Category: eHealth

Exploring Dating Application Profile Fields Through Health Behavior Theories

Location-aware or geososocial mobile dating and sex-seeking applications are becoming more and more common for men who have sex with men (MSM). Of these apps, Grindr is likely the most popular with 3.5 million users opening the app each day (Kelly, 2018). This mobile app presents other users profile images in a 3-column grid, allowing a user to quickly scan through the profile images of other users to find potential partners. Goedel and Duncan (2015) suggest that MSM use multiple apps and spend considerable time on them, meaning that there are many different sites for interventions with MSM but also the sustained time on the apps might suggest that these would be fruitful locations.

Given the high use of these applications, I’m interested in the ways that public health researchers can work with(in) these applications or the ways that these applications can make themselves more socially responsible with respect to users’ sexual health. Using Grindr as a case study, we can look at the ways that the user profile works with the Health Belief Model (HBM) and Social Cognitive Theory (SCT) to possibly result in health behavior changes for HIV testing and pre-exposure prophylaxis (PrEP) usage (Glanz, Rimer, & Viswanath, 2008).

On Grindr, there are currently options for sharing information about HIV status and last tested date (see image below). Users can select from various restricted vocabulary options to show to their fellow users. In this sense, seeing that other people are taking PrEP or have gotten tested recently might work within the SCT concepts of collective efficacy and observational learning. MSM on these apps can see other MSM are getting tested and taking PrEP, and these aspects might impact individual self-efficacy and perceived benefits within the Health Belief Model while also serving as a cue to action for the behavior change. As such, combining these aspects of SCT and the HBM, these two simple factors on the dating profile might increase the likelihood of users on these apps engaging in HIV testing or PrEP usage.

However, it was recently revealed that Grindr was sharing this health information with other companies (Kelly, 2018). It will be interesting to see how users make choices about using these fields in the future if they feel distrust towards the application. This news came quickly after Grindr proposed offering reminders and information about HIV testing to users based on the last tested dates provided on their profiles (McNeil, 2018).

Other dating applications for MSM, and for other populations, could employ similar strategies in their user profile descriptive schemas. Future research could also look empirically at the impact of these aspects of the profile on health behavior change. It may also be possible to expand sexual health information sharing to include information about other STIs to encourage testing and prevention beyond HIV.

 

Bibliography

Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2008). Health behavior and health education: theory, research, and practice. John Wiley & Sons.

Goedel, W. C., & Duncan, D. T. (2015). Geosocial-Networking App Usage Patterns of Gay, Bisexual, and Other Men Who Have Sex With Men: Survey Among Users of Grindr, A Mobile Dating App. Journal of Medical Internet Research, 17(5), 1-1. doi:10.2196/publichealth.4353

Kelly, H (2 April 2018). Grindr to stop sharing HIV status of users with outside companies. CNN Money. Retrieved 4 April 2018.

McNeil, D. G., Jr (26 March 2018). Grindr App to Offer H.I.V. Test Reminders. NY Times. Retrieved 4 April 2018.

 

What you need to know about SESTA and the recent seizure of Backpage

Late last week, classified ad website Backpage.com went offline after being seized and disabled due to an “enforcement action by the Federal Bureau of Investigation, the U.S. Postal Inspection Service, and the Internal Revenue Service Criminal Investigation Division”. Backpage.com is known for personal ads, and was considered by many to be the dominant online platform for sex workers to advertise their services.

Various websites have been shutting down their personal ads section in response to the Stop Enabling Sex Trafficking Act (SESTA), which has taken aim at online platforms as a playing a perceived role in sex trafficking and prostitution. While many advocates have been fighting SESTA for a large part of the year, awareness seems to be low of the laws implications among the general population.

Advocates against SESTA argue that the act will do more harm than good in regards to the safety of sex workers. Online platforms for sex work have been viewed as safer than street based sex work, allowing for screening of potential clients. Others have argued that SESTA would limit online free speech, arguing that it would require platforms to put strong restrictions on users’ speech, extending beyond the space of personal ads. If you’re interested in seeing what you can do stop SESTA, check out https://stopsesta.org for more information on how to contact your elected officials.

 

Sources – Buzzfeed News: Backpage Has Been Taken Down By The US Government And Sex Workers Aren’t Happy – https://www.buzzfeed.com/blakemontgomery/backpage-service-disruption?utm_term=.mceyodXp#.bkjAQmNK

App Grindr under scrutiny over privacy concerns

In an article published yesterday by BuzzFeed News, it was released that Gay Dating App Grindr has been sharing its users’ HIV status with two outside companies, a move which many consider dangerous to the queer community that the app claims to serve.

The sites, Apptimize and Localytics, work with Grindr to optimize the app and user experience. While it has been noted that these companies do not share information with third parties, there are still concerns with the sharing of sensitive information of a historically vulnerable population. This could raise flags for users sharing their HIV status on the app, which could negatively impact public health interventions that work to reduce HIV transmission and stigma.

Grindr recently announced that they would remind users to get tested for HIV every three to six months, offering a cue to action for users to be more aware of their HIV status. Knowing ones status is a crucial component for reducing the number of new HIV infections, such as by offering the opportunity to those who are living with HIV to be connected to care and achieve viral suppression.

 

Sources:

BuzzFeed News: Grindr Is Sharing The HIV Status Of Its Users With Other Companies –https://www.buzzfeed.com/azeenghorayshi/grindr-hiv-status-privacy?bfsplash&utm_term=.eu9v16ZaQ#.akvOQgNJj

Literacy and e-Health

By Rachel Kurtzman

Your phone buzzes and you look down- it’s a text that your prescription is ready for pickup, a medication reminder, or a communication from your doctor. For most of us reading health messages like this isn’t an issue, but it is for millions of adults in the U.S. who have low literacy skills. Nearly 14% of U.S. adults have below basic literacy skills and 29% have basic literacy skills- about 92 million people.1 Low literacy is linked to many adverse health outcomes, including increased mortality and poor control of chronic health problems.2

Many mobile health applications rely on individuals being able to read and interpret health messages, and fail to consider those who cannot. Studies have found that most apps available through the app store rely on high literacy and numeracy skills.3 There are very few guidelines on how to develop apps that are more accessible for this population, but some recommendations include using larger font, more images, larger graphics, lowering the reading level, and having the option of text to voice responses.3

Our health care system is evolving and e-health has the potential to help more people engage with the tools necessary to manage their health, but not creating products that are accessible for individuals with a broad range of literacy levels risks widen disparities and leaving behind a vulnerable segment of our population.

References:

  1. Eichner J, Dullabh P. Accessible Health Information Technology (Health IT) for Populations With Limited Literacy: A Guide for Developers and Purchasers of Health IT. (Prepared by the National Opinion Research Center for the National Resource Center for Health IT). AHRQ Publication No. 08-0010-EF. Rockville, MD: Agency for Healthcare Research and Quality. October 2007.
  2. Pignone, M.P., DeWalt, D.A. Literacy and Health Outcomes: Is Adherance the Missing Link? J Gen Intern Med. 2006 Aug; 21(8): 896-7.
  3. Chaudry, B.M., Connelly, K.H., Siek, K.A., Welch, J.L. Mobile interface design for low-literacy populations. IHI’12. January 28-30th, 2012. Miami Florida, USA. DOI: 1145/2110363.2110377

 

Stethoscopes and Smartphones? How Doctors are Using mHealth Apps for Patient Care

By Elizabeth Adams, MA

There was a time when doctors circulated the hallways of hospitals with nothing but a beeper pinned to the waistline of their scrubs.

But today, you might notice your doctor enter the exam room clutching a more advanced communication device – a Smartphone or tablet. A 2014 survey reported that 85% of medical faculty, 90% of medical residents, and 85% of medical students used a Smartphone in a clinical setting1. Modern doctors are increasingly replacing laptops or desktops with Smartphones and tablets2.

Doctors are constantly on their feet, moving throughout hospitals, emergency rooms, or clinics.  They use these devices for variety of job-related tasks, including remote patient monitoring, electronic health record access, e-prescribing, drug reference calculations, reading medical news, and decision-making support3. Now there is a marketplace for health professionals to locate apps designed specifically for clinical practice. In 2011, the iPhone App Store introduced the “Apps for Health Care Professionals” section, which has expanded to include more than 80 app options4.

Here are a few ways doctors are using apps to improve patient care:

 Retrieving Information. Doctors increasingly rely on mhealth to inform complex clinical assessments and decisions. One survey indicated that two-thirds of doctors use medication-interaction assistance apps to aid in the prescription decision-making process5. In addition, medical residents rely on mobile phones in clinical consultation to look up drug information, perform clinical calculations, take notes, or look up clinical guidelines4. Instantaneous access to information can help doctors and trainees make more accurate decisions regarding treatment.

 Communicating with Patients. Electronic health record software, such as Epic (link to: https://www.inova.org/for-physicians/epiccare-apps) – the program used by UNC HealthCare – incorporate apps Haiku and Canto, which facilitate direct correspondence between patients and health care teams. Other third-party apps, such as OhMD (link to: https://www.ohmd.com), TigerText (link to: https://www.tigertext.com/), and Hale (link to: http://hale.co/), are compatible with electronic health record programs and connect patients to doctors through text messaging platforms.

Continuing Education. Mobile continuing education curricula promises to supply doctors and trainees with current medical information and impart recent standards of practice without the time-consuming requirement of sitting at a desktop or in a classroom. In addition, top-tier medical journals, including the New England Journal of Medicine’s This Week app (link to: http://www.nejm.org/doi/full/10.1056/NEJMe1201837) and the American Medical Association’s CPT QuickRef app (link to: https://www.ama-assn.org/practice-management/applying-cpt-codes), deliver scientific articles and guidelines.

 More research is necessary to understand the relationship between mhealth app adoption and improved clinical care outcomes. Smartphones could be considered impediments to patient care, so they must be used with some discretion. But next time your doctor walks in with a tablet or glances at a Smartphone, remember that he or she might be using an app to make better decisions for your health.

References

  1. Ventola, C. Lee. “Mobile Devices and Apps for Health Care Professionals: Uses and Benefits.” Pharmacy and Therapeutics5 (2014): 356–364.
  2. Murfin, M. Know your apps: an evidence-based approach to evaluation of mobile clinical applications. Journal of Physician Assist Education. 2013; 24(3):38-40.
  3. Kaufman, Michele B,PharmD., R.Ph. “Mobile Health Increases as Physicians Seek New Ways to Manage Patients.”Formulary, vol. 47, no. 4, 2012, pp. 161-162, ProQuest, http://libproxy.lib.unc.edu/login?url=https://search-proquest-com.libproxy.lib.unc.edu/docview/1145903653?accountid=14244.
  4. Dolan, B. Apple’s Top 80 Apps for Doctors, Nurses, and Patients. [Online] November 27, 2012. http://www.mobihealthnews.com/19206/apples-top-80-apps-for-doctors-nurses-patients/
  5. Boruff, J. T. M., & Storie, D. M. M. A. Mobile devices in medicine: a survey of how medical students, residents, and faculty use smartphones and other mobile devices to find information. Journal of the Medical Library Association, (2014): 102(1), 22-30.

What Do You Meme? How Memes Can Be Used to Affect Health Behavior Change

By Trevor Bell

In today’s world, memes rule supreme, particularly for teens and young adults. Whether it’s Barack Obama’s portrait, crying Michael Jordan, or dogs, memes have the ability to make light of almost any situation. But, what if memes can help those affected by illnesses? In a qualitative study looking at how Instagram could be used to portray type 1 diabetes (T1D)1, humor – in particular the use of memes – was shown to be a simple way in which teens with T1D were able to both have more positive attitudes and inform the general public about T1D.

In the study, participants used pre-existing T1D memes or created memes themselves and shared these on their personal pages. The authors suggested that humor could be an important point of potential interventions for health behavior changes, and that, “Humor seemed to be a prominent coping strategy and could be used to address the negative feelings that often emerge in adolescents with T1D” (p. 1380). In the context of eHealth, perhaps healthcare providers should take notice of how society deals with issues. For example, eHealth interventions could encourage patients to post memes on their own social media accounts or to a specified website/forum. This is obviously no substitute for clinical care, but it could be a unique way in which we improve the outlook of those affected by chronic illness while also spreading information to the general public. The possibilities are endless, if you know what I meme.

Reference:

1Yi-Frazier, J. P., Cochrane, K., Mitrovich, C., Pascual, M., Buscaino, E., Eaton, L., … Malik, F. (2015). Using Instagram as a Modified Application of Photovoice for Storytelling and Sharing in Adolescents With Type 1 Diabetes. Qualitative Health Research25(10), 1372–1382. http://doi.org/10.1177/1049732315583282

Celebrities, Social Media, and Mental Illness

By Jacob Rohde

Earlier this month, Selena Gomez opened up to Harper’s Bazaar magazine about her struggles with mental illness [1]. When asked about her upcoming plans for the new year, Gomez responded:

“I will always start with my health and my wellbeing. I’ve had a lot of issues with depression and anxiety, and I’ve been very vocal about it, but it’s not something I feel I’ll ever overcome… I think it’s a battle I’m gonna have to face for the rest of my life…”

Gomez is joined by several other celebrities, from Gina Rodriguez to Kid Cudi, who have spoken out about the realities of their mental illnesses and have used social media to publicly vocalize their related experiences [2]. For example, Gomez recently used Instagram to talk about her lupus diagnosis, which she has linked to her depression and anxiety [3]. All too often, celebrities are viewed as immune to such circumstances when, in reality, they share many of our own battles with mental illness. Social media allows celebrities, like Gomez, to connect with their audiences who may also struggle from mental illness, or to those who do not fully understand the complexity of mental illness symptoms.

Fifty percent of Americans will experience some form of mental illness in their lifetime [4], yet public perceptions about mental illness remain highly stigmatized, especially among young adults and college students [5]. In my own experiences, I have witnessed several students express their reluctance to seek mental health services as to avoid being “outed” by peers and stereotyped.

Efforts to reduce mental illness stigma can benefit from the stories and experiences shared by celebrities through their social media accounts. Indeed, a recent study found that college students exposed to celebrity narratives about mental disorders were far less likely to stigmatize mental illness overall and had fewer negative perceptions about those who seek help for mental illness than students in control conditions [6]. Given this, celebrity use of social media as a platform to talk about mental illness may have a positive effect on how the public perceives mental illness.

Of course, I am not advocating for celebrities to share deeply personal experiences. However, if they choose to address certain issues pertaining to their mental health, it may serve to reduce the taboo culture currently surrounding depression, anxiety, and other mental illnesses. At minimum, doing so shows that celebrities, like Gomez, are not so different than ourselves.


Mental illness is a serious concern. If you are struggling, please seek professional help or reach out to the 24/7 suicide prevention hotline: 1-800-273-8255

If you are a UNC student, free support is available through the Counseling and Psychological Services program (CAPS). Information available here: https://caps.unc.edu/


References:

  1. Langford, K. (2018). Selena Gomez’s Wild Ride. Harper’s Bazaar. Retrieved from http://www.harpersbazaar.com/culture/features/a15895669/selena-gomez-intervi ew/
  2. Yang, L. (2017). 23 celebrities who have opened up about their struggles with mental illness. Retrieved from http://www.thisisinsider.com/celebrities-depression-anxiety-mental-health-awaren ess-2017-11#cara-delevingne-struggled-with-depression-as-a-teenager-8
  3. Chiu, M. (2016). Selena gomez taking time off after dealing with ‘anxiety, panic attacks and depression’ due to her lupus diagnosis. People Magazine. Retrieved from http://people.com/celebrity/selena-gomez-taking-a-break-after-lupus-complication s/
  4. Kessler, R. C., Angermeyer, M., Anthony, J. C., De Graaf, R. O. N., Demyttenaere, K., Gasquet, I., … & Kawakami, N. (2007). Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry, 6(3), 168.
  5. Eisenberg, D., Downs, M. F., Golberstein, E., & Zivin, K. (2009). Stigma and help seeking for mental health among college students. Medical Care Research and Review, 66(5), 522-541.
  6. Ferrari, A. (2016). Using celebrities in abnormal psychology as teaching tools to decrease stigma and increase help seeking. Teaching of Psychology, 43(4), 329-333.

Dear Apple, Keep doing what you are doing

The new Apple Watch commercial “Dear Apple” has the world talking after its debut during this year’s Winter Olympics. It’s personal, heart wrenching and most importantly highlights the incredible impacts of it’s less advertised features. This commercial emphasizes that this technology could revolutionize healthcare and provide life-changing health support. It features anecdotes of a car accident survivor using the feature on the watch to call 911 after their phone was thrown from the vehicle and a child with Type 1 diabetes pairing the watch with her glucose monitor that alerts her when her blood sugars are at low levels. While the ad still features its more traditional feature of tracking physical activity, it was nice to see that the more innovative features of its products and it’s direct benefits. While I love a good selfie, it’s reassuring to know that Apple and other technology companies are using their technology for just more than just three dimensional emojis and higher quality selfies. I look forward to seeing what other technology these companies come up with in the future to help us lead healthier lives.

If you haven’t seen the commercial check it out here: https://www.youtube.com/watch?v=N-x8Ik9G5Dg

 

 

HIV Medication Adherence Apps: Challenges Faced

By Chunyan Li

The success of HIV medications has changed HIV from a fatal disease to a chronic illness. However, like other chronic diseases that require lifetime medication (at least for now), maintaining good adherence to antiretroviral therapy is not easy for HIV-positive people for reasons such as the complex drug regimens, strict requirements on the time of daily medication, and sometimes intolerable side effects. Having a mobile phone-based application to remind patients of daily medication is a good way out, but the effectiveness of such medication adherence apps remains less studied.

One significant challenge that such apps often face is a lack of behavioral science in design. Some experts described the development of many healthcare apps as a “black box”[1], blaming that app developers often focus too much on technology while neglecting behavior change theories or research evidence. One 2016 research study [2] reviewed all health apps on Google Play, Apple App Store and Windows Phone Store, and found that the reviewed 28 eligible health apps only used 5.6 out of the total 37 behavioral change principles on average. Among the four categories of behavior change principles proposed by the researchers (task support, dialogue support, system credibility and social support), the most used principles were about “system credibility” and “task support”, including features like surface credibility, expertise, authority, and providing general information and function of self-monitoring.  The two categories “dialogue support” and “social support”, which require higher user-provider interactivity and more constructive design based on behavioral science, are somehow neglected.

In another systematic review [3] that reviewed all eHealth-based HIV intervention studies (including smartphone-, Web- and general Internet-based interventions), 10 out of the 14 studies that had a component of adherence improvement were smartphone-based. As HIV patients are usually required to take medicines on quite a strict daily schedule, and sometimes even to be in private if HIV/AIDS is heavily stigmatized, smartphone-based apps are better for portability and privacy protection. However, it could also be challenged when people feel unsafe to disclose HIV status or worry about leaving digital footprints on such apps. In lower-income settings where cell phones are shared with family members, using apps to keep track of medication adherence might not be an ideal option for HIV-positive people.

In a qualitative research study about the HIV treatment continuum that I’m recently working on, a frequently-mentioned desired feature of app-based interventions by HIV-positive people is having communication with human counselors. Many adherence apps may have functions of knowledge education, tracking medications and pushing reminders, but lack an emotional support. Living with HIV is a chronic and multidimensional (physical, psychological and cultural) stress, and a successful coping with such a stress requires consistent support from families, friends and health professionals. Though the advantages of health apps include its mass-reach to users and increasing access to care in limited-resource settings, we should never ignore the needs for human caring and support. How to incorporate human support into HIV medication adherence apps could be one of the future research directions.

 

[1] Tomlinson, M., Rotheram-Borus, M. J., Swartz, L., & Tsai, A. C. (2013). Scaling Up mHealth: Where Is the Evidence? PLoS Medicine, 10(2). https://doi.org/10.1371/journal.pmed.1001382

[2] Geuens, J., Swinnen, T. W., Westhovens, R., de Vlam, K., Geurts, L., & Vanden Abeele, V. (2016). A Review of Persuasive Principles in Mobile Apps for Chronic Arthritis Patients: Opportunities for Improvement. JMIR mHealth and uHealth, 4(4), e118. https://doi.org/10.2196/mhealth.6286

[3] Muessig, K. E., Nekkanti, M., Bauermeister, J., Bull, S., & Hightow-Weidman, L. B. (2015). A Systematic Review of Recent Smartphone, Internet and Web 2.0 Interventions to Address the HIV Continuum of Care. Current HIV/AIDS Reports. https://doi.org/10.1007/s11904-014-0239-3

 

Electronic Health Record Coming to a Phone Near You

When I go for my yearly check-up, my doctor asks me things like “When was your last tetanus shot” and “What was your last Pap smear.” Since these services only happen every 3, 5, or 10 years, my answer is usually an “I don’t know.  I’d have to track down the records.”

Apple has realized that most of us have foggy memories when it comes to our healthcare.  In January, Apple announced that they are extending their AppleHealth app to interface with people’s electronic health records.  This means that instead of having to request records to be sent from office to office, you will be able to see your medical history on your phone.

This version of the app is currently still in beta-testing, and therefore is only available to patients of Johns Hopkins Medicine in Baltimore, MD, Cedars-Sinai in Los Angeles, CA, Penn Medicine I Philadelphia, PA, Geisinger Health System in Danville, PA, UC San Diego Health in San Diego, CA, UNC Health Care in Chapel Hill, NC, Rush University Medical Center in Chicago, IL, Dignity Health in AZ, CA, and NV, Ochsner Health System in Jefferson Parrish, Louisiana, and MedStar Health in Washington D.C., MD, and VA, OhioHealth in Columbus, OH, and Cerner Health Clinic and Kansas City, MO.

Hopefully this will allow people to take more ownership of their healthcare in the future.

 

Reference:

Apple, Inc. (2018, January 24). Apple announces effortless solution bringing health records to iPhone. Retrieved from Apple.com: 2018