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Digital Health Solutions for Vulnerable Populations

August 26, 2016 | Jacob Kraybill | Watch the web forum at Dialogue4Health

The popularity of digital health solutions and mHealth apps has exploded over the past few years with over 165,000 health apps on the market. Unfortunately, the clinical review of best practices has lagged behind, especially in the use of these apps by vulnerable populations.

In a recent D4H web forum, PHI’s Valerie Steinmetz and Andrew Broderick, MA, MBA, presented data from recent focus groups they conducted in three vulnerable communities around the country and Dan Gillette, BA, EdM reviewed the current state of digital health apps. Their results provide an overview of technology access and use among vulnerable groups, recommendations for improving digital care, and opportunities for further research.

Diverse and Underserved Communities

Steinmetz and Broderick interviewed 345 people from multiple vulnerable communities in Louisville, KY, New York City, and Miami-Dade County, including residents in public housing, formerly homeless, older adults, clients in recovery, physically disabled persons, immigrant and refugee populations and persons living with HIV/AIDS. They represented all ages, and two thirds were women.

Internet Access Comes Primarily Through Cell Phones

Before the beginning of the focus groups, participants filled out a survey to get a sense of each group’s access to technology. Results showed that:

  • 90% of participants reported that cell phones are the predominant technology used for internet access
  • 66% of users owned smartphones
  • Android is the predominant mobile operating system, but most visually impaired users used Apple devices
  • Few participants had access to other digital platforms, like laptops, tablets, eReaders, game consuls, and smart TVs

Many users owned more than one phone — one used primarily for calling and texting and one used mainly to access the internet via Wi-Fi with cellular service turned off. Through the Federal Life Line Assistance Program, many lower-income clients are eligible to receive subsidized phones and close to 20% of people reported they used these phones as their primary cell device. Of the remaining participants, a third had standard contract plans and a third had no-contract or monthly pre-paid plans.

The Internet is a 911 Surrogate

About two thirds of respondents said that the internet is very useful or useful in helping make health decisions and that access to health resources on the internet was very important or important. 

  • 77% participants that went online in the past 12 months searched for information on a health-related concern
  • Google is a top expert and many reported that it can serve as a de facto surrogate to 911
  • Many better trusted sites like WebMD and Mayo Clinic and .org and .edu sites and were more skeptical of Yahoo and Wikipedia or .com and .gov sites
  • Facebook is one of the most popular consultation websites and personal testimonies of friends and others are highly valued

Most did not use their phones as a way of directly communicating with their providers. Many health systems have patient portals that allow direct communication with health providers and access to test results. Although some participants were aware of these types of patient portals, most were not. Once aware of the portals, participants became very interested in the tools’ potential for connecting with providers.

Many also used their phones like an administrative support tool, receiving text reminders about appointments and reminders about medications. There was great interest in expanding the use of texting to make appointments or get connected to resources.

Patients are Not Using Specialized Health Apps

Dan Gillette, BA, EdM supplemented the focus group results by sharing findings from a review of the current state of digital health solutions. A big takeaway is that the vast majority of health apps have failed to capture momentum and maintain a user base. Healthcare systems and the pharmaceutical industry tend to release specialized apps that tackle a single issue. However, retention rates for these types of apps dwindle by 30 days and often drop off completely by 60 days after usage begins. “Siloing” off apps by health issue is not working, especially for vulnerable populations. Instead of specialized health apps, most patients end up repurposing their default apps to meet their health needs. They use Facebook for consulting friends and family, Google for looking up services and the calendar app to manage appointments.

The few success stories come from apps that are more holistic. Rango integrates services and resources for HIV/AIDS patients in New York City. The app helps with general care management and also synchronizes with other healthcare services. It was created by Village Care of New York, which both provides services and connects people to related services. Village Care worked with technology providers to include specific components such as text messaging, video chat, and other tools which allowed them to devise customized solutions for their client’s needs. In addition, Rango was introduced as only one tool in Village Care’s suite and not as a fix-all solution.

It is clear that there is a disconnect between what health experts want — apps that secure data and meet regulatory requirements — and what user actually will use. Health professionals need to connect to the tools and platforms patients are already using.

Suggestions for Future Action and Research

Based on the focus groups and review of existing studies, researchers recommend that  digital health solutions should:

  • Create training programs that teach patients to use their default apps for health management
  • Look to other industries like banking apps to recreate functional, trustworthy user experiences
  • Create subsidies for tablets for vulnerable populations to replace their 2nd Wifi only cell phones
  • Work with cellular providers to provide data subsidies for free data while using specific health app
  • Integrate voice services like Apple’s Siri to match patients to relevant health resources
  • Develop community based pilot programs for new technologies that integrate local needs, community organizations and innovate tech companies

You can watch the entire webinar or download slides or a transcript on the Dialogue4Health website. 

Jacob Kraybill is a writer in PHI's communications department.