Self-care is more self-directed than ever before

When I was expecting my first child, I wanted to learn anything and everything that was going to happen to my body and my baby over the next nine months. Sure, I had prenatal care appointments — 13, in fact.

But my pregnancy apps? I looked at them every day. Usually several times a day. I used one app to follow my body’s and baby’s physiological changes, track my weight and store my health data. I used the other app to get advice about what to eat, what activities to avoid and even what over-the-counter medications I could take.

Here I was, experiencing my first baby — arguably the most important thing to ever happen to my body — and the vast majority of how I took care of myself was directed and informed not by a qualified medical team, but by health apps on my cell phone. No doctor told me to use those apps. I chose them. I searched for them, I selected them (based on app store reviews, nonetheless), I downloaded them, and I decided they were good enough.

After entering some personal data, my apps knew my due date, when my prenatal appointments should be and what foods I should eat based on my weight changes… and I could store my sonogram photos and belly selfies. Just what I needed and wanted!

And I’m not alone in having these requirements.People expect to use technology to meet them where they are and where they want to be, especially when it comes to their health. Many folks often ask me how I got into tech. My answer: “To educate people and promote health. Technology isn’t an option, but a requirement to working in this field.” Phones, trackers, tablets and computers are delivering health information more than ever before. Everyone has to be able to access, understand and apply that information to become and stay healthy.

As a Vanderbilt University Medical Center scientist, my research studies found that certain types of people use technologies to take care of their health. These people have health literacy skills — they can understand and apply health information. We also found that having health literacy skills means you’re more likely to have a cell phone and be savvy in how you use it. People without these skills may not be taking advantage of the more than 200,000 health apps that now exist.

Earlier this fall, Dr. Michael Mackert at the University of Texas in Austin published a study of nearly 5,000 Americans that found people with health literacy skills are in fact more likely to use health apps as well as activity trackers and patient portals. They’re also more likely to believe these technologies are easy to use and useful.

So that raises a few key questions, each of which has a number of answers:

1. How can we get more people to use health tech?

• Engage users of all types in the design, development and refinement of digital health solutions.

• Leverage what people use. That includes iOS and Android devices and even feature phones.

• Use familiar channels to communicate. Text messaging is the No. 1 cell phone activity for everyone.

• Make the first impression say, “I’m easy to use.”

• Make the user interface and user experience intuitive.

• Be interoperable with other platforms.

2. Once people are in, what’s the most effective way to educate and change behavior?

• Health education and support must be data-driven.

• Personalize health messages. Tailor. Tailor. Tailor.

• Simplify messages but make them engaging and compelling.

• Develop and/or enhance users’ knowledge about the importance of the health behavior. Correct any misinformation and create accurate heuristics.

• Develop and/or enhance users’ personal motivation towards the health behavior. Deliver content to promote favorable attitudes by saying something like “Doing the behavior will make you feel good in these ways.” Also, promote favorable beliefs about performing the behavior and the outcomes of doing so. Let people know there are more benefits than costs to performing this behavior.

• Develop and/or enhance users’ social motivation about doing the health behavior. Make social normative support accessible by showing people others like them or the people they care about think they should do this or are doing it, too. Then give concrete advice on how to get practical support. That can include saying things such as, “This is how you can ask your partner to join you for a walk.”

• Finally, develop and/or enhance users’ skills for performing the health behavior regardless of the situation. Help people build the infrastructure to be successful regardless of what life throws at them. For example, this calculator will help you determine how much medication you need to bring on your next trip.

So what does health literacy- and behavior change-friendly health tech look like? In 2013, Dr. Shelagh Mulvaney and I developed and tested a mobile health program called MED for people with diabetes receiving care at safety-net clinics. MED sends one data-driven, personalized text message each day at a random time during waking hours. This message educates, motivates or helps build skills around taking medications and/or insulin. MED sends a second text at the end of the day asking, “Did you take all of your meds today?” MED also calls people at the end of each week to give self-care feedback and encouragement.

In our research, all users said MED was easy to use and useful and were engaged in 84 percent of the text messages over three months — the highest engagement we’ve seen in the scientific literature. Users also improved self-care, reduced barriers to self-care and improved glycemic control.

If MED produced such great results, one can only imagine the potential of technologies at the forefront of hyper-personalized support. My next project is working with One Drop, a health tech startup revolutionizing diabetes care. Unlike MED’s automated, data-driven text messages, One Drop supports people with diabetes and prediabetes via personalized coaching and a digital therapeutics program delivered entirely through a mobile app. Users enter self-care data — most of which is entered automatically, greatly reducing the burden on the user — and receive health literacy- and behavior change-friendly insights.

We’re harnessing technology to make living with diabetes hyper-personalized and simple. We’re meeting people where they are and where they want to be. The best health tech is all of these things. It’s easy to use, personally relevant, empowering and actionable. For people with chronic health conditions, it’s comprehensive, interoperable, engaging and ongoing. The secret sauce is health literacy- and behavior change-friendly, but also dynamic and continuous.

Chandra Y. Osborn is vice president of health and behavioral informatics at One Drop, a diabetes management platform.