Design of mobile Apps for health and well-being

Transcription

1 Design of mobile Apps for health and well-being NIHR MindTech Healthcare Technology Co-operative Dr. Jen Martin & Dr. Michael Craven Design for Health and Well-being, Nottingham 25/02/2013

2 MindTech One of 8 Healthcare Technology Co-operatives: focusing on high unmet clinical need Our focus: Mental health & neurodevelopmental disorders Based in Nottingham but national centre Officially launched November 2013, London 2

3 Clinical Landscape 1 in 4 people will experience a mental health problem Estimated cost to UK: 105b per year Mental retardation 1.0 Current prevalence of mental health disorders in Europe opiate dependence 0.4 Mood Disorders OCD 0.7 Unipolar depression Bipolar depression Eating disorder Cannabis dependence Psychotic disorder Neurodevelopmental disorder Personality dis. PTSD Autism spectrum disorder (ASD) Tourette syndrome Conduct disorder Alcohol dependence Somatoform disorders Attention Deficit Hyperactivity Disorder (ADHD) ADHD Dementia Unipolar depression Dementia Insomnia Anxiety disorders Wittchen et al European Neuropsychopharmacology 3

4 Research Strategy Technology Innovation Pipeline High quality collaborative projects User-led design New partnerships National resource Transformation of mental health care and services

5 MindTech Partnerships Users Patients, clinicians, NHS Trusts, charities & the public SMEs & Developers Tourettes Action MindTech University Research Behavioural Science, Psychiatry, Computer Science, Human Factors, Clinical Trials, Bio-engineering Funding, Policy, Regulation & Governance 5

6 Opportunities for apps and ICT for health and wellbeing Increase use of ICT in general population 73% of adults in the UK access the Internet every day 51% of UK adults now own a smartphone, 24% own a tablet 72% of all adults buy goods or services online 43% of adults use the Internet to seek health related information Rise of mhealth and ehealth Appetite for users to be empowered as Partners in Care More community-based care Improved self-management Re-designed and new services

7 Self-reporting App case studies Left to right: 1. Asthma Self-Reported Wellness PEF data entry 2. Asthma Self-Reported Wellness diary entry 3. PEF meter & Bluetooth pulse oximeter 4. SimpleEye Live Pulse Oximeter App (third party App) 5. Sickle Cell Monitoring App 6. IVF Stress App 7

8 Example Sickle Cell Disease Home monitoring device Improved communication between clinician and user Research on causes of sickle cell crises Improve self-management and control Need to balance needs of users and clinicians What do clinicians want to know What do users want to say No clinical mechanism for monitoring or intervening How to define and measure benefit Adherence poor especially when in crisis 8

9 Is there a need for more ecological data collection? Active Passive Degree of user/patient involvement Active Diaries (wellness, mood,activities) Collect physiological data from devices (weight, heart rate, blood pressure) Self-testing (blood glucose) Passive Ambient monitoring ambulatory, remote Wearable devices and sensors Sensors in mobile devices Issues: Improved compliance Worries of excessive monitoring Data security 9

10 A few mental health Apps Buddy App Text messaging therapy with goal setting My Journey App Early Intervention in Psychosis Service for year olds. Graded self-assessment, mood management tips, emergency contacts, information Clintouch Serious Mental Illness (schizophrenia, bipolar disorder) WellHappy signposting to MH services in London Doc Ready checklist for patient/gp communication (website) CANTABmobile memory assessment using Paired Associates Learning test umotif example of clinical engagement and evidence gathering with potential in MH 10

11 Text messaging app to support therapy Diary: SMS or web Analysis tool Goal reminders Appointment prompts

12 Psychometric assessment of ADHD QbTest Computerised assessment of attention and activity Supports clinical decision making Provides patients with objective reports on their condition SnappyApp Continuous AX performance test delivered by mobile phone App Measure of attention & impulsivity In-built accelerometer and gyroscope Assesses levels of activity during test 12

13 App design Perceptions Limited involvement of health professional involvement during App development Lack of end user involvement in the App design process Little good quality evidence of benefits Demands Regulatory is it a medical device? Safety? Patient & Public Involvement imperative for R&D funding Ethical 13

14 Ethical issues with Apps Security data storage and communication. Apps vs. text messaging & (also a regulatory issue) Privacy - What do patients/participants expect or imagine might happen with their data e.g. a trained professional monitoring it and acting upon it. Sensitive information - maybe better revealed face-to-face, in a group situation? Burden - what frequency of data collection is acceptable? Impact on clinical care - how to respond to results of data collection: do nothing, give advice, treat as an emergency? Reliability e.g. if phone is off. Impact on health stress, being reminded could cause exacerbation, constant reminder of condition? Social effect on family, carers etc. 14

15 Towards a protocol? Conduct a phone audit before commencing a research study Discover range of prior experiences & preferences for phone functions amongst participants (e.g. alarm clock) Detect potential for conflict between normal daily use & research study use of phone (since functions may mix or conflict) Investigate design tolerance to real-world phone use amongst user group Not keeping devices turned on or charged up Effect of missing or ignoring prompts Ensure secure collection and storage of data Pre-empt ethical approval issues Determine patient burden and adherence Frequency of self-monitoring prompts Pilot studies aimed at measuring adherence Could more passive monitoring be preferable? Early stage user involvement and/or a participatory design process helps reveal needs which may not initially be apparent 15

16 Work with us: Principal Investigator: Prof Chris Hollis Programme Manager: Dr Jen Martin Senior Research Fellow (Technology): Dr Michael Craven