The realm and possibilities of mHealth have grown substantially in a short period of time. Last year, 325,000 mHealth apps were available for use on mobile devices. Of those, 158,000 were on Google Play, a 50% increase from 2016.
Researchers are finding mHealth and the opportunities it provides for better healthcare to be a fertile ground for study. Yet in a rapidly changing technological environment, it’s a challenge to collect and analyze data that withstands clinical scrutiny but also can apply “in the wild.”
As top researcher Dror Ben-Zeev, Ph.D. and his colleagues noted in their seminal 2015 study on mHealth research:
“Without realistic expectations and planning, integration of complementary sets of expertise in the research team, and an ability to remotely monitor, detect, and flexibly resolve obstacles as they arise, researchers will find mHealth projects to be daunting and difficult.”
Three years later, these guidelines still apply, said Beth Jaworski, Ph.D., a researcher at the National Center for PTSD, part of the U.S. Department of Veterans Affairs. Researchers, she said, are learning best practices and ideals, often as they go along.
Here are five best practices and tips that can guide your mHealth research campaigns in a fully digital — and mobile — world.
1. As with most research, good mHealth research comes down to definitions
It was only a decade ago that “mobile health” meant remote health clinics set up in rural or underserved populations. Now, mHealth could mean telehealth, remote monitoring with an app or measuring data from a fitness device. Jaworski said researchers have to define what specifically they are accessing and the research questions they hope to answer.
“Be clear about the definitions of what you’re researching so that you know what the scope and bounds of the claims you can make so people can understand it,” she said.
That also goes with communicating constantly with your technological partner in the study. The same words can have different connotations among researchers, engineers and designers. A strong partnership can help steer the ship the way the study should go, as to not get caught in ambiguity.
2. Think carefully about who you’re studying and under what conditions
It can be easy to target research toward well-served communities and those with the means to get quality healthcare. But the promise of mHealth is in reaching underserved communities and those who lack the means or the motivation to seek healthcare through a provider or clinic.
“How can we work for folks that don’t have a primary care provider or have difficulty and feel ashamed to seek mental health care and making sure we’re building products and tools and resources that meet the needs of those folks?” Jaworski said.
Jaworski also issues a call to research on the social determinants of health, as well as including strong qualitative research to complement the often data-centric approach of research campaigns. It helps tell the full story of healthcare and technology.
3. Allow for creativity as well as validity
The gold standard for clinical research — randomized control trials — are useful for peer and industry efficacy and validity. But often in the case of mHealth research, it may be too difficult to accomplish.
Jaworski said that having a good sense of the traditional research outcomes you want as well as thinking through other possibilities mHealth can provide will guide your thinking into what will and what won’t work.
In 2015, Jaworski and her colleagues assessed the scope of “PTSD Coach,” an app created by the VA to help track PTSD symptoms. In their assessment of research, they relied upon tracking the app’s ratings in the Apple App Store and Google Play, as well as measuring the user experience with Flurry Analytics. That gave them the data they were looking for, while following IRB protocol.
She is also partnering with Overlap to conduct the Aware Study, which is looking into the relationship between mood and PTSD, researching the use of the Aware app in myriad ways.
In short, mHealth researchers must account for variety (and even some creativity) to assess the efficacy of a particular mHealth intervention.
4. A thoughtful design of the research is key
With the promise of the field, there are ways to design a study to get good data for analysis. Researchers with the National Cancer Institute posited incorporating “SMART design” processes for study that takes into account the dynamic engagement with a subject and the technology. Allowing for different research design methods can help the study overcome the often slow nature of a trial, as well as the iterative nature of mobile technology.
In another context, mHealth researchers are using gamification and VR to treat mental health disorders. This is a nascent field that is integrating both RCT and new tools for analysis and application.
That also means staying on top of the academic literature as well as the technological update. Also, Jaworski said that the technology cannot be an afterthought. “It’s not like you come with the entire research protocol and say, ‘Let’s slap that into an app and run with it.’ I think those pieces have to come together,” she said.
5. Be mindful of the pros and cons of collaborations
The main players in the mHealth research field: academia, the government, the private sector and tech startups, offer advantages and disadvantages in conducting research.
- Academia, for example, may offer more freedom to conduct different aspects of research but the long-term guarantee of funding often isn’t present.
- The private sector does have funding but the main goal is monetization.
- The federal government may not have funding constraints but the time and patience required to meet regulations and proposal guidelines can loom large.
Also, being open to other collaborators can ease the process. Jaworski said it’s not worth reinventing the wheel and making the same mistakes others have made in the past. She suggests establishing a team across disciplines, having engineers, designers and researchers that are in the space.
With these best practices, mHealth researchers who conduct this important work will add to the dynamic growth of technology and healthcare.