When the report called Tracking for Health was released last month, media headlines announced:
“Over Two-Thirds Track Health Indicators!”
This statistic, borrowed from the Pew Research Center’s Internet & American Life Project’s report, referred to the 69 per cent of people who say they keep track of things like their weight, exercise, heart rate, food, stress or other health indicators. It also, however, includes almost half of self-reporting trackers who, according to Pew’s Susannah Fox, track these health indicators for themselves or others – but only in their heads.
Surprisingly, very few headlines ran the real news from the report:
“Only 21% Use Technology to Self-Track!”
The 21% who report using some kind of self-tracking technology are split among using a medical device (like a glucometer), phone app, spreadsheet, or website.
Yet as of last autumn, more than 500 tech companies are busy developing The Next Big Thing in self-tracking tools.
So after the Pew report came out, Fard Johnmar wrote in his DigiHealth Pulse column last month:
“The disconnect between consumers’ low appetite for technology and the activities of these developing new self-tracking technology tools has some wondering whether technology will ever ‘win the hearts and minds’ of most.
“It may take some time for self-tracking technologies to reach the mainstream, if a majority of digital health early adopters are not yet using them.”
Two systematic reviews by Dr. Caroline Free published in the journal PLOS Medicine last month examined evidence on whether mobile technology can help improve health behaviours, improve disease self-management, or help health care delivery processes.
Her conclusions? First, that rigorous studies in low- and middle-income settings (where experts believe that mobile health technology may have tremendous potential) largely do not exist.
In the first study, only three of the 75 clinical trials involving patients considered to be good quality trials with a low risk of bias showed any clear benefits: two of these tested health tech interventions developed to help smokers quit (both conducted in the U.K.) and one trial in Kenya examined an intervention that helped HIV-positive patients take their medications accurately. That’s three trials out of 75 investigated.*
The second study was a systematic review that evaluated the effectiveness of mobile technology-based interventions for health care providers or services. Researchers reviewed 32 trials of interventions designed to support communication among health care providers, and 10 trials of interventions targeting communication between health services and their health care consumers (things like appointment reminders and information about test results).**
Results showed only “modestly improved aspects of clinical diagnosis and management”. Most notably, the use of mobile technology-based photos for diagnosis resulted in incorrect diagnoses compared with face-to-face-diagnosis.
And despite what the health tech hypemeisters are assuring us, technology like patient appointment reminders was better than no reminders, but not better than reminders by phone or mail.
The trouble with us pesky patients – specifically those living with serious chronic health issues who would likely benefit most from monitoring these health indicators – is precisely that: we are patients.
As such, we represent a demographic described by Mayo Clinic physician Dr. Victor Montori as those who struggle with what’s known as “the burden of treatment“. He explains:
“A patient’s education level, literacy, state of depression, pain, fatigue, social connectivity and supports, financial status – all of these affect a patient’s capacity to do the ‘work’ of being sick.
“This workload can simply exceed capacity to cope.”
David E. Williams, in his January Health Business post called Health Tracking Apps Not Yet Ready to Make a Big Impact, added that the current generation of health apps is not going to take us very far, and here’s why:
“It’s tedious to enter data, and many people would rather just forget about their illness then spend a lot of time gathering, entering and analyzing it. And even if the information is tracked it doesn’t mean it will be used.
“Until we get to really smart, passive devices, which will take a decade or more, you should expect to see successive editions of the Pew report saying more or less what this one says.”
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This article also appeared as guest post on the Center for Advancing Health’s Prepared Patient blog on April 8, 2013.
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* “The Effectiveness of Mobile-Health Technology-Based Health Behaviour Change or Disease Management Interventions for Health Care Consumers: A Systematic Review”, Free C, Phillips G, Galli L, Watson L, Felix L, et al. (2013) PLoS Med10(1): e1001362. doi:10.1371/journal.pmed.1001362
** “The Effectiveness of M-Health Technologies to Improve Health Care Service Delivery Processes: A Systematic Review and Meta-Analysis”, Free C, Phillips G, Watson L, Galli L, Felix L, et al. (2013)
PLoS Med 10(1): e1001363. doi:10.1371/journal.pmed.1001363
See also:
- Public humiliation as self-tracking motivation
- If you’re clueless and you know it
- Why 74% of smartphone apps are dropped by the 10th use
- The Quantified Self meets The Urban Datasexual
- Does knowing change behaving?
- Dr. Sherry Turkle: “I share, therefore I am”
- When the elephant in the room has no smartphone
The Ethical Nag 
Once again, Carolyn, you’ve hit the nail on the head.
For me, this excerpt says it all: “…many people would rather just forget about their illness then spend a lot of time gathering, entering and analyzing it.” I feel strongly that the constant glut of advice on micro managing our health has the potential to cause serious depression and take the joy out of life while we’re trying to get the most out of living it.
Thank you for your wonderful advocacy and intelligent analysis. You so often articulate what I feel but find difficult to put into words.
Thank you Kate. I like that excerpt too, because it captures beautifully what many in the tech/design sector fail to grasp – as quoted in a previous post on this: ““Fundamentally, sick people … relish the thought of NOT obsessing about our health, to take it for granted like we do, say, gravity.”
Completely agree. People want to connect with a person; not a “device”. It is all about relationships, and let’s remember that technology is being so constrained by “privacy” and “information security” that it will likely render itself obsolete.
You’re not alone, Mark. There are those ‘early adopters’ in the Quantified Self movement who are happy to embrace every possible emerging technology for health tracking – but that still leaves four out of five reported self-trackers who don’t!
When Dr Free says this this in your article: “the use of mobile technology-based photos for diagnosis resulted in incorrect diagnoses compared with face-to-face-diagnosis”, the first thing that comes to mind for many of us is the “but you don’t look sick” phrase. I think many diseases will not lend themselves to mobile interventions.
They may have to start saying “But you don’t look dead”
@anetto
Good point. I’ve been alarmed lately by studies showing the shocking unreliability even in experienced physicians when interpreting current high-quality diagnostic tests (most famously the Michigan State University study on radiologists, 60% of whom failed to notice a missing clavicle in the chest x-rays they were interpreting!) Now marry that “normal” challenge in medical accuracy with the lesser technology of a cell phone photo. Not quite ready for prime time, despite the hype.
I just wanted to drop you a quick line to say thanks for highlighting our research on your blog today.
It’s always gratifying to know that people are not only reading our data, but using it.
Thanks so much for taking the time to comment here, Fard. Your research is important!
regards,
C.
Good and helpful post as always.
I think if we look at technology as complementary to the doctor-patient relationship, and specific apps being designed to reduce ‘the burden of treatment’, then we may make progress for the vast majority of people, not just the data obsessed. Most apps increase the ‘burden’, very few are automatic enough to reduce it.
Thanks Andrew. For the non-sick, tracking health indicators may not seem a burden at all – but for many of us Real Live Patients, it can loom as yet one more thing on our To Do lists.
I do track a number of health indicators (weight, blood pressure) but I think there’s a difference between HEALTH indicators and what industry is calling self-tracking health apps (many of which are actually fitness apps). The “worried well” as you would call them.
I use several self-tracking apps like for financial and health. Other than that, the apps that I download are mostly for entertainment purposes.