lifestyle and values.
To be sustainable, digital health interventions need to be economically viable, manage data security and privacy, and be well engineered as well as engaging and useful. There are many theories – of behaviour change, interaction design, and clinical knowledge relating to particular conditions – that can inform the design of effective, engaging digital health interventions. However, every intervention needs to be iteratively developed and tested to ensure that it is clinically effective as well as engaging to the intended users. This is not a quick route to success, but it is essential if digital health interventions are to realise their promise.
By Professor Ann Blandford, Professor and Director of UCL Institute of Digital Health, UCL