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Psychology in health apps... or the lack thereof!

 

Hello and welcome to my first blog. I hope that this will be the first of many and that I won't fall off the blog bandwagon soon after I get started...

 

I am currently working towards a Master's degree in Health Psychology (just 7 months to go!) and am passionate about combining health prevention with digital health. I joined Quealth 8 months ago as Clinical Product Executive to support various aspects of the development and clinical validation of Quealth. I have learned lots about the app world in a relatively short space of time.

 

Probably the thing that surprised me most was finding out that there are a staggering number of mobile health apps on the market – over 165,000 to be more precise [1]. Many of these apps claim that they can alter your behaviour, improve your health, and, ultimately, change your life. Bold claims indeed. Some academics call these health apps ‘behaviour change interventions’ (or activities designed to alter your actions or behaviour patterns) [2]. In a health context, these interventions are designed to improve your health and promote a healthy lifestyle, with the aim of reducing your risk of disease and, more seriously, death. Sounds simple, right?!

 

The success of these interventions can be measured in terms of how many people take part in the behaviour in the population of interest (e.g. the number of smokers who have quit smoking after using a smoking cessation intervention) [2]. Behaviour change interventions are typically delivered face-to-face, but since the explosion of technology, interventions can now be delivered online and via smartphones, which is a whole new ball game! Some apps say they can stop you smoking, others claim to increase your activity levels or improve your diet – they all sound very convincing and paint a rosy picture, but, where’s all the psychology behind this?

 

Well, unfortunately, this appears to be somewhat lacking. Academic research suggests that large numbers of behaviour change interventions have been developed, with no evidence that they are based on scientific theory [2]. Behaviour change is a rapidly evolving scientific field, and academics at a number of leading universities are working hard to get to grips with what the current evidence on behaviour change is telling us, in order to generate new insights into behaviour change. With so many health apps out there, it really is a minefield. I don’t know about you, but I have loads of health apps on my phone and have no idea which ones are actually the most effective in changing my behaviour – which apps will encourage me to go for a brisk walk on my lunch break or persuade me to resist that piece of cake tempting me in the kitchen?

 

Having a background in psychology, it’s difficult for me to accept these bold statements about the effectiveness of apps being bandied about with little scientific evidence to back them up. What’s worse is that people are investing time (and possibly money) in using these apps, thinking that they are going to radically change lives, when they may not. From the first day that you start studying psychology, it’s drilled into you that you shouldn’t take anything at face value. You should be challenging and sceptical, always asking the questions, ‘what does the evidence say?’; ‘does the methodology stack up?’; ‘is the study valid and reliable?’; ‘could there be any other factors that may explain the results?’.

 

Psychology is the scientific study of the mind and behaviour and it can offer critical insights into why we do what we do; think what we think; and feel what we feel. I might be a little biased, but I personally think that psychology should lie at the heart of behaviour change interventions, including mobile health apps. If we don’t understand why people choose to engage in activities that influence health (known as ‘health behaviours’), then how can we predict behaviour and, ultimately, improve the health of the population by changing their behaviour? It isn’t as simple as educating people about the health risks or benefits of taking part in a health behaviour by giving them information. Most of us know that smoking, excessive alcohol intake and lack of exercise is bad for us, yet some of us still choose to engage (or not!) in these health behaviours. There are obviously other things at play and that’s where psychology comes in!

 

Don’t get me wrong, this isn’t an easy area to explore; us humans are pretty complex beings. But by developing interventions that are based on evidence and psychological theory, we stand a much better chance of developing effective behaviour change interventions, because otherwise – let’s face it – what’s the point of them?

 

This is the reason why we at Quealth are tackling this head on. We want to make sure that Quealth does what it sets out to do and integrates psychological theory and scientific evidence to help change behaviour. We already know from our clinical validation programme that Quealth is effective at predicting the risk of you developing diabetes, cardiovascular disease, lung disease and dementia – with cancer a work in progress. In fact, its predictive accuracy is directly comparable to, and in many cases higher than, other internationally recognised and respected disease risk prediction algorithms.

 

But we want to make sure that Quealth is just as good from the behaviour change side of things. We want to make sure that it achieves its aim of supporting you to actively make changes to your lifestyle to improve your Quealth Score, and, ultimately, your health. To do this, we’re in the process of reviewing Quealth from a behaviour change perspective. More specifically, we’re reviewing Quealth’s ‘behaviour change techniques’, by mapping Quealth against the Taxonomy of Behaviour Change Techniques [2] developed by Susan Michie (Professor of Health Psychology and Director of the Centre for Behaviour Change) and colleagues at UCL. We are in the process of examining which behaviour change techniques are most commonly used in Quealth so that we can evaluate the effectiveness of each feature. Then, we can develop new and exciting features, all based on scientific evidence. Academic research shows us that, despite evidence that the inclusion of behaviour change techniques can increase the effectiveness of an intervention, most apps don’t adopt behaviour change techniques, and this hasn’t really improved in recent years [3]. We want to change that. We want to ensure that Quealth uses evidence-based behaviour change techniques so that it is effective at changing your behaviour.

 

Needless to say, this could take some time. Quealth focuses on 28 different health areas – which is a lot for a health app(!), ranging from ‘increasing vitamin D intake’ to ‘reducing caffeine intake’.  It also includes a huge amount of content and several features, such as goal setting and trackers. We are focusing on each health area in turn, because the effectiveness of each behaviour change technique varies according to the health area in question. So a technique that is effective at stopping you smoking may have little impact on increasing your levels of physical activity, and vice versa.

 

This is a very exciting time for Quealth, and in the field of behaviour change more generally, so watch this space; I’ll be sure to update you on how we’re getting on!

 

 

- Sophie

 

 

References

 

[1] Misra, S. (2015). New report finds more than 165,000 mobile health apps now available, takes close look at characteristics & use. Retrieved from http://www.imedicalapps.com/2015/09/ims-health-apps-report/.

[2] Michie, S., Hyder, N., Walia, A., & West, R. (2011). Development of a taxonomy of behaviour change techniques used in individual behavioural support for smoking cessation. Addictive Behaviors, 36, 315-319.

[3] Ubhi, H. K., Kotz, D., Michie, S., van Schayck, O. C. P., Sheard, D., Selladurai, A., & West, R. (2016). Comparative analysis of smoking cessation smartphone applications available in 2012 versus 2014. Addictive Behaviours, 58, 175-181.

 

 

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