1. Course overview and structure Dates: May 23-June 20, no class May 28 Times: 5:30-8:30pm ET + team meetings What to do if missing all or part of class? Meet in person: for class session, separately, or not at all? Twitter and other social media Social media survey Online course feedback: you are not guinea pigs! Questions: l.gualtieri@tufts.edul.gualtieri@tufts.edu, cell: 781-330-9456 dickie.wallace@tufts.edudickie.wallace@tufts.edu, cell 413-335-3803 1 Digital Strategies for Health Communication Mobile Health Design Lisa Gualtieri, PhD, ScM Tufts University School of Medicine lisa.gualtieri@tufts.edu July 18, 2013

2. Mobile is only part of digital landscape 2

3. Cell phone use in US 82% of adults in the US own a cell phone Unlike the internet, which has been associated with a large digital divide, mobile phones are being used by people in – All geographic settings – Across all age and racial/ethnic groups – Pew Research Center 2011 3

4. Smartphone owners by age Smartphone adoption has grown more than 54% in the past year to 82.2 subscribers (9/11/11) 36.1% of Americans 13+ use smartphone 4

5. Smartphone growth is across all ages 5

6. Android Phones and iPhones Dominating App Downloads in US 83% of app downloaders (in past 30 days) use iPhone or Android smartphones Which is best choice? 6

7. Health search, apps, devices 7

8. Past, present, and future of health information seeking behavior 8 Democratization of medical information “Democratization of location” ?

9. 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 outnumber feature phones 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

10. 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

11. 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?

12. 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

13. 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!

14. 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?

15. Mobile access to health information 2/3 of mobile users used browsers instead of apps to find health information 15

16. Search to apps 16

17. Who uses health apps? Individuals with varying – Demographics – Health literacy skills – Health needs – Medical knowledge and experience – Skills – Disabilities – Cultural and language differences – Economic situations 17

18. Consumer Health Apps 18

19. Having smartphone = having apps Easy to find out about pre-loaded and downloaded Harder to find out about use Having apps and using them are not synonymous – 26% who download health apps use them only once – Pamela Culver, Yahoo! News, 3/21/11Yahoo! News 19

20. Mobile design is the entire experience Having a need and/or learning about an app Deciding to download Deciding to try - initial use Sustained or ongoing use Can an app be successful with only initial or sporadic use? 20

21. Design rules apply – even more so Make first experience positive Make subsequent experiences helpful and compelling Consistency between screens Similar metaphors to other apps, as appropriate Well-written text Judicious use of imagery Name and branding Creative use of mobile capabilities! 21

22. Applying user experience design to apps – and the app store! Appeal – Immediate reaction – Recommend to friend – Rate or review Usability – Easy to accomplish tasks and know capabilities Effectiveness – Accomplish goals – Sustain use 22

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

24. 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?

25. 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

26. 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

27. 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

28. 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?

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

30. 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

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

32. Number of search results viewed on smartphone versus computer

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

34. 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

35. Mobile First Designing for mobile first instead of retrofitting existing practices into mobile format Is what is best for people what is most successful in the marketplace? – Evaluation and market research only go so far – My apps were mobile first 35

36. App challenges 36

37. My app design Business travelers have increased rates of poor health and health risk factors, including obesity and high blood pressure Many apps help locate restaurants based on cost, location, and ethnicity 37

38. Videos on Mobile Health Design 38

39. Accelerators and Incubators HealthBox TheraVid (Kim)

40. Sensor and devices The newest “sensor” that transmits data – Smaller than a vitamin, easy to swallow – Used for space travel and my athletes, expanded uses – Ex: CorTemp Ingestible Core Body Temperature Sensor Don’t want people to overheat – Ex: Proteus Digital Health Body is power source – magnesium and copper on each side generates electricity from stomach acids - so no battery Used to monitor vital signs FDA approved Next…

42. Google Glass

43. Nike Fuelband Terabytes of data from wearers – Average run duration 35 minutes – Active cities New Yorkers move more than Angelenos

44. “Fuel” How is Fuel calculated? What are the advantages to a secret algorithm?

45. How can they… Increase use and loyalty with current owners? Increase sales? Compete with Fitbit, Jawbone, and newcomers? – What should Apple do? – What should Google do?

46. Nike Accelerator: 3 month “boot camp” $20K and mentorship to 10 startups GeoPalz – Track kid’s efforts; points traded for gifts – CEO sold shoe charm business to Crocs GoRecess – Find nearby workout classes – Select based on Fuel My submissions 1.Fuelband covers bundled: sequins for dancing 2.Fueling classes to maximize Fuel (think spinning)

47. My challenge Up to 3 months Up to $20,000 seed money for design + development What would you do?

48. 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