Global health researchers are increasingly seeing the value of mobile apps to collect data, promote positive health behaviors and provide health information and services in parts of the world where access to a traditional healthcare infrastructure is limited. But as ubiquitous as these apps have become, it’s still far from easy to design an effective one. We talked to three faculty members with experience in building mobile apps for health about the lessons they’ve learned.
Gary Bennett, the Bishop-MacDermott Family Professor of Psychology & Neuroscience, Global Health and Medicine, directs the Duke Global Digital Health Science Center. Bennett’s research program designs, tests and disseminates digital obesity treatments, such as iOTA, an interactive weight loss program.
Assistant professor Eric Green’s primary research interest is how technology can improve health and health systems in low-income settings. Currently, Green and his collaborators and students are developing and testing Nivi, an app that connects women and men to family planning services.
Lavanya Vasudevan, research scholar at the Center for Health Policy and Inequalities Research at DGHI, is interested in mobile technologies that support improved maternal and child health outcomes in resource-limited settings. She’s currently working on developing and evaluating an app designed to improve timely vaccinations in Tanzania, and she teaches an “Introduction to mHealth” course.
DGHI: What global health problems lend themselves well to mobile apps?
Gary Bennett: I have yet to encounter a global health problem that isn’t amenable to a digital health application. However, I think it’s important to note that digital tools are really just that: tools. The advantage of using digital is that we can heighten the efficiency, personalization and automation of tasks so that care providers can be more effective in their work.
Eric Green: I think any problem characterized by process inefficiencies or information deficits represents a good opportunity for digital health.
DGHI: What are some essential considerations for developing global health mobile apps?
Gary Bennett: Creativity, imagination and patience. In the old days, when treatment materials were all paper-based, we only had so many ways to engage the audience. With digital, opportunities for creativity abound. We’ve only scratched the surface at finding out the best ways to design engaging tools that help patients improve their health.
Lavanya Vasudevan: A good place to start is with the “principles of digital development,” which summarize nine best practices for digital development—such as design with the user in mind, be data driven and build for sustainability.
DGHI: In your experience, what’s worked well?
Eric Green: The ability to iterate—that is, develop an application incrementally, building on what was learned during each stage of development through testing and user feedback—is very helpful in creating a successful product. This “fail fast” approach is often not used because it’s hard enough to build a new product or service, let alone the mechanisms to learn quickly and change. But new tools are becoming available that will make iterative development easier.
Lavanya Vasudevan: Taking the time to understand the user and health system constraints related to the mHealth solution has not only allowed us to identify innovative strategies, but also ensure that the end result is really aligned with the need. This is an area where global health formative research methods are a great asset.
Gary Bennett: It’s easy to get excited about apps and devices, but some of the most effective approaches are simply text messaging or automated telephone calls. We design these tools to provide immediate, highly personalized feedback and we find that keeps patients engaged for far longer than if they were using a smartphone app.
DGHI: What has surprised you about your work with global health mobile apps?
Lavanya Vasudevan: You don’t have to design something complex to get the most impact. In many situations, simple text message-based health education content or appointment reminders have made the biggest impact on health behaviors and outcomes.
Gary Bennett: In the early days of this work, people were very suspicious about the idea of using advanced technologies in low-income populations, but many people in these groups use smartphones more frequently than those in higher-income populations, and their rates of engagement with digital health applications are extremely high. We used to consider these populations hard to reach, but digital tools allow us to reach and engage them.
DGHI: What are the biggest challenges you’ve encountered, and how have you overcome them?
Lavanya Vasudevan: Two of the biggest challenges in designing mHealth applications for maternal and child health in low- and middle-income countries are gender differences in mobile phone ownership and literacy among women. Those women, especially from the most underserved areas, are less likely to own phones or be literate, so delivering health information to women often requires engaging husbands or other members of the household who own phones and/or are literate. In some of our interventions, we’ve broadened the group of users to include “advocates”—that is, individuals who are not part of the household, but whom women trust to receive and relay health information on their behalf.
Gary Bennett: Universities weren’t really designed to test, host, support and license services of the type that we’re creating in digital health applications. When you’re creating these tools, you have to consider a whole range of additional issues like back-end infrastructure, privacy and how to get them beyond the university walls.
DGHI: What types of partnerships have you found helpful in doing this work?
Lavanya Vasudevan: Partnerships with local, regional, and/or national health administrations are key to ensuring that the global mHealth apps are aligned with national priorities and can be integrated with health system processes and resources.
Gary Bennett: We work extensively with community health centers in the United States where many low-income patients receive their healthcare. These are locations that are very open to adopting the types of technologies we create.
DGHI: What advice would you give to people or organizations looking to create mobile apps to address global health issues?
Gary Bennett: Find good partners. Digital health science requires multidisciplinary teams and ongoing collaboration. Technical proficiency really helps. Fortunately, it’s easier than ever to learn about software engineering, and even a little bit of background knowledge helps a lot.
Eric Green: In my work, the most helpful thing has been working with people with a strong knowledge of business models. A close second is finding top-notch software engineers. I would also advise people to make sure their app, service, or product is filling an actual need. Then build something small and see if anyone cares.
Lavanya Vasudevan: In addition to finding the right partners, it’s important to engage key stakeholders from the beginning. Incorporating monitoring and evaluation throughout the development of the mHealth app can be critical in identifying problems early. The World Health Organization has developed several practical resources that help people develop stage-based monitoring and evaluation plans and assess progress on the pathway to scale.
The advantage of using digital is that we can heighten the efficiency, personalization and automation of tasks so that care providers can be more effective in their work.Gary Bennett, director of the Duke Global Digital Health Science Center