[Paper Review] Empowering Patients Using Smart Mobile Health Platforms: Evidence From A Randomized Field Experiment

Anindya Ghose, Xitong Guo+2 more|arXiv (Cornell University)|Feb 10, 2021

Mobile Health and mHealth Applications31 references25 citations

TL;DR

The paper conducts a randomized field experiment with 1,070 diabetes patients to evaluate how a smart mobile health (mHealth) platform affects health behaviors and outcomes, comparing mobile vs. PC versions and personalized vs. generic reminders.

ABSTRACT

With today's technological advancements, mobile phones and wearable devices have become extensions of an increasingly diffused and smart digital infrastructure. In this paper, we examine mobile health (mHealth) platforms and their health and economic impacts on the outcomes of chronic disease patients. We partnered with a major mHealth firm that provides one of the largest mHealth apps in Asia specializing in diabetes care. We designed a randomized field experiment based on detailed patient health activities (e.g., exercises, sleep, food intake) and blood glucose values from 1,070 diabetes patients over several months. We find the adoption of the mHealth app leads to an improvement in health behavior, which leads to both short term metrics (reduction in patients' blood glucose and glycated hemoglobin levels) and longer-term metrics (hospital visits and medical expenses). Patients who adopted the mHealth app undertook more exercise, consumed healthier food, walked more steps and slept for longer times. They also were more likely to substitute offline visits with telehealth. A comparison of mobile vs. PC version of the same app demonstrates that mobile has a stronger effect than PC in helping patients make these behavioral modifications with respect to diet, exercise and lifestyle, which leads to an improvement in their healthcare outcomes. We also compared outcomes when the platform facilitates personalized health reminders to patients vs. generic reminders. Surprisingly, we find personalized mobile messages with patient-specific guidance can have an inadvertent (smaller) effect on patient app engagement and lifestyle changes, leading to a lower health improvement. However, they are more like to encourage a substitution of offline visits by telehealth. Overall, our findings indicate the massive potential of mHealth technologies and platform design in achieving better healthcare outcomes.

Motivation & Objective

• Motivate the study by assessing how mHealth platforms influence health behaviors and clinical outcomes for chronic disease patients.
• Evaluate the health and economic impacts of using a large-scale mHealth app in diabetes care.
• Compare the effectiveness of mobile versus PC versions of the same app on behavior change and health outcomes.
• Examine the differential effects of personalized versus generic health reminders on engagement and outcomes.

Proposed method

• Randomized field experiment with 1,070 diabetes patients over several months.
• Use detailed patient data on health activities (exercises, sleep, food intake) and blood glucose values.
• Partnership with a major mHealth firm providing a diabetes-focused app in Asia.
• Random assignment to app adoption versus non-adoption to identify causal effects.
• Comparison of mobile app version against PC version to assess platform effects.
• Investigation of personalized health reminders versus generic reminders as a treatment variation.

Experimental results

Research questions

• RQ1 Does adoption of an mHealth platform improve health behaviors and clinical indicators for diabetes patients?
• RQ2 Is the mobile version of the app more effective than the PC version in driving behavior change and health outcomes?
• RQ3 Do personalized reminders yield greater engagement and health improvements than generic reminders?
• RQ4 Do mHealth-enabled changes substitute offline care with telehealth, and what are the implications for healthcare utilization?

Key findings

• Adoption of the mHealth app improves health behaviors, including more exercise, healthier eating, more steps, and longer sleep.
• Mobile app use yields stronger behavioral changes than the PC version, leading to better healthcare outcomes.
• Personalized mobile reminders with patient-specific guidance have a smaller effect on engagement and lifestyle changes compared to generic reminders, but they promote greater substitution of offline visits with telehealth.
• There are short-term improvements in blood glucose and glycated hemoglobin levels and longer-term reductions in hospital visits and medical expenses associated with app adoption.
• The study highlights the potential of mHealth platforms and thoughtful design choices to improve health outcomes for chronic disease patients.