Psychology in digital health: It’s the missing piece of the jigsaw…

Guest blog by Jessica Auton from Aseptika Ltd (Activ8rlives), winners of  the ‘Manage My Condition’ Category in this year’s AXA PPP ‘Health Tech & You’ Awards

The psychology of self-management and the impact of digital technology:

Screen Shot 2015-05-26 at 23.51.25With the shift towards self-monitoring utilising digital healthcare, the public, with no clinical training, can track and aggregate their health, diet and activity data, set goals and healthy targets, visualise and learn from their data (e.g. weight, activity, nutrition, blood pressure and respiratory health) and monitor their progress in the form of charts and dashboards.

Bringing about individual behavioural change success is influenced by 3 important elements: readiness to change; barriers to change; and expected relapse. You cannot force an individual to make behavioural changes without considering these 3 factors. In the preparatory stages of behavioural changes learning from an individual’s baseline behaviours and data is important to set realistic goals and targets.  Once goals have been set, behaviour change activities with small achievable steps can be incorporated within daily routines. Mindfulness techniques come into play with recording, review, learning and providing an opportunity for accountability to this process.

Education and knowledge throughout the change process is very important, with notification of accurate science/clinical based information and the understanding of what constitutes healthy behaviours. A common technique used is groups, self-help, or social networking groups who share similar goals, providing group dynamics of reinforcement and encouragement.

Taking action towards an achievable goal, needs celebration and reward for positive steps taken, and this in turn reinforces and supports positive steps towards change. In the same way gamification of the digital experience encourages greater engagement and provides feedback and celebration of achievements. Time to periodically review motivations, resources, and progress to healthier behaviours and renew commitments and belief in abilities is key. Avoiding former negative behaviours and temptations by replacing with healthier habits is key to forming lifelong changes.  Knowing that we might fail along the way is part of the process and that’s okay. This is a common stumbling block for many but to reassure them to take it each day as it comes.

Users can receive instructions, nudges and prompts for behaviour change based on “expert learning” from the automated analysis of their data. This is personalised feedback in real-time based on an individual’s health behaviours, used as an assist to make changes in behaviour, reminders for medication, warnings about lack of adherence and alerts of declining health to the user or if the user is incapable of responding, to their carers and supporters. These steps to behaviour change provide individuals with the ability and confidence to know when and how to self-manage themselves. It also provides guidance parameters under which they need to seek medical intervention and when to use other services, such as community pharmacy or carers/family members.

Our thinking: 

Key to maintaining health is adherence to care plans and medication schedule  that we agree with our  own clinical team for self-management. Digital interventions can be assists to keep track of how well we are doing and report what is happening when we go off plan, or when our health suddenly deteriorates.

Patient education and training in self-management represents a significant opportunity. Empowering patients who have diagnosed conditions, which are incurable, so that they can take better care of themselves, particularly by initiating treatment at the outset, represents an opportunity to make a step change. But healthcare providers lack the practical tools and the communications infrastructure to turn this philosophy into clear actions that patients/carers can understand and use.

Self-management means moving from reactive admissions to partnership with patients/carers in which they become expert in their disease. For NHS Trusts already innovating in this arena, digital solutions can provide support of locally driven initiatives. Digital tools can be used, promoted and implemented by any healthcare provider and range from “wellbeing assists” through to an IVD tests. When they are used together, they form a comprehensive solution for the self-management of long-term health and co-morbidities, providing information to all stakeholders. This is not telemedicine – there is no continuous remote monitoring – so the patient/carer/family undertake this unpaid role directly and must do so to benefit from the information provided (empowerment). This prevents the transfer of savings from paying clinicians for face-to-face time to then be spent paying for a call centre staffed by clinicians.

Our own platform  has been designed to support laypeople, carers/family members and their healthcare team bring about lasting positive healthy behaviour change, adherence to care plans and medication regimes, self-management of long-term health conditions through self-monitoring of health parameters and a significant increase in engagement of patient centred healthcare.

Our solutions are designed so that the patient becomes responsible for their self-generated data and makes it accessible (if and when they decide to), to their clinical team. This also transfers responsibility for the cost of managing and securing these data to the patient and away from the NHS because these data are owned by the patient.

By self-monitoring with several simple gadgets  our platform  can stop small problems turning into a situation that requires emergency care in hospital.

The system is ideally suited for those with long-term conditions such as: Asthma, Chronic Obstructive Pulmonary Disease (COPD or emphysema) and Cystic Fibrosis (CF). Stimuli that increase long-term engagement in using our Cloud-connecting health tracking devices (Activity tracker, Smart Scales, Peak Flow meter, Pulse Oximeter, Blood Pressure monitor and Food Diary) and uploading to the Cloud so that patterns can be seen, will in turn, increase the efficacy of treatment processes – we become more focused on the management of our health.

We include a social media element (self-help groups), social networking, rewards and gamification to encourage self-monitoring as the cornerstone of a self-management strategy.

Screen Shot 2015-05-26 at 23.44.12Our platform has a rounded approach to self-management utilising  the technology available to us today, but apply it with an eye to the future, enabling those to whom healthcare matters most the individual, to take control of their lives.

About Julia Manning

Julia Manning is a social pioneer, writer, campaigner and commentator. Formerly a clinical optometrist specialising in diabetes and visual impairment, she is the founder and Chief Exec of 2020health, an independent, social enterprise Think Tank whose aim is to Make Health Personal and Social. 2020health has through research, events and campaigning influenced opinion and action in fields as diverse as bioethics, alcohol, emerging technologies, fraud, education, consumer technology and vaccination. In 2014, 2020health were founding partners of the Health Tech and You Awards with Axa PPP and the Design Museum, now in their 5th year. Since 2016, 2020health has increasingly focused on digital health and public health in the community through the concept of 'Whole School Wellbeing'. Julia is a Fellow of the RSA and a part-time PhD student at the UCL Interaction Centre, studying the use of digital technologies for stress management in the workplace. Julia has shared 2020health's research widely in the media (BBC News, ITV, Channel 5 News, BBC 1′s The Big Questions & Victoria Derbyshire, BBC Radio 4 Today, PM and Woman's Hour, LBC) and has taken part in debates and contributed to BBC’s Newsnight, Panorama, You and Yours and ITV’s The Week.
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