Going global with mobile health
Dr. Heather Patrick is the Associate Director of the Smokefree.gov Initiative which provides cessation resources in an electronic format. She is also the co-chair of WHO’s Mobile Cessation/Health Behavior Committee.
Tell us about your work with the Smokefree.gov Initiative:
The Smokefree.gov Initiative (SFGI) launched in 2003 as a single website offering intervention resources to support people who are trying to quit smoking. SFGI has since expanded to include mobile optimized websites targeting specific populations (e.g., women: women.smokefree.gov, teens: teen.smokefree.gov, and Latino: espanol.smokefree.gov, seven text message libraries with more in the works, six mobile applications, and engagement in more than a dozen social media platforms.
One of the unique aspects of SFGI is that it is one of few resources in the .gov space to provide evidence-based interventions and not just information. Additionally, since 2009, SFGI has had an active presence in social media including Facebook, Twitter, YouTube, Pinterest and Instagram.
One of the things the SFGI Team is particularly excited about is the emergence of online communities that have developed organically in places like the Smokefree Women Facebook page (www.facebook.com/smokefree.women[MH8] ). The Smokefree Women Facebook page has become a really active community of more than 20,000 women who quit. They engage and support each other and help when someone is struggling in their quit attempt. This has also provided a unique opportunity to drive traffic to other SFGI resources.
Tell us how the text message libraries work as an intervention:
Smokefree.gov has several streams of text message-based smoking interventions, and is expanding these in several international markets.
The text message library is a series of texts we send beginning up to two weeks prior to someone’s quit day. These “countdown messages” offer tips and information about quitting leading up to the quit day. Users then receive four weeks of text messages dealing with issues related to quitting.
The text platform offers the potential for two-way communication between users and the SFGI text resources. So, for example, a user can text the word “crave” back to us, and they will get an on-demand tip for how to deal with tough cravings.
SFGI has adult, teen and Spanish language versions of the text libraries, in addition to text libraries specific to active military and veteran populations. We have translated these text libraries into Chinese and are in the process of translating into Hindi and Brazilian Portuguese and British English (South Africa) as we expand international work in tobacco cessation.
Tell us about your work as co-chair of WHO’s mobile cessation/health behavior committee:
This is an emerging project and we anticipate it will start to take off over the next year or so. It will be a way to really engage with researchers and practitioners around the globe who are working in the mobile health space to inform an international agenda for how best to leverage technology to promote tobacco cessation and other health behaviors (e.g., diet, physical activity, weight management).
Tobacco use and exposure, poor diet, physical inactivity and obesity are major contributors to the bulk of the healthcare and quality of life burden of non-communicable diseases (e.g., cancer, diabetes, heart disease). The potential for mobile health to reach an overwhelming majority of the global population and to provide real-time, on-demand intervention affords an opportunity to have substantial public health impact on a scale that even 10 years ago was unimaginable.
What are some of the challenges you face in your work?
Although this is not unique to SFGI, one of the inherent challenges of any intervention is how to provide a set of general resources that have sufficient tailoring to reach a range of users, particularly vulnerable populations.
This is partly about being sensitive to how particular health behaviors fit into broader cultural, family and personal values and partly about the tones and approaches that are likely to resonate with some populations more than others. This is something that comes up repeatedly within our international research where often we provide a text message library, but our in-country collaborators change words, phrases and tone to better reach the particular population.
One thing that can be particularly challenging in mobile health is how to keep up with the changing face of technology while maintaining the scientific rigor of our products and interventions. This often means getting out of our “scientific comfort zone” – but that’s part of what makes working in this space so interesting and enjoyable.
What are some success stories as a result of your work?
We are learning how we can best leverage the technology to engage with a broader population. We are developing strategies that have such extensive reach so we have better capacity to influence global public health.
This is also a particularly unique time to be doing this work in the developing world as these countries transition from infectious to non-communicable diseases as major causes of morbidity and mortality. We can learn a lot from the scientific literature that has emerged in developed countries in areas like general behavior intervention and the use of mobile technology for intervention delivery to potentially mitigate in the developing world some of the problems we have already experienced in developed countries with respect to non-communicable diseases.
What was the reason you got involved with this type of work?
My background is in social psychology – which is a field of study that is about understanding how people interact with and are influenced by their broader social and physical environments. Many of the major theories from social psychology have important implications for how people navigate health behavior change and maintenance, so toward the end of graduate school I started to study things like how motivation influences the ways in which people approach weight loss, physical activity and diet goals.
During my post-doctoral fellowship, much of my research focused on how parents influence children’s self-regulation for behaviors like eating and physical activity. Prior to coming to NCI I was on the faculty at the University of Rochester where I worked on a large-scale tobacco cessation induction trial. It was through my experience at Rochester that I developed an interest in tobacco control and expertise in tobacco dependence treatment.
The work I get to do on SFGI affords me the opportunity to bridge my interests in a range of health behaviors, my expertise in the role of motivation in health behavior change and my appreciation for clinical and therapeutic approaches that are likely to yield sustained motivation and maintained health behavior.
Is there anything you would like to add?
This is a really exciting time to be working in mobile health. There’s a great scientific literature on health behavior change from which to draw, and the potential for technology to engage with users in real time, where they are is a new frontier for both research and practice.
One thing we know less about is how best to engage with people who are engaging in health risk behaviors – like tobacco use – but don’t really have behavior change on their radar. Thinking strategically about how the flexibility afforded by mobile technology and the creative potential of that medium as an intervention delivery device provides a unique opportunity for us to reach populations beyond what we typically reach with traditional randomized trials and public health campaigns.