Does mHealth technology actually improve people’s health ? This is the question that researchers in New Zealand were addressing when they described a model for development and testing of mobile phone based health interventions in a recent article in the Journal of Health Communication. According to the researchers, mobile phones are used extensively in New Zealand with an estimated penetration of more than 100%.
In this article, the authors described a process that has been utilized to formulate and test multiple mHealth interventions in New Zealand. Among their conclusions was that early feedback from the target audience and a real-world pilot are important steps. In addition, researchers cautioned that people with mobile devices are likely to share information which could “contaminate” results. Read below to learn more from this interesting study.
What is the process?
The steps of the process discussed by the researchers include:
- Formative research to inform the development
- Pretesting content
- Pilot study
- Pragmatic randomized controlled trial
- Further qualitative research to inform improvement or implementation
The researchers indicate that the early stage of innovation requires a process referred to as “intervention mapping” in which a theoretical approach is translated into more practical health promotion materials. This approach applies to the creation of an mHealth intervention because researchers have to take complex messages and therapies and translate them into small, user friendly bits of information. The researchers noted that marketing experts are good advisers during this stage of development.
Formative research to inform the development
As stated, researchers sought feedback earlier from the target audience for all of their mHealth interventions. This feedback was sought through focus groups and online surveys. They stated that this was important to determine how the individuals used their mobile phones and how a health intervention could be integrated into their normal use of the phone.
These initial preferences helped researchers decide if interventions should focus on the use of text messaging, video, or some other form of communicating with the target users. This early investigation also helped researchers determine the frequency of mobile phone contact, such as number of text messages per day, that was optimal for end users.
The take home point for pretesting is that people developing mHealth interventions should pretest their approach prior to testing it on a larger population. The researchers noted that the pretesting phase helped them understand what features of their interventions were the most useful and allowed them to tweak the intervention before using it in a larger research project.
The pilot study step of the development process is similar to the pretesting phase in terms of the information it yields while allowing researchers to identify flaws in their interventions.
However, the pilot study step differs in that researchers are able to test out the logistics of their research project – such as how well their data collection method works, effectiveness of recruitment strategy, and technical aspects of delivering the mHealth intervention. This stage allows end users to provide feedback on the intervention so that researchers can make final adjustments to it.
Pragmatic randomized controlled trial
The researchers indicate that people developing mHealth interventions should expose the interventions to rigorous research methods which identify whether the intervention is truly effective. Their suggested method is to use a pragmatic randomized controlled trial which have two characteristics:
- The trials occur in a real world setting
- The analyses of the trials include all participants whether or not they remain in the trial.
One key consideration for researchers is whether the mHealth intervention can be compared to a usual treatment. In some cases, there is no treatment that serves as a good control for an mHealth intervention so researchers will have to create the control treatment (such as creating another mobile health interaction with the control group that does not achieve the same goals as the intervention).
The researchers also indicate that the ease of sharing information with mobile phones can lead to the treatment group sharing information with the control group. Researchers suggest that this “contamination” be estimated by researchers when determining the effect of an mHealth intervention on health outcomes.
Further qualitative research to inform improvement or implementation
In this last step, the researchers surveyed or interviewed a sample of research participants in order to determine their level of satisfaction with the intervention and how it impacted their lives. The researchers point out that this information is quite useful to funders of the research, providers who are interested in utilizing the intervention, and also informs future mHealth research.
Limitations of the Process
Of course the process comes with some limitations. One key concern for innovators is the amount of time required to complete such a detailed rigorous process. This added time also comes at a cost, making the process much more expensive upfront.
In addition, a rigorous process may reveal what innovators fear the most – the intervention does not work. A failed intervention prevents the public from being exposed to an ineffective mHealth intervention, but may be a substantial setback for researchers and industry innovators.
Despite these limitations, this evidence informed approach is a useful model for developing and evaluating mHealth interventions which researchers and innovators should consider.