Digital Health Communication
Course introduction
What is digital health communication?
= Digital applications that support communication in a health-care setting
- Sender-receiver model: sender → message → receiver → feedback
- To inform people about health via digital apps (thuisarts.nl/wijzer bij darmkanker)
- Information provision
- Doctor-patient communication/shared decision-making (inform patient about
treatment options (pros & cons) and via digital app make the decision)
= Persuasive health technology
- Goes beyond information provision
- Change attitudes towards health behaviours
- Support initiation and maintain health behaviours that require self-control (difficult
to control, like keeping up with your workout routine)
- Eet meter: take into account how much vitamins you eat
- Virtual reality
- Other often used definitions:
- eHealth/digital health = the use of information communication technologies (ICTs)
to deliver or support the delivery of health services
- mHealth = the use of mobile wireless technologies for public health
- Not VR
- Subsection of eHealth, but often interchanged
Taking health communication to the digital sphere
- Design theory: how to design digital health applications with high impact
- Where to begin
- How to design
Health communication theory
- Everything, always, everywhere: phone always with you
- Anywhere and at any time
- Reminders of getting active for example
- Intervene in someone’s real life and in real time because of digital devices
- Social technology: involve peers, peer support, leaderboard of health challenge
- Novel media, modes for communication
- Power of still images, animation, interaction
- Could facilitate info transfer or remembering info
- Immersion, experiental effects: virtual reality can let you experience consequences of
(un)healthy behaviour/decisions that you make, app that shows that you age because of
smoking
- The user and personalization: can take user into account better, relevant differences that
make some approaches more effective, text vs animation for example
Course information
Lectures
- 2 sessions per week
1
,- Mondays: Q&A session of theory lectures
- Not mandatory
- Only online
- After watching pre-recorded lectures + reading literature
- Not recorded + no additional content
- Thursdays: development lectures
- Mandatory
- Hybrid
- Tied to group assignment
- D1 is general introduction
- Course schedule shows which groups are expected to attend the session on campus
- Groups present their group assignment: present about the work of last week
(non-graded)
- Lecturer provides instructions about the work accompanying the development phase
of that week
- See course guide on canvas
Grading/assessment
- Group assignment (40%) → 6 or higher
= Develop a novel digital health application for a specific problem in the health
domain
- CeHReS roadmap: describes steps to take
- During Development lectures this is explained and how to use it in your assignment
- 6 persons
- 3 cases: free choice of topic
A. Stimulating fruit and vegetable intake with a retail smartphone application
in university canteens
B. Decreasing alcohol intake of student with a social digital health application
C. Self-management in cardiovascular disease: involving patients and
providers
- Final report on canvas
- Individual assignment (20%) → can be a fail (compensate)
- Analyze existing digital health app
- Analysis based on theory of choice
- Take on critical perspective: to what extent do theory and practice match?
- Explained in 3rd week
- Exam (40%) → 6 or higher
- MC and open
- Example questions on Canvas
- Mandatory literature and slides of T lectures and literature of D lectures is NOT
(only slides)
T1 – Persuasive technology 1/2
How impactful are digital health applications?
- 100.000 apps available
- In different domains
2
,- Half of smartphone owners are monitoring or have monitored their health in the past
- Also done by health insurance companies (like CZ) with intention to facilitate preventive
measures → decrease cost they make
- Governments also have contracts with apps → Fitbit + Singapore
- People trust that there will be benefits to health apps
- The use of digital technologies holds the potential to deliver interventions designed to
promote healthy life-style habits to large sections of the population
- Especially young people, who are prime users of Internet and digital technologies
- Such interventions are convenient for providers as they are easy to disseminate and
low in cost compared to traditional modes of delivery
- Digital interventions can incorporate interactive materials, such as video streaming
and chat rooms, in order to maximize engagement
- Digital interventions are also available 24-hours a day and so can be accessed at
critical moments
What is the evidence?
Physical activity
- Romeo et al. (2019): Can smartphone apps increase physical activity? Systematic review
and meta-analysis
- Aim: This systematic review and meta-analysis aimed to determine the effectiveness
of smartphone apps for increasing objectively measured physical activity in adults
- Current status:
- Which health behavior theories are employed most often?
- Which features are employed most often?
- 169 studies to begin with, but ended up with 7 studies after exclusion criteria
- Not so much
- General level of studies not that good, only best ones included in this study
- RCT: randomized controlled trial
- Cross-sectional studies were excluded
- People who install apps are already motivated to move more
(confounded correlations)
3
, - People who install apps move less because people who move a lot
think they don’t need such an app (confounded other way around)
- Only included intervention in which there was no combination of app use and
training sessions for example
- So you know the pure effect of the app
- Studies with self-reported physical activity (PA) excluded
- Can be biased (socially answering, answering to goals, people forget)
- Theory use and implemented features in apps targeting physical activity
- App based on recognized behavior-change theory (of the 7 included apps) (4)
- Social cognitive theory (3) (e.g., theory of planned behavior): rational model
of human behaviour
- Principles of reinforcement (1)
- Social influencers’ perspective (1)
- Taxonomy of behavior change (1)
- App features (of the 7 included apps)
- Visible display of steps (all 7 apps)
- Physical activity performance summary (4)
- Goal setting (4)
- Visual display of goal achievement (4)
- Motivational prompts (3)
- Results Romeo et al. (2019) → only included the best studies
- No significant effect of app-based physical activity interventions = steps per day and
moderate-to-vigorous PA
- Only one study with significant effect (1500 more steps)
- BUT: interventions were effective (significantly) when the intervention duration
was 3 months or less (compared with longer interventions)
- Less effective after longer period? Maybe
- Longer exposure to intervention less effective?
- Intervention adhered to less after longer period? Maybe
- And: physical activity apps that targeted physical activity in isolation (alone) were
more effective than apps that targeted physical activity in combination with diet (or
alcohol intake for example)
- Focusing on multiple health behaviours may dilute the effect, because
participants choose to focus on a single behaviour
- Intervention may increase stop smoking for some, but overall quite
small effects
Healthy eating behavior
- Villinger et al. (2019): The effectiveness of app-based mobile interventions on nutrition
behaviours and nutrition-related health outcomes: a systematic review and meta-analysis
- Aim: This systematic review and meta-analysis aimed to determine the effectiveness
of smartphone apps for changing nutrition behaviors and nutrition-related health
outcomes
- Current status:
- Which health behavior change techniques are employed most often?
4
Course introduction
What is digital health communication?
= Digital applications that support communication in a health-care setting
- Sender-receiver model: sender → message → receiver → feedback
- To inform people about health via digital apps (thuisarts.nl/wijzer bij darmkanker)
- Information provision
- Doctor-patient communication/shared decision-making (inform patient about
treatment options (pros & cons) and via digital app make the decision)
= Persuasive health technology
- Goes beyond information provision
- Change attitudes towards health behaviours
- Support initiation and maintain health behaviours that require self-control (difficult
to control, like keeping up with your workout routine)
- Eet meter: take into account how much vitamins you eat
- Virtual reality
- Other often used definitions:
- eHealth/digital health = the use of information communication technologies (ICTs)
to deliver or support the delivery of health services
- mHealth = the use of mobile wireless technologies for public health
- Not VR
- Subsection of eHealth, but often interchanged
Taking health communication to the digital sphere
- Design theory: how to design digital health applications with high impact
- Where to begin
- How to design
Health communication theory
- Everything, always, everywhere: phone always with you
- Anywhere and at any time
- Reminders of getting active for example
- Intervene in someone’s real life and in real time because of digital devices
- Social technology: involve peers, peer support, leaderboard of health challenge
- Novel media, modes for communication
- Power of still images, animation, interaction
- Could facilitate info transfer or remembering info
- Immersion, experiental effects: virtual reality can let you experience consequences of
(un)healthy behaviour/decisions that you make, app that shows that you age because of
smoking
- The user and personalization: can take user into account better, relevant differences that
make some approaches more effective, text vs animation for example
Course information
Lectures
- 2 sessions per week
1
,- Mondays: Q&A session of theory lectures
- Not mandatory
- Only online
- After watching pre-recorded lectures + reading literature
- Not recorded + no additional content
- Thursdays: development lectures
- Mandatory
- Hybrid
- Tied to group assignment
- D1 is general introduction
- Course schedule shows which groups are expected to attend the session on campus
- Groups present their group assignment: present about the work of last week
(non-graded)
- Lecturer provides instructions about the work accompanying the development phase
of that week
- See course guide on canvas
Grading/assessment
- Group assignment (40%) → 6 or higher
= Develop a novel digital health application for a specific problem in the health
domain
- CeHReS roadmap: describes steps to take
- During Development lectures this is explained and how to use it in your assignment
- 6 persons
- 3 cases: free choice of topic
A. Stimulating fruit and vegetable intake with a retail smartphone application
in university canteens
B. Decreasing alcohol intake of student with a social digital health application
C. Self-management in cardiovascular disease: involving patients and
providers
- Final report on canvas
- Individual assignment (20%) → can be a fail (compensate)
- Analyze existing digital health app
- Analysis based on theory of choice
- Take on critical perspective: to what extent do theory and practice match?
- Explained in 3rd week
- Exam (40%) → 6 or higher
- MC and open
- Example questions on Canvas
- Mandatory literature and slides of T lectures and literature of D lectures is NOT
(only slides)
T1 – Persuasive technology 1/2
How impactful are digital health applications?
- 100.000 apps available
- In different domains
2
,- Half of smartphone owners are monitoring or have monitored their health in the past
- Also done by health insurance companies (like CZ) with intention to facilitate preventive
measures → decrease cost they make
- Governments also have contracts with apps → Fitbit + Singapore
- People trust that there will be benefits to health apps
- The use of digital technologies holds the potential to deliver interventions designed to
promote healthy life-style habits to large sections of the population
- Especially young people, who are prime users of Internet and digital technologies
- Such interventions are convenient for providers as they are easy to disseminate and
low in cost compared to traditional modes of delivery
- Digital interventions can incorporate interactive materials, such as video streaming
and chat rooms, in order to maximize engagement
- Digital interventions are also available 24-hours a day and so can be accessed at
critical moments
What is the evidence?
Physical activity
- Romeo et al. (2019): Can smartphone apps increase physical activity? Systematic review
and meta-analysis
- Aim: This systematic review and meta-analysis aimed to determine the effectiveness
of smartphone apps for increasing objectively measured physical activity in adults
- Current status:
- Which health behavior theories are employed most often?
- Which features are employed most often?
- 169 studies to begin with, but ended up with 7 studies after exclusion criteria
- Not so much
- General level of studies not that good, only best ones included in this study
- RCT: randomized controlled trial
- Cross-sectional studies were excluded
- People who install apps are already motivated to move more
(confounded correlations)
3
, - People who install apps move less because people who move a lot
think they don’t need such an app (confounded other way around)
- Only included intervention in which there was no combination of app use and
training sessions for example
- So you know the pure effect of the app
- Studies with self-reported physical activity (PA) excluded
- Can be biased (socially answering, answering to goals, people forget)
- Theory use and implemented features in apps targeting physical activity
- App based on recognized behavior-change theory (of the 7 included apps) (4)
- Social cognitive theory (3) (e.g., theory of planned behavior): rational model
of human behaviour
- Principles of reinforcement (1)
- Social influencers’ perspective (1)
- Taxonomy of behavior change (1)
- App features (of the 7 included apps)
- Visible display of steps (all 7 apps)
- Physical activity performance summary (4)
- Goal setting (4)
- Visual display of goal achievement (4)
- Motivational prompts (3)
- Results Romeo et al. (2019) → only included the best studies
- No significant effect of app-based physical activity interventions = steps per day and
moderate-to-vigorous PA
- Only one study with significant effect (1500 more steps)
- BUT: interventions were effective (significantly) when the intervention duration
was 3 months or less (compared with longer interventions)
- Less effective after longer period? Maybe
- Longer exposure to intervention less effective?
- Intervention adhered to less after longer period? Maybe
- And: physical activity apps that targeted physical activity in isolation (alone) were
more effective than apps that targeted physical activity in combination with diet (or
alcohol intake for example)
- Focusing on multiple health behaviours may dilute the effect, because
participants choose to focus on a single behaviour
- Intervention may increase stop smoking for some, but overall quite
small effects
Healthy eating behavior
- Villinger et al. (2019): The effectiveness of app-based mobile interventions on nutrition
behaviours and nutrition-related health outcomes: a systematic review and meta-analysis
- Aim: This systematic review and meta-analysis aimed to determine the effectiveness
of smartphone apps for changing nutrition behaviors and nutrition-related health
outcomes
- Current status:
- Which health behavior change techniques are employed most often?
4
