One size does not fit all: making apps personal


Dr Elin Haf Davies, CEO & Founder, Aparito and Eric Kihlstrom, Tech entrepreneur, Aging 2.0 UK Chapter Lead, are both members of the AXA Health Tech & You Expert Group. Here they make the case for more complex, human-centred design in apps

Tech start-ups are everywhere. Every day you read about yet another tech product being developed to somehow disrupt the world that we live in. Considering not all solutions include mobile, it’s even more daunting to know that in 2017, the total number of mobile app downloads was estimated to be a staggering 197 billion. But how do we decipher which ones have real value and which ones are commercial hype? The market is competitive and most solutions end up in the app graveyard.

study conducted in 2018 found that the average lifecycle an app was only 28 days. Poor marketing and content are often cited as the reason for so much failure.

However, we believe these failures are symptoms of a larger issue around the ecosystem of stakeholders, including the human at the centre.

Checking the reality

How do we really make sure that tech products add value and impact on the way we live today? One of the key issues is to consider how that tech product functions or exists within a greater ecosystem. People’s lives today exist in extremely complex circles. Nothing is in isolation and you can rarely change one thing without impacting on another. Solutions designed without considering the needs of key stakeholders have almost no real value. The design process cannot be shortcut but is often a source of failure.

In healthcare today, human-centred design se even more essential. Our actions as patients and carers have a significant impact on healthcare professionals, the healthcare system plus our family and friends in the circle of care that need to look after us. Likewise, any change in the healthcare system can have a huge impact on patients and the people around them.

At the two extreme ends of life – paediatric healthcare and care of the elderly, the impact of disease and poor health is significant for the individual and their immediate family members. Loss of health becomes a major motivation to fight to regain it. But when we have good health the motivation to maintain it is frighteningly low.

Putting the individual first

The you in healthcare therefore needs to be readdressed. We need to readdress our understanding an individual’s context and personal motivations in order to create effective solutions that deliver value and impact on our health and the healthcare system as a whole. We believe it’s overlooked because understanding the influence of all stakeholders in the context of an individual’s motivations to be healthy is hard to do well. It can be hard because a solution provider often doesn’t influence other essential elements of a patient’s health context. However, just because it’s hard doesn’t mean this essential step can be overlooked and still deliver impact on healthcare.

Rather than taking a comprehensive approach to designing a solution, developers often take a short cut and implement a -one size fits all approach’.  It sounds obvious but it’s often an ignored obvious fact that not everyone is the same. ‘One size does not fit all’ is particularly true of individuals’ motivation to change behaviour, irrespective of your life stage. Creating effective behaviour change solutions requires a wider understanding of a person’s situation and the influence different stakeholders, including GPs, nurses, carers, and other community health professionals can have on creating effective behaviour change solutions for people.

In fact, it’s just the opposite, understanding a person’s motivations for living healthy is even more essential than ever before. Healthcare around the globe is changing. So much of healthcare today is about long-term conditions at any age such as diabetes, hypertension and mental health. Long-term conditions are highly influenced by lifestyle and the choices we make every day.  Supporting people to make healthy decisions is complex. It is now well documented that information alone is not sufficient to modify damaging behaviour. So what other motivators can be applied?

Mastering motivation

Solutions range from face-to-face support by health professionals, peer support groups, sympathetic family and friends to simple text messaging.  According to the research of one US health technology company, there are up to 15 different ways the supercomputer in your back pocket (your smartphone) can support behaviour change. In the UK, Susan Michie, Professor of Health Psychology and Director of the Centre for Behaviour Change at UCL have developed The behaviour change wheel – a guide to designing intervention. Professor Michie’s model takes into account ‘capability’ (knowledge, skills, stamina) ‘opportunity’ (physical, social, political, cultural), and motivation (automatic or self-reflective) and how all this results in engagement in changed behaviours. Different behaviour change theories can be applied together with Professor Michie’s model.

Elin Haf Davies

Applying a mix of theories will become more important for solution developers. As the NHS puts increasing focus on prevention, technology is planned to play an increasing role from the health system perspective in an individual’s circle of care. Matt Hancock certainly believes technology solutions should be a vital part within his vision for digital, data and technology in health and care and his Vision for Prevention that sets out a new approach to:

  • keeping people healthy, happy and treating their health problems quickly
  • empowering people to manage their own physical and mental health needs closer to home with the support of professionals in the community
  • delivering care in the right place, in settings that suit them and their needs

A key phase in the vision statement is the acknowledgement of the complex ecosystem around our health, ‘prevention cannot be solved purely by the health and social care system alone. Everyone has a part to play, and we must work together across society’.

Eric Kihlstrom

The key for solution providers is to avoid shortcuts. One example of a well human-centred designed healthcare solution is Welldoc’s Bluestar solution for managing diabetes. After a lengthy user-centred design process and clinical trials to validate results, the Bluestar diabetes-focused behaviour change solution is clinically proven to outperform traditional solutions including medication. Welldoc’s Bluestar is an example of combining a user-centred design process and the generation of supporting evidence. Two essential aspects that should be considered mandatory in the healthcare sector in order to avoid falling foul to ‘fake news’ claims, disengaged patients, high drop outs and ultimately damaging health outcomes.

The third aspect needed at a societal level is the ethics that will govern these new innovations. The ethics surrounding data ownership, informed consent, and the business model applied to improving and maintaining people’s health is one that needs to be formulated as a matter of urgency, before it’s too late and before we lose the trust of the people and the freedom to self-regulate in which we now operate in. Any foul play in this arena will see a knee jerk reaction and clamp down by regulators which could ultimately hamper innovation and delay the implementation of public health benefits.

About the author

With well over 100 years experience between us, we've been around the editorial and medical blocks a few times. But we're still as keen as any young pup to root out what's new and inspiring.

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