Tag: mhealth

behaviour changecomplexityeducation & learninginnovationpublic health

Time and Chance Doesn’t Happen to Us All


Again I saw that under the sun the race is not to the swift, nor the battle to the strong, nor bread to the wise, nor riches to the intelligent, nor favor to those with knowledge, but time and chance happen to them all. – Ecclesiastes 9:11

According to the bible, we are all subject to the randomness of life and the effects of time, regardless of our status, knowledge or skill. There are many days when that doesn’t seem true at all.

For those working in creative fields or knowledge working environments, time is something that is a critical ingredient for influencing the products that emerge from those settings. Time is needed to find information, process it, and make sense of it, particularly if that information is of a complex nature.

In the health sector, evidence-based decision-making is considered the gold standard. It stands to reason that using the best knowledge accumulated from what we’ve already done is a good idea when people’s health is at the centre of attention. But how often do we actually have the time to do actually get evidence, process it, and sense-make around it to apply it in a reasonable way? My informal read on my colleagues in the research and clinical practice fields is that the answer: none. Go to any meeting and nearly all the participants are at some point checking their Blackberry or iPhone in the meeting itself, or right before or immediately after. These are the times when we used to talk to each other, ask questions about each other, and build social relationships.

Now, its addressing the mountain of email that seems to be growing.

Chance, those opportunities to take advantage of spontaneous emergence of information, is also lost. By being so focused on the information coming in through mobile devices, or in one’s own memory, we lose opportunities for the sense-making that enables us to discover new things.

So we have this remarkable paradox where the demands for more, better, appropriate, timely knowledge is greater than ever on problems that are becoming ever-more complex with more tools to generate and sort this information, and no time to actually use it effectively.

In my health behaviour change course we look at literature on changing all kinds of behaviour from eating, physical fitness, smoking, sexual health promotion, and beyond, but not time. Perhaps it is time for that to change, for if that element changes, the chance that it will lead to improved health and innovation might increase along with it.

innovationsystems science

Systems (Science): Sexy and Not So Much

Recently I was discussing what I do with someone relatively unfamiliar to my research, yet in the same field and I described my interest in systems thinking, knowledge translation, and eHealth and how they go together. Somehow in the conversation the term “sexy” was used to describe these fields along with “hot” and “upcoming”. It’s nice to be at the forefront of a field — or three — but it also has some downsides.

One of the downsides is that rigor often gets displaced by enthusiasm. Even fields like knowledge translation, which first emerged in the mid 1990’s (and far earlier than that if you’re willing to consider different terms), is just now evolved to the point where it is widely accepted and supported as a legitimate area of research. There is still much work that calls itself KT that is really just dissemination with a different name, but the concept of KT at least has some respect.

So too, does the idea of systems thinking. With recent special issues in respected journals like the American Journal of Preventive Medicine and American Journal of Public Health and full monographs from the National Cancer Institute, the idea of transmitting systems science from the backwaters of public health to the forefront is close to reality.

eHealth was sexy too, but too much investment matched with too little patience for good evidence quickly burned through much of the potential that consumer-directed eHealth had for making transformative differences on a broad scale. No worry, mHealth is here and that is quickly proving to be as “hot” as eHealth was ten years ago.

The problem is that “hot” and “sexy” terms often presage their demise in respected discourse before too long. I was once told by a senior official with a large health NGO that he’d given up on eHealth because he knew it didn’t work. This was 2002. Most of the best evidence hadn’t been generated yet and already people had thrown in the towel.

Knowledge translation is having its problems too, because the evidence of a shortening from “evidence to effect” is hard to generate. Often, KT requires systems level changes and systems thinking to create the conditions to generate effective KT practice. That suddenly transforms something that is “sexy” into something difficult and much less so in the eyes of those who are responsible for implementation of KT plans.

Systems science as it is applied to health is in greater danger because the scale and scope of change required to generate good evidence is often at a scale that is prohibitive. Take gambling as one potential public health problem. Governments are now deriving enormous revenue from gambling, while the social costs seem to rise with it. So important is gambling to provincial government revenues in most Canadian provinces that the only way to really change is to change the system as a whole. Diabetes care, mental health, and public nutrition and food security are other issues that are complex and of a scope that requires a true systems-level intervention to effectively address. Suddenly, when you speak of connecting the private sector to the public sector, changing regulations, building true KT systems within these areas, supporting public health education and practice, and tackling the social inequalities that are propped up by a current system of organization, systems don’t seem as sexy.

Furthermore, in the case of systems, KT, or eHealth, acknowledging complexity in the way we handle things, and considering problems from a systems perspective, means hard work, different time horizons, and truly working collaboratively across disciplines and settings. That is hard stuff and it sure isn’t sexy.

There are lots of areas within the health system that are not sexy, but few are seen less interesting than issues that were once viewed as sexy, but now not so much. That’s the danger with systems, knowledge translation and eHealth.

behaviour changedesign thinking

Design and Health: Systems, Substance and Style

Style, Substance and Getting You Where You Want to Go

Does style matter when it comes to your health?

Consider a visit to your family doctor or dentist. Imagine two scenarios that describe what you find at the office.

Picture one office as having old, worn-out tiles on the floor, the tiled ceiling with fluorescent lights; worn and torn magazines that are many years out of date, and a PC running Windows 98.

Compare that with an office that might be streaming live news feeds on a monitor or TV set, is brightly lit with natural light, simply laid out, and office staff allowing you to fill out your information in the waiting room on an iPad.

In both cases nothing is said about the quality of care or professional competency of the physician, yet if you compare the two by their looks it is quite likely that a person is much more likely to judge the quality of service or care by these first impressions.

Marketers and retailers know this well — the effective ones at least — and spend inordinate amounts of resources in refreshing their stores, developing their brand image, and ensuring that there is some consistent experience that is attractive to customers. If the place is attractive to the eye at first glance, it will elicit a reaction that may last for a very long time and colour everything about how you see that store, organization, group or person.  This thesis about snap decision-making and first impressions has been accessibly summarized by Malcolm Gladwell in his book Blink. In short: first impressions last a long time and are very powerful.

It also means that style is not something that we should necessarily dismiss as ‘just’ the aesthetic part of design. Good design is about form, function and overall fit with the environment the product or service operates within. It’s why Apple products are so distinct for example and why they are often held up as a model for good design. Apple tools play well with each other and often with different products too (although Apple is by no means the model for this — consider the fact that you can only run the Mac OS on an Apple-made computer unless you do something quite drastic) .

Consider Lady Gaga, someone I recently discussed along with mHealth. It is fair to say that she would have nowhere near the fans and following were it only for her singing and songs (whatever you think of them). For her, it is about linking those things to a style that she has created along with a system to support that integration of music, video, fashion, marketing, and entrepreneurship. Her style is what connects a lot of people to her, but it is her substance and the systems around her that make people fans.

What if we thought more about style in our work? Imagine a stylish system for health? It’s not just aesthetic or superficial, it just might be essential. Good design is about linking all of them together.

design thinkingeHealthpublic health

The Lady Gaga – mHealth Connection

Lady Gaga: Calling Health?

It’s probably fair to say that Lady Gaga isn’t the first person you think of with Mobile Health (mHealth). Accessing patient records, behaviour change resources, and information on wellbeing are topics that reside closer on the spectrum of similarity than those most associated with the current reigning queen of pop.

But looking a little deeper, there is reason to consider that this image is a little more than a poker face (bad pun intended). Let me point to the comparisons.

1. One of central points of comparison is that, like mHealth opportunities, there is no escaping Lady Gaga. Her music is everywhere — in front, as background music, as a harbinger of taste (good and bad, depending on the audience), and something people are talking about. MHealth is in the same boat.

2. Consider that Lady Gaga herself is the subject of considerable attention. She’s on the cover and profiled in this month’s Vanity Fair and her image is strewn all over the Internet. She is what people are talking about. MHealth is likewise. If you want more Twitter followers, add #mhealth. If you want more readers, subscribers, and conversation, talk of mHealth. It is a very hot topic in the world of healthcare and mobile technologies.

3. Lady Gaga is a mystery. While we know her roots and her family name, there is surprisingly little that is known about the “real” Lady Gaga. How much is style and show and how much is her? That holds true for mHealth. Without a large field of research and evidence, the entire mHealth phenomenon is a bit of a mystery to many in and out of the industry. It is perhaps for that reason that many members of the public are not sold on the reasons for why they should need or want to access medical information like personal health records using electronic tools as was recently reported this week.

There are also a couple of areas where the comparison between her and mHealth should be strong, but isn’t.

4. Lady Gaga is enmeshed with social media. This past week, Lady Gaga surpassed Britney Spears to become the pop Queen of Twitter. Never to miss an opportunity to mark this regal occasion, Ms. Gaga went to YouTube, where she was, until recently upended by Justin Beiber, creator of the most watched video on that channel of all time. Surprisingly, mHealth hasn’t quite got there yet. There are many apps for health to be sure, and some of them are quite well put together, but most of them use a model of service that represents a push model of service, rather than a social model of conversation.

This issue of conversation was the topic that marketing thought leaders Mitch Joel and Joe Jaffe spoke about yesterday in their live-fed podcast discussion. That conversation centred on the idea that marketing is rarely about conversation per se, but trying to get information to people quickly with the hope that it will lead to something. True conversation requires relationships and time and many companies are not willing to do what it takes to get there. I would argue that the same holds true in the health sector and its related industries. There is too much money to be made quickly to slowly develop relationships, healthcare institutions are not (ironically) set up for relationship development, and health providers are rarely given the resources or incentives to spend the time with their patients in real time, let alone develop social media channels. Its therefore no surprise that mHealth and social media are struggling to find their way in their relationship.

5. Lady Gaga delivers.  In conversation with colleagues and reading reviews of her concerts by even reluctant fans (I have not yet seen the spectacle that is the Monsters Ball) one story emerges: it is an amazing performance. And by performance, it means that she entertains and delivers something of value to her audience. From what I hear and read, even those who do not consider themselves as one of Gaga’s ‘Little Monsters‘ (i.e., fans), she is worth the price of admission to see. MHealth still isn’t there…yet. Indeed, for the reasons discussed above and in previous posts, there is a lot of questions about mHealth and what it can, will and should deliver. So far, its delivering on simple things like iPhone apps and push-model tools, but little on interactive, social media-based programs. The potential is to create environments of truly interactive, user-driven health content.

A project that I’m involved with is trying to do this. My research group and partners  just lauched the Youth4Health website and, in the next few weeks, will have our multi-platform app distributed to youth with iPhones to provide mobile content as well. It’s a start.

6. Lastly, Lady Gaga is a 360 degree celebrity. She makes much of her own clothes, runs her own design shop, writes her songs, and produces many of her own work. She also has relationships with her distribution channels, including a sponsorship with Virgin Mobile. MHealth is nowhere near this. As an mHealth researcher, I can point to few peers who have relationships with developers, producers, the public, funders and distribution channels at the same time. It is for that reason that this work takes so long to build and why mHealth is either run by non-health professionals or run badly and in obscurity by health professionals.

Maybe mHealth needs to take a little more from the reigning Queen of Twitter and get a little more bold, stylish and out there. Then, and maybe then, will we see its promise unfold.


eHealthpublic healthsocial media

eHealth / mHealth And Privacy Will Never Coexist

Erasing Privacy?

There is some debate right now in the tech world about whether or not there is or will be two Internets: one that is the domain of computers and one that is the domain of mobile devices. If you’re like me, there is only one Internet that involves both.

Throughout the day I access information using a variety of devices from different places that combine wired and wireless Internet. Much of my Facebook updates are done on a Blackberry, while my Tweets might come equally from my laptop, iPod or that same Blackberry. I don’t think about what I am using when I engage the Internet world and that’s pretty common.

But this past week a joint statement by Google and U.S. mobile service provider Verizon pointed to the idea that these two ways of accessing the Internet are distinct and they are seeking to create dialogue about rules on how we engage each ‘Internet’. This statement, summarized and discussed by Elliot van Buskirk on Wired.com , basically points to a preference by both companies for some kind of restricted (controlled) form of wireless Internet. This is about net neutrality, the concept that all traffic on the Internet is treated equally, regardless of who you are and what content you are producing or consuming.

Google has responded to the criticism on their own blog and go to point out that their apparent repudiation of the idea of net neutrality on the wireless web is a myth.

Net neutrality is a big issue and one that is worth paying attention to even if you are not a ‘techie’. It is not my intention to discuss it here, but rather discuss another piece of media that got me to this issue and to a place of thinking that privacy and eHealth are an impossible pair.

How did I get there? The inspiration came from Mitch Joel’s Twist Image podcast, Six Pixels of Separation. If you’ve never listened to it before, it is well worth an hour to drop in** and hear someone who is quite articulate about social media issues explore in a casual, but engaging way the social mediasphere. The last episode (#215), was particularly good. Actually, scary might be a better term. Why? In one hour, Joel and his guests discussed, over sushi, a range of issues that, for me, cemented the fact that eHealth and privacy will never coexist. Ever.

They did this without actually using the term eHealth or mHealth (mobile health), but for those of you in this area of work you’ll immediately know why I came to this conclusion. Interestingly, none of the issues that they covered were new to me (aside from the Google-Verizon one). But I had never heard them all discussed in the same narrative in a manner that got me to imagine the future in the way I did when I listened to it. What it did was showcase the already loose controls we have on our “regular” online data, stored in website host servers and ISP provider databases and how these already poor provisions are nothing compared to wireless data, where our data providers and devices give up every little piece of information about us every time we engage in this “other” Internet — the one that has Verizon and Google so interested in controlling/influencing.

The example used to point this out was a health one — albeit a hypothetical one — and it shows just how vulnerable we can be, particularly if you imagine someone posting all of your search data online. This is a real threat. These things happen. Just look at what is going on with the current Wikileaks / Afghan war documents.

I have no suggestion for how to address this and, frankly, I don’t really see any solution that will work to address privacy in eHealth/mHealth; the problem is too embedded. Having some faceless corporation holding our confidential information or some government bureaucracy doing the same are two lousy options. This is the price we pay for convenience, for the power that information has in helping us keep well and for the tools that allow us to connect to others. It’s a big price and no doubt there will be some who listen to this podcast and view the topic through an eHealth light and start questioning whether its worth it. But unless we go back to paper with all we do, I don’t see an option for addressing it in any practical manner. We’ve paid the price of admission to the fair that is eHealth/mHealth and now we need to pay it off with the cost of running the show.

** I like Joel’s style and frankness about media issues, but I will say that his podcast — particularly those that are cross-labeled as ‘media hacks’ episodes — features occasional off-colour jokes among his guests in dialogue (often including fellow social media marketing leaders like Julien Smith, Chris Brogan, and Hugh McGuire) that smack of sexual inappropriateness that I think is unnecessary, beneath him and frankly add no value to the show or his brand. These are relatively mild, but still not worth it. To them I say: Swear all you like guys, but cut out the sexual joking around. It cheapens the whole experience and makes you smart guys look like sophomoric jocks when you do it.

eHealthhealth promotioninnovationpublic healthsocial media

Mobile Health Promotion and Web 3.0

Telephones of the Distant Future by Catmachine.

This week the MaRS Discovery District in Toronto is hosting NetChange Week, which describes itself as being “A week exploring tech for change” .

(follow comment on Twitter using #ncwk).

Yesterday’s focus was on mobile technologies and the ways in which they’ve been used to promote health and facilitate fundraising and knowledge development with non-profits. A series of innovations and novel forms of engagement were proposed, most notably in the area of sexual health.

Toronto Public Health presented work on a sexual health promotion program that uses proximity marketing through Bluetooth technologies. Health promoters with TPH go into the (mostly) gay community, particularly bars and clubs, wearing monitors that allow people to opt-in to receive Bluetooth-transported messages directly to their phones. The messages, contained in a GIF format so they can be viewed at a later time, provide a discrete way to deliver sexual health information specifically suited to the gay population.

Another similar program came from Black Cap, which has sought to engage the black community in Toronto through a variety of sexual health programs aimed at men who have sex with men and youth. The latter program involves a group of youth opinion leaders / health promoters who use text messages and their personal social networks to spread positive health messages in the community. Thus far, the program appears to be creating a buzz and leading to some action.

A third presentation from Lisa Campbell Salazar, a health promoter working with TakingITGlobal (among others), presented her research on youth and mobile technologies. Although the survey was not all focused on health issues, they certainly provided highlights (details of the survey can be found here).

One of the most salient findings from this survey was that mobile tools provide youth with a safe, accessible way to offer peer support to one another and connect in real time in situations where their health risk behaviour takes place. As TPH Health Promoter Michelle Hamilton-Page said in her presentation:

No one who is coming up to our booth is having sex at the moment, they need information for later when they are. Mobile phones provide a means to do that.

This is the bottom line for mobile technologies and health promotion. It provides support where people are — literally and figuratively — rather than where we wish them to be. Where we wish them to be are in places where we don’t have to work too hard to reach them (or are not complex): clinics, traditional media spaces, office buildings. Traditional media is usually passive, it can be crafted in boardrooms and office buildings, with little need to actually engage the community your trying to reach*. It is harder to do that with mobile messaging (although there are examples where this works in practice — TPH’s messages are crafted in advance, but the way they are delivered by an ambassador in the community adds that customized component that is part of the message. Black Cap’s youth opinion leaders custom craft their own messages on the fly using guidelines).

*- although even traditional media tries to solicit input before deploying things into the field.

Traditional, developer-designed, limited-authored websites (Web 1.0) allowed us the opportunity to broadcast messages in new ways to an enormous population. Social media enabled people to not only take part in a conversation, but initiate and re-create dialogical spaces and express themselves in ways that transcend text to pictures, video and other creative media (Web 2.0). Mobile technologies combine both of these earlier phases and enable conversations to take place where people are physically situated, freed of wired connections (Web 3.0). Here, the concept of ‘web’ is truly a network, a spiderweb of connections that are poised to promote health and engage the public in new ways.

It is here that the future of health promotion,  and public health more broadly, lies.

A Web of Digital Health Promotion

design thinkingeHealthfood systemsscience & technology

Amazing Stuff: November 14th Edition

It’s been another busy week filled with lots of ideas, but little time to post them. Expect a lot more on the blog in the coming weeks however as there is too much going on not to discuss.

Thankfully, the rest of the world was still Tweeting, blogging, You-tubing and sharing all kinds of amazing things with us and here are the top ones that captured my attention this week:

1. I love food from all kinds of sources and certainly those that come from animals are the ones I spend the most time thinking about. A new book by Jonathan Safran Foer looks at the ethics and industry of eating animals. I haven’t read the book, but a detailed and insightful review in the New Yorker suggests that I might be thinking a lot more about this in the days and weeks to come based on the arguments that Foer puts forth. Natalie Portman is one who also has thought differently because of this book — this time about vegetarianism and veganism — and she writes her review in the Huffington Post. Read any of the reviews and you’ll know that this is a book making buzz and adding to our already considerable array of options when considering the merits of what we choose to eat. Tofu anyone?

2. Keeping with the contrarian perspectives: have you thought about how healthcare might actually be unhealthy for the planet? This week Ariel Schwartz posted an interesting article in Mother Jones (and replicated in Fast Company ) questioning the carbon footprint of the healthcare industry and whether we ought to be working harder to consider how green our care facilities are. Could a sick planet be coming from healthy humans?

3. While we’re on health care, The New York Times published a story about text messaging for teens as a possible way to engage young people more in health care using mobile phones. Seems like a no-brainer to me, but will it fly in the face of most healthcare organizations, which are a little slow to adopt technologies like this into practice?

4. The international social innovation leadership group, Ashoka, announced the winners of this year’s sustainable food (GMO: risk or rescue?) contest. The blog biofortified was the grand winner. There are some novel ideas and certainly opportunities to expand the dialogue on food safety and security in some new ways through this initiative. GMO good or bad? The answer seems to be: yes.

5. Lastly, Mobifest is coming to Toronto and I was captivated by some of the novel and creative films on display as the finalists in this year’s competition. Mobile filmmaking is getting bigger, better and more creative all the time and I’d encourage anyone interested in looking at one of the futures of film to check this mini and mobile film fest out.