Exercising too little can lead to obesity.

Ingrained habits can lead to continued smoking and substance addiction.

Forgetfulness can lead to medication noncompliance and hospital readmissions for diseases like heart failure. What is the one thing these medical issues all have in common? Behavior.

These medical issues are influenced by patient behaviors. As providers, we often craft the perfect-sounding assessment & plan for our patients’ health, but these efforts are for naught if patients aren’t equipped with tools and support to change their habits or behaviors.

Many believe that mhealth apps can modify patient behaviors. However, as Brown University emergency medicine physician Dr. Megan Ranney points out, statistics show that few patients use their health app more than once.

There are many ideas for how to avoid that common pitfall and use mhealth tools for more effective behavior change. Here are some we recently learned from researchers and innovators in mobile health.

One way of engaging patients is to make the process enjoyable and fun. Julie Kling, mHealth Director at Verizon, proposed multiple ways of incorporating fun into apps: contests, sweepstakes, social networks, QR codes, geotargeting, and gamification.


Another method is allowing other people to participate in your patient’s care. Mary Anne Sterling (@sterlingHIT) proposes bringing in caregivers, and incorporating them into the app process by giving them secure messaging channels and online resources. Sterling emphasizes education of caregivers as important, especially making them aware of what is accessible to them.

Additionally, the act of self-monitoring can be an intervention. Ilkka Korhonen PhD from Tampere University of Technology in Finland notes that people who record their weight and do it on a daily basis lose weight more frequently than those who don’t–and non-adherence to the act of using a weight scale actually correlates with weight gain.

Edward Boyer MD PhD from the University of Massachusetts Medical School stresses that behavior change needs to be as simple as possible. “Interventions only work if they want to use it… I think we need to focus on things that don’t jam up my workflow. Don’t create an mHealth intervention that increases [my workload] by 20%.”


One prominent theme throughout the panels and sessions are that there are few sure-fire recipes for designing the perfect app that successfully encourages changes in a patient’s behavior. At the moment, there are only processes that app creators need to follow to at least ensure their app appropriately functions.

One approach, according to Rochelle Rosen PhD at Brown Medical School’s Centers for Behavioral & Preventive Medicine, is to continuously evaluate design ideas with your target patient population. This evaluation process solicits their feedback throughout the development timeline. Rosen also recommends pilot studies. Qualitative methods, such as focus groups & interviews, can bring about new ideas and changes that designers have not considered.

Finally, Donna Spruijt-Metz PhD from the University of Southern California highlights a useful resource at http://www.behaviorchange.be. Their site — a collaborative effort among engineering, psychological, and health researchers — includes slides as well as papers. Their material covers techniques for conducting trials on behavioral interventions, sidestepping time-consuming randomized controlled trials which often become out-of-date and out of sync with the rapid pace of technologies. It also has information on behavioral theories, such as the control-theoretic framework and the transtheoretical model, that can be applied to app development.

Although the conference presented some key points, researchers argue that more needs to be done to improve the current research body of behavior change. Much of this potential can be unlocked if engineers, designers, and health researchers form interdisciplinary teams. We’ll focus on that some of the work that we’d like to see done in our next article on mobile health apps for behavioral change.

The comments and viewpoints shared in this article are a synopsis of some of what we learned at the recent mHealth Summit.

Steven Chan, M.D., M.B.A., is a resident physician at the University of California, Davis Health System, researching psychiatry, telemedicine, mobile technology, & human behavior. Steve previously worked as a software and web engineer as well as creative designer at Microsoft & UC Berkeley. Visit him at www.stevenchanMD.com and @StevenChanMD.