The 2011 version of Mobile Health was designed around 'What Really Works?' Our intention in using this question as the conference theme was to shift the conversation from 'look at we did, or can do!' to one more focused on evidence about practical, proven solutions. Despite the best efforts of our content team, of which I was a member, to solicit the evidence, the answer seems to be: we have some clues, but research beyond pilots and feasibility tests is sorely needed.
Few of the presentations were data-driven, many were anecdotal, and perhaps more maddening were the number of academicians there who said to me "Oh, I have some data under review at a journal right now - but can't talk about it before it is published." As was noted by more than one presenter, that's likely 6-7 years between submitting a research idea, having it funded, conducting the study and analyzing the results, and then having it appear in a peer-reviewed publication. That process might work for people who measure their careers in decades, but in the quickly changing world of mobile health technologies, that's at least a generation or two. Whether those results will have any ecological validity by the time they appear in print is debatable, and I believe not very likely. It does raise the issue (again) of how do we increase the speed of diffusion of data while not undermining the peer-review process? Another question for another time. And for the research wonks, we learned about a Workshop on mHealth Evidence that will be convened by the Robert Wood Johnson Foundation, McKesson Foundation, National Science Foundation and the National Institutes of Health later this Summer at which alternative designs to randomized controlled trials (RCTs) will be a particular focus. Check the site for more information about it and a call for papers.
The conference attracted over 420 participants, the largest registration yet, which led to a larger venue and more complicated logistics that BJ Fogg and his crew handled tremendously well. We had 60 speakers packed into 12 hours of presentations over 2 days. A most important feature, however, is the amount of programmed break time for networking; not the typical 15-20 minute segments twice a day plus lunch, but a full 6 hours worth. Any seasoned conference attendee will tell you, this is where the full value of a conference lies.
Susannah Fox kicked things off with a quote from Mark Zuckerberg: most of the mHealth space is uncharted territory. And she noted that the data from the Pew Internet and American Life Project serves as a GPS for the explorers of this space. Among the new findings to be released shortly from the Project is that 1 in 4 adults say they are using mobile apps. For the diffusion crowd, and the naysayers, that is bumping right up to the tipping point of 20-25% the research finds is the take-off zone for innovations.
She also reported that analysis of their data finds two main drivers of online health conversations: The Mobile Difference (people who use mobile phones are more active in these conversations) and The Diagnosis Difference (people who have chronic diseases are more active as well).
In my lead-off to the first session of what works, I used the time to briefly talk about 'theoretically' what we know works in mobile. The answer is 'contiguity.' Beginning with Aristotle, and tracing through learning theorists including Pavlov, Guthrie and Skinner, the idea that things that are in close relationship or proximity to each other are most likely to be associated with each other and affect learning is a foundational premise for mobile health. We talk about ubiquity and the 24/7 nature of mobile devices, but the secret sauce is when it provides a platform for introducing contiguity in new ways, whether it be by:
- spanning geographic boundaries,
- bending time by making events more contemporaneous or asynchronous as needed,
- bringing new perspectives to situations as we are seeing with augmented reality applications or introducing highly localized ones,
- satisfying immediate needs for information (as Bill Gates has said: Search is a verb),
- allowing people to seek ways of motivating themselves through digital record-keeping and other applications of self-change principles as well as increasing access to social support networks,
- developing co-presence among people whether it is through mobile social networks, digital coaches or connecting in real time with other agents, and
- increasing access to information not just through apps, but through better design of information that can be easily accessed and understood through the mobile web.
We had two reviews of the state of the science for mobile health and both concluded that the evidence was limited. Rob Furberg made the observation from his review that the US lags behind several other regions of the world in the number of randomized studies that have been done on mobile health (kudos to Australia/New Zealand, the UK and the EU - and there are many descriptive studies available from developing world countries). Charlene Quinn added more emphasis to this lack of US research in her study of Federally funded research in mobile health over the past 6 years. She found only 29 mHealth studies in the databases of the Federal agencies she surveyed, the majority of which were funded through Small Business Innovation Grants from the National Institutes of Health rather than investigator-initiated ones.
There were a number of excellent presentations; among the highlights for me were:
The audience research and segmentation studies of texters being done by Public Health - Seattle and King County as part of their text messaging project.
The challenge for mobile health identified by BJ Fogg and his family on the lack of mHealth apps that can be used by family units to encourage and support healthy behaviors among themselves.
Jody Ranck's observation that "public health just focuses on epidemiology and not the future" as well as his introduction of the new HUB site for health technologies, including mHealth, by the mHealth Alliance and HMN.
Michael Cross from Kaiser Permanente talking about 'innovation hunters' in the K-P system nationwide and his observation that of all the mHealth meetings he attends each year, this one is by far the best (a sentiment I share).
Eric Leven from Rip Road and who was part of the group that developed the text voting system for American Idol. He reminded us that the program was a major experiment in changing consumer behaviors. He related that there were 50,000 votes cast on the first show and they thought they had hit a home run. Now there are at least 31 million and the last show of the 7th season had 97.5 million votes cast (not the same as the number of voters since one can vote multiple times). Eric also identified that mobile needs to be a business channel as well as a consumer one and to use for feedback from users to improve offerings and performance.
You can find more about the people, content and some of the great applications that were introduced at the links below. In the meanwhile, though dates have not yet been set, it's not too early to make your plans to be in Palo Alto next June. I have.
[Update 9 May 11]
Links to other conference coverage:
Kevin Clauson - Mobile Health 2011: A Look Back at What Really Worked
Katie Malbon - Lessons, home runs and more from Mobile Health 2011 (Stanford)
Thulcandrian - Thoughts from Mobile Health 2011