Course overview and structure

1. Course overview and structure Digital Strategies for Health Communication Mobile Health Design Dates: May 23-June 20, no class May 28 Times: 5:30-8:30pm ET + team meetings What to do if missing all or part of class? Meet in person: for class session, separately, or not at all? Twitter and other social media Social media survey Online course feedback: you are not guinea pigs! Questions: l.gualtieri@tufts.edu, cell: 781-330-9456 dickie.wallace@tufts.edu, cell 413-335-3803 Lisa Gualtieri, PhD, ScM Tufts University School of Medicine lisa.gualtieri@tufts.edu July 18, 2013

2. Mobile is only part of digital landscape

3. Cell phone use in US • 82% of adults in the US own a cell phone • Unlike the internet, which has been associated with a large digital divide, mobile phones are being used by people in • All geographic settings • Across all age and racial/ethnic groups • Pew Research Center 2011

4. Smartphone owners by age • Smartphone adoption has grown more than 54% in the past year to 82.2 subscribers (9/11/11) • 36.1% of Americans 13+ use smartphone

5. Smartphone growth is across all ages

6. Android Phones and iPhones Dominating App Downloads in US • 83% of app downloaders (in past 30 days) use iPhone or Android smartphones • Which is best choice?

7. Health search, apps, devices

8. Past, present, and future of health information seeking behavior • ? • “Democratization of location” • Democratization of medical information

9. Before looking at mobile health search, need to ask if people use mobile devices • 321.7M wireless subscribers in US at end of 2011 • Penetration of 101% • Smartphones outnumber feature phones in the US • 1 in 8 internet page views are on smartphone or tablet, doubling in just a year • Comscore 9/12 • Almost impossible to focus only on laptops and desktops when considering health information seeking

10. Not only are mobile devices used but they may eradicate the “digital divide” • Smartphone ownership in US • 49% of Hispanics • 47% of African Americans • 42% of whites • Pew Internet & American Life Project 9/12

11. Some people are only using mobile devices • 34% of US household are wireless only • Stephen J. Blumberg, Julian V. Luke, Wireless Substitution: Early release of estimates from the National Health Interview Survey, July-December 2011, National Center for Health Statistics, 2012, http://www.cdc.gov/nchs/data/nhsr/nhsr061.pdf • But one device or many?

12. Some people are using lots of mobile devices • 40% of US households have 3 or more mobile devices in addition to their PCs & TVs • Differences in • Where mobile phones and tablets are used • Frequency of use

13. Where are mobile phones and tablets used? Note that doctor’s office isn’t listed! Base: 2,116 US online adults who own a mobile phone; Base: 549 US online adults who own a tablet Source: North American Technographics Telecom And Devices Online Recontact Survey, Q3 2011 (US)

14. Tablets are used more frequently than smartphones with the exception of daily health content users • Source: comScore Custom Research – Jan/Feb 2010 Total n=1191 and Jan 2012 Total n=1033 • How often do you use your device for health purposes?

15. Mobile access to health information • 2/3 of mobile users used browsers instead of apps to find health information

16. Search to apps Lifestyle/Health

17. Who uses health apps? • Individuals with varying • Demographics • Health literacy skills • Health needs • Medical knowledge and experience • Skills • Disabilities • Cultural and language differences • Economic situations

18. Consumer Health Apps

19. Having smartphone = having apps • Easy to find out about pre-loaded and downloaded • Harder to find out about use • Having apps and using them are not synonymous • 26% who download health apps use them only once • Pamela Culver, Yahoo! News, 3/21/11

20. Mobile design is the entire experience • Having a need and/or learning about an app • Deciding to download • Deciding to try - initial use • Sustained or ongoing use • Can an app be successful with only initial or sporadic use?

21. Design rules apply – even more so • Make first experience positive • Make subsequent experiences helpful and compelling • Consistency between screens • Similar metaphors to other apps, as appropriate • Well-written text • Judicious use of imagery • Name and branding • Creative use of mobile capabilities!

22. Applying user experience design to apps – and the app store! • Appeal • Immediate reaction • Recommend to friend • Rate or review • Usability • Easy to accomplish tasks and know capabilities • Effectiveness • Accomplish goals • Sustain use

23. What do mobile devices provide health seekers? • Immediacy and access • Affinity • Multiple methods of input/output • Context

24. Immediacy and access • 85% of respondents had cell phones • 53% of these, or 45% of US adults, had smartphones • Cell phone owners • 31% look for health or medical information • 11% have health apps • 9% receive text updates or alerts from doctor or pharmacist • Pew 9/12 via Susannah Fox • Mobile devices may be used immediately after leaving doctor’s office, especially with a new diagnosis or prescription • Impact on health literacy especially recall and retention • Impact on patient-physician communication • Could patients listen or ask questions differently due to reliance on search?

25. What do mobile devices provide health seekers? • Immediacy and access • Affinity • Multiple methods of input/output • Context More lovable when they’re cute and little

26. Affinity • People relate to computers differently than people • What about smartphones? Tablets? • Mobile users have an ongoing intimate and personalized relationship with their “digital appendage” or “cognitive prosthetic device” • Do people seek information differently? • Searches on mobile devices tend to be about private/sensitive conditions: sexually transmitted diseases, mental health • How is use changing? • Greater online community use

27. Top 10 health searches 2011 Web • 1. Cancer • 2. Diabetes • 3. Symptom • 4. Pain • 5. Weight • 6. Infection • 7. Virus • 8. Diet • 9. Thyroid • 10. Sleep • Healthline Networks Mobile • 1. Chlamydia • 2. Bipolar disorder • 3. Depression • 4. Smoking/quit smoking • 5. Herpes • 6. Gout • 7. Scabies • 8. Multiple Sclerosis • 9. Pregnancy • 10. Vitamin A

28. Online research is up in every category with the greatest growth in community support Largest shift: more people were seeking online communities! Source: comScore Custom Research – Jan/Feb 2010 Total n=1191 and Jan 2012 Total n=1033 • What types of health-related information have you looked for online in the last 6 months?

29. What do mobile devices provide health seekers? • Immediacy and access • Affinity • Multiple methods of input/output • Context

30. Methods of input/output • Input: less typing, fewer spelling mistakes • Text: Autocomplete, word suggestions, etc. • Voice: “Siri, what is…” • QR codes • Search: many types of mobile search: app and browser • In mobile browser • On mobile website • In app store • In an app • Output: limitations are screensize and location/privacy • Text • Images • Video

31. 52% Thousands 59% • SOURCE: COMSCORE MOBIL LENS, 3 MOS ENDING MARCH 2012

32. Number of search results viewed on smartphone versus computer

33. What do mobile devices provide health seekers? • Immediacy and access • Affinity • Multiple methods of input/output • Context

34. Context • People are exposed to a wealth of contextual information: what they see, hear, feel, remember • How do people act on it using their mobile device? • Multiple devices monitor and record contextual information, including sensors and GPS • How do weather, location, time of day, blood pressure, etc. impact personalization and tailoring? • Big data and predictive analytics

35. Mobile First • Designing for mobile first instead of retrofitting existing practices into mobile format • Is what is best for people what is most successful in the marketplace? • Evaluation and market research only go so far • My apps were mobile first

36. App challenges

37. My app design • Business travelers have increased rates of poor health and health risk factors, including obesity and high blood pressure • Many apps help locate restaurants based on cost, location, and ethnicity

38. Videos on Mobile Health Design

39. Acceleratorsand Incubators • HealthBox • TheraVid (Kim)

40. Sensor and devices • The newest “sensor” that transmits data • Smaller than a vitamin, easy to swallow • Used for space travel and my athletes, expanded uses • Ex: CorTemp Ingestible Core Body Temperature Sensor • Don’t want people to overheat • Ex: Proteus Digital Health • Body is power source – magnesium and copper on each side generates electricity from stomach acids - so no battery • Used to monitor vital signs • FDA approved • Next…

42. Google Glass

43. Nike Fuelband • Terabytes of data from wearers • Average run duration • 35 minutes • Active cities • New Yorkers move more than Angelenos

44. “Fuel” • How is Fuel calculated? • What are the advantages to a secret algorithm?

45. How can they… • Increase use and loyalty with current owners? • Increase sales? • Compete with Fitbit, Jawbone, and newcomers? • What should Apple do? • What should Google do?

46. Nike Accelerator: 3 month “boot camp” • $20K and mentorship to 10 startups • GeoPalz • Track kid’s efforts; points traded for gifts • CEO sold shoe charm business to Crocs • GoRecess • Find nearby workout classes • Select based on Fuel • My submissions • Fuelband covers bundled: sequins for dancing • Fueling classes to maximize Fuel (think spinning)

47. My challenge • Up to 3 months • Up to $20,000 seed money for design + development • What would you do?

48. Near future • Design for mobile first instead of retrofitting health websites into mobile format • Make smarter smartphones and better integrate sensor data • Learn from strategies used by well-funded retail • Use of big data and predictive analytics to provide accurate and timely health information