Physicians call it the 5,000-hour problem. If you have a common chronic condition such as cardiovascular disease or diabetes, the expert in charge of your health for almost all of your 5,000 waking hours annually is—you. And, frankly, you won’t always make the best choices.
With that in mind, a rapidly evolving set of new digital health tools is angling to help patients engage better with their own care. Wearable health monitors already on the market help to track heart rate, footsteps, or blood glucose levels; sophisticated home health sensors can report on weight and blood pressure; and phone apps can present key feedback and maybe even offer personalized advice.
The only problem: It has thus far proved very difficult to know what really works.
Many early attempts to truly test the efficacy of such digital technologies have shown them to be a flop in clinical trials—in large part because participants drop out. An analysis of five health apps built with Apple iPhone software, for example, found that only about one-eighth of participants, or less, were still hanging in after 10 weeks. Another recent study out of Singapore found that about 200 people outfitted with fitness trackers showed no better health outcomes than a similar control group after a year. And when Cedars-Sinai Medical Center in Los Angeles invited about 66,000 patients registered on its portal to share data from their fitness trackers, less than 1 percent did so, according to a paper published last year in the journal PLOS One, part of the open-access Public Library of Science.
In chronic disease, people lack instant gratification for, say, dropping that slice of pizza and eating their damn broccoli. Individual patients need to find personally meaningful ways to motivate themselves, like picturing themselves playing actively with their grandchildren, Chang said. A trained human health coach can help them build this motivational framework, but it remains a real challenge for a mobile app.
Research in behavioral economics can help to optimize more concrete healthy-habit incentives offered by employers or health plans, Volpp said. A clinical studypublished last year in the Annals of Internal Medicine, for example, either paid participants $1.40 for each day they took 7,000 steps, or gave them a virtual bank account holding 30 days’ worth of those payments—or $42—and then subtracted $1.40 for each day they didn’t walk 7,000 steps. The second method worked appreciably better.
“If you build it,” quipped Brennan Spiegel, an internal-medicine physician and head of the Cedars-Sinai Center for Outcomes Research and Education, “they will not come.”