1. Mobile Advantage: Context and Immediacy in Health Information Seeking Lisa Gualtieri, PhD, ScM Assistant Professor Dept. of Public Health and Community Medicine Tufts University School of Medicine Email: lisa.gualtieri@tufts.edu Twitter: @lisagualtieri

2. Health search is everywhere Last night, in J.K. Rowling’s The Casual Vacancy, I read… – “She navigated away from the Parish Council message board and dropped into her favorite medical website, where she painstakingly entered the words "brain" and "death" in the search box. The suggestions were endless. Shirley scrolled through the possibilities…”

3. Agenda Past Present – Focus on what mobile devices provide health seekers Future 3

4. Distant past: Literature, family, friends Past: Look it up at work or at home Present: Look it up on mobile device in waiting room, elevator, car, walking, etc. Future? Past, present, and future of health information seeking behavior 4 Democratization of medical information “Democratization of location” ?

5. Before looking at mobile health search, need to ask if people use mobile devices 321.7M wireless subscribers in US at end of 2011 – Penetration of 101% Smartphones now outnumber feature phones for the first time in the US 1 in 8 internet page views are on smartphone or tablet, doubling in just a year – Comscore 9/12 Almost impossible to focus only on laptops and desktops when considering health information seeking

6. Not only are mobile devices used but they may eradicate the “digital divide” Smartphone ownership in US – 49% of Hispanics – 47% of African Americans – 42% of whites – Pew Internet & American Life Project 9/12

7. Some people are only using mobile devices 34% of US household are wireless only – Stephen J. Blumberg, Julian V. Luke, Wireless Substitution: Early release of estimates from the National Health Interview Survey, July-December 2011, National Center for Health Statistics, 2012, http://www.cdc.gov/nchs/data/nhsr/nhsr061.pdf http://www.cdc.gov/nchs/data/nhsr/nhsr061.pdf But one device or many?

8. Some people are using lots of mobile devices 40% of US households have 3 or more mobile devices in addition to their PCs & TVs Differences in – Where mobile phones and tablets are used – Frequency of use

9. Base: 2,116 US online adults who own a mobile phone; Base: 549 US online adults who own a tablet Source: North American Technographics Telecom And Devices Online Recontact Survey, Q3 2011 (US) Where are mobile phones and tablets used? Note that doctor’s office isn’t listed!

10. Tablets are used more frequently than smartphones with the exception of daily health content users Source: comScore Custom Research – Jan/Feb 2010 Total n=1191 and Jan 2012 Total n=1033 How often do you use your device for health purposes?

11. What do mobile devices provide health seekers? Immediacy and access Affinity Multiple methods of input/output Context

12. Immediacy and access 85% of respondents had cell phones – 53% of these, or 45% of US adults, had smartphones – Cell phone owners 31% look for health or medical information 11% have health apps 9% receive text updates or alerts from doctor or pharmacist – Pew 9/12 via Susannah Fox Mobile devices may be used immediately after leaving doctor’s office, especially with a new diagnosis or prescription – Impact on health literacy especially recall and retention – Impact on patient-physician communication Could patients listen or ask questions differently due to reliance on search?

13. What do mobile devices provide health seekers? Immediacy and access Affinity Multiple methods of input/output Context More lovable when they’re cute and little

14. Affinity People relate to computers differently than people – What about smartphones? Tablets? Mobile users have an ongoing intimate and personalized relationship with their “digital appendage” or “cognitive prosthetic device” Do people seek information differently? – Searches on mobile devices tend to be about private/sensitive conditions: sexually transmitted diseases, mental health How is use changing? – Greater online community use

15. Top 10 health searches 2011 Web 1. Cancer 2. Diabetes 3. Symptom 4. Pain 5. Weight 6. Infection 7. Virus 8. Diet 9. Thyroid 10. Sleep Healthline Networks Mobile 1. Chlamydia 2. Bipolar disorder 3. Depression 4. Smoking/quit smoking 5. Herpes 6. Gout 7. Scabies 8. Multiple Sclerosis 9. Pregnancy 10. Vitamin A

16. Online research is up in every category with the greatest growth in community support Largest shift: more people were seeking online communities! Source: comScore Custom Research – Jan/Feb 2010 Total n=1191 and Jan 2012 Total n=1033 What types of health-related information have you looked for online in the last 6 months?

17. What do mobile devices provide health seekers? Immediacy and access Affinity Multiple methods of input/output Context

18. Methods of input/output Input: less typing, fewer spelling mistakes – Text: Autocomplete, word suggestions, etc. – Voice: “Siri, what is…” – QR codes Search: many types of mobile search: app and browser – In mobile browser – On mobile website – In app store – In an app Output: limitations are screen size and location/privacy – Text – Images – Video

19. Thousands 52% 59%  SOURCE: COMSCORE MOBIL LENS, 3 MOS ENDING MARCH 2012

20. Number of search results viewed on smartphone versus computer

21. What do mobile devices provide health seekers? Immediacy and access Affinity Multiple methods of input/output Context

22. People are exposed to a wealth of contextual information: what they see, hear, feel, remember – How do people act on it using their mobile device? Multiple devices monitor and record contextual information, including sensors and GPS – How do weather, location, time of day, blood pressure, etc. impact personalization and tailoring? Big data and predictive analytics

23. Sometimes asking questions leads to more questions: fighting the Hydra

24. Some of my questions… Do people conduct health searches differently – On smartphones or tablets? – In mobile browsers or mobile websites or app stores or apps? – Using text or voice? – Based on location? Are people more or less easily able to locate “helpful” information? Are there different indicators of quality or reliability? How can mobile health search better help people to seek information and achieve their health goals?

25. Near future Design for mobile first instead of retrofitting health websites into mobile format Make smarter smartphones and better integrate sensor data Learn from strategies used by well-funded retail – Use of big data and predictive analytics to provide accurate and timely health information

26. Future From digital appendages to… Google glasses The ultimate in seamless mobile health search? Stay in touch – Email: lisa.gualtieri@tufts.edu – Twitter: @lisagualtieri