Whether it’s personalising information or bridging geographic divides, the internet is broadening the possibilities for health service delivery. But it’s important to remain focused on the goal and not get caught up in technology for its own sake.
There are already a range of websites and apps available that appear to be useful, according to a panel discussion on health and digital technology at the Australian Internet Governance Forum in Melbourne on Tuesday.
Child and adolescent psychologist Dr Michael Carr-Gregg praised youth counselling service eheadspace — “which works”, even if not perfectly. He also professed to using in his own practice MoodGYM, a 20-year-old online program for the treatment of depression and anxiety — “probably the most researched piece of online technology that psychologists use … [which] is as effective for low level depression and anxiety as an hour with [a psychologist]” — and Clear Your Vision, an online do-it-yourself guide to quitting cannabis which “seems to work”.
Youth, he says, are easier to engage through new technology because “the people who own the most mobile phones are young people, the people who download the most apps are young people”.
VicHealth chief innovation officer Christian Stenta cited Hello Sunday Morning as a good example of a successful digital program. HSM provides a platform for people to commit to not drinking alcohol for three, six or 12 months, who can then blog about their experience and update others on their progress towards achieving personal goals. The platform has had over 20,000 sign up to go three months without drinking since it launched in 2010; the Australian Defence Force is a partner.
One of the benefits of digital services is the ability to personalise information. The Cancer Council’s SunSmart app provides users with information about peak UV times based on location, as well as how much sunscreen is needed, taking into account skin tone, size and clothing.
Monash University’s Breast Cancer Knowledge Online website offers information tailored to an individual’s specific circumstances, acting as a reliable, understandable source on a disease that can affect different women in different ways.
Monash University’s Professor Graeme Johanson told the forum there was an app under development for people with autism spectrum disorder — allowing access to personalised music preferences and specific carers, for example — and one to help dementia patients carry information about their lives, useful to themselves and their carers.
Unfortunately, it can be difficult to discern exactly how well many digital programs work — or if they work at all. New apps are appearing on the market all the time and have often been updated or are out of fashion in the time it takes to evaluate their efficacy. Discussing apps, Carr-Gregg argued that “most of them are crap” and without scientific backing, adding that private software developers tend to be more interested in making money than improving health outcomes.
Julie Rae, head of information and research at the Australian Drug Foundation, expressed scepticism about the use of the newest technology for its own sake, highlighting the importance of matching the technology to the needs of the customer. She said one of the foundation’s most successful programs had been Get the Effects by Txt, an SMS-based service for parents — which has also proven popular with paramedics treating drug-affected patients — to find out what drugs their kids are talking about when they use street names. Another useful initiative had been a radio program run by high school students — proving, she said, the value of many older technologies.
Rae said that one of her first requests on starting at the Australian Drug Foundation three years ago was that she wanted an app. It did not take long, however, for her to realise there were already a huge number out there, so the ADF decided it would be more worthwhile to review those that already exist.“…the people who own the most mobile phones are young people, the people who download the most apps are young people.”
One problem with digital is reach. Technological illiteracy and a lack of internet connectivity among vulnerable groups mean that often new apps and programs end up being used largely by those Rae refers to as “the worried well”, who are already healthy and connected to services. More than half of public housing residents, for example, do not have access to the internet. Something as simple as lacking the ability to charge mobile devices means many homeless people are unable to access such services.
Similarly, although it can be cheaper to advertise a campaign through YouTube than through traditional means, audiences for digital videos are still much narrower than those for television.
Another issue is designing programs so that they are appropriate for the habits of the consumer. Adding too much complexity or failing to account for how citizens want to engage can exacerbate the problem of reach, meaning that only the most dedicated will bother. If an app encouraging exercise is based around running, but your preferred activity is lifting weights, said Rae, you are unlikely to use it.
Cairin Conway, a communications adviser at Cancer Council Victoria, emphasised that gaining social media likes and follows should not become an end in itself, and that organisations need to conduct other research into how that engagement influences behaviour. The Cancer Council, for example, has used follow-up surveys to examine how liking or not liking their Facebook page had affected the behaviour of tracking survey participants.
The conference also heard that, although internet connections in rural Australia are still not as good as they could be, telehealth is helping reduce the instances of frail patients commuting several, often stressful hours for a quick check-up in the city. In some cases, doctors were able to reduce traveling time by speaking to patients through video services. Mental health services in the Mehi cluster in New England, New South Wales, are saving more than 1500 kilometres per week in staff travel by utilising clinical telehealth.
One questioner raised concerns that there were many legal uncertainties surrounding online health data that governments had failed to address, such as who owns personal information gleaned from apps, how it can be used, the insurance implications of knowing more about citizens’ individual health circumstances, and indeed whether such data could create a liability for failure to act when a patient suffers harm.
The government announced yesterday that SANE Online was launching two new forums for people living with mental illness and their carers.
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