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Mobile Health Design:Global Mobile Health

June 10, 2013

Lisa Gualtieri, PhD, ScM, Course Director

Chinyere Amobi, Teaching Assistant

Agenda• Designing a mobile health intervention to increase diabetes adherence in India: Fiona Akhtar• Global Health: Lisa Gualtieri• In person meeting discussion: June 21/22?• Team presentations: Personas and scenarios

– What did you learn about the design of your app?• Conducting a competitive analysis

– Questions about Lisa’s video and/or handout: http://www.youtube.com/watch?v=whpK-MXcnxI&feature=youtu.be

• Example of competitive analysis• Another video?

– What do you want to know about health app wireframes and development?• Team assignment (due June 12)

– The first steps in conducting a competitive analysis are determining how your personas would look for or learn about apps and any search terms they would use. Create a list of apps they might find. Which are closest to what you plan to do?

• Team assignment (due June 12)– Laurel Leslie, MD, MPH, joins us on June 12. Do you specific questions for her related to your app

design?• Individual assignment (due June 12)

– Read The Death of Reflection and Why I Run: A Reflection at the “Action Stage” at http://lisagualtieri.com/

Global Mobile Health• 2009 WHO survey assessed global eHealth

initiatives • Results on mHealth published in 2011 report • Report includes overview of: – Adoption of initiatives (where?)– Types of initiatives (what?)– State of evaluation (do they work?)– Barriers to implementation

Source: http://www.who.int/goe/publications/ehealth_series_vol3/en/index.html

mHealth Definition

“The use of mobile and wireless

technologies to support the

achievement of health

objectives”

Why and how?

• Reach– Leverage existing phones to

provide life-saving information to people in difficult-to-reach or remote areas

• Design– Tailor delivery and content to

the needs of poor, illiterate and/or marginalized populations

• Scale– Operate in a cost-effective,

financially sustainable way

Where?

• 5 billion wireless subscribers across the globe• 70% live in low or middle-income countries• Higher income countries have higher mHealth

activity than lower income countries – Europe most active– Africa least active

mHealth by Region

mHealth by Income

Types of mHealth Initiatives • 14 Categories– health call centers– emergency toll-free telephone services– managing emergencies and disasters– mobile telemedicine– treatment compliance– patient monitoring– health awareness raising– decision support systems– etc.

• Most initiatives are small-scale pilot projects that address single health issues

Case StudyUse of SMS in Bangladesh to educate people in low-income group on health topics

Barriers to Implementation

• Competing health priorities• Limited budgets• Shortage of health workers• Lack of evaluation/evidence of efficacy• Lack of policy to support mHealth

development/implementation

Future Directions for mHealth Programs

• Larger, more complex mHealth programs will increase over time

• Policies and strategies to integrate eHealth and mHealth initiatives are key

• Best-practices design guidelines are needed• Standardized technologies for easy and

efficient data exchange will increase reach and reduce costs

Global Mobile Health Design• Know your target audience• Mobile users across different countries vary

drastically in smartphone usage, mobile app usage, and internet usage– Designers should look at the most popular OS among

a target audience, the style of smartphones they use (and the features available on them), the limitations of the common cell phone plans users are on (ex. do they have a small data plan?), and concerns over privacy when transmitting information

Our Mobile Planet• Our Mobile Planet (www.ourmobileplanet.com) collects early data on

mobile usage across the world. This is a great web site for finding information about a target audience

• Data is mainly on the national level, although it is possible to get demographic information like gender and age, as well as download the full data charts for each country

Mobile Device Usage• Largest foreign markets are China, India, Japan,

and Brazil• Increasing most in Brazil, Egypt, UAE, and Saudi

Arabia• iOS is most popular in Switzerland, Australia,

and France• Android more popular in Japan, China, and New

Zealand• BlackBerry most popular in UAE

Mobile Internet Usage• Users in other countries are less likely to use the

web browser for information• Sweden, UAE, Japan, and China are the only

nations with higher mobile internet use than USA• Native apps become more important since they

use less data and can potentially provide more privacy– Mobile apps are becoming more popular in some

countries more than others

Potential Growth of Mobile App Usage

Usage Differences Across Settings

• USA is the country with the highest use of a mobile smartphone in a doctor’s office

• Almost half of smartphone users in Spain never use their smartphone at work

• The majority of smartphone users in Belgium, Italy, and Finland do not use their phones in a restaurant– What does this mean for mobile user experience

and the design of features in weight loss apps?

Smartphone Use at Medical Office

User Differences• Many smartphone users in some countries

(ex. Japan and Argentina) are first time smartphone users– In Japan, most new smartphone users are 18-29

y/o– In Argentina, most new smartphone users are 50+

• In most countries, males are more likely to use Android OS and females are more likely to use iOS

Feature Differences• Mexico, Argentina, and China have the highest rate

of social network use on their smartphones• In most countries, users are far more likely to use

their smartphone for communication (email, text messaging, phone calls) than entertainment consumption

• Privacy is very important in some areas. Respondents in China, Egypt, Mexico, and Brazil rated mobile privacy very highly in their smartphone usage

Mobile App Markets• 8 of the top 10 app markets are primarily non-

English users

Making Your App Global

Culture and Design: High and Low Context

• Web designers and app designers have used Contextual Communication Theory to inform design decisions around the world

• High context cultures are less governed by reason than by intuition or feelings. Trust is important in all social interactions, including business ones. These cultures are collectivist and prefer group harmony over independence. Tradition is history is highly valued.

• Low context cultures are logical, linear, individualistic, and action-oriented. People from low-context cultures value logic, facts, and directness. Solving a problem means lining up the facts and evaluating one after another. Decisions are based on fact rather than intuition. Discussions end with actions. And communicators are expected to be straightforward, concise, and efficient in telling what action is expected. To be absolutely clear, they strive to use precise words and intend them to be taken literally.

High and Low Context

High Context• Less verbal• Decisions based on face-to-face

interaction rather than from authority

• Local, cultural images are more preferable to words

• Tend to be polychrone time oriented with fewer fixed schedules, more flexible concerning time, short term orientation, and conducting different tasks at one time

• Cultures: Africa, Middle East, Asia, South America

Low Context• More explicit• Rule oriented• Task-centered• Tend to be monochrone

time oriented with a fixed, less flexible schedule that focuses on long term views and one task at a time

• Cultures: North America and Western Europe

Low Context Apps

Low Context Apps

High Context App

Cost Influences Phone and Feature Choices

• iPhones are most expensive in India ($850) and Brazil ($970) due to tariffs

• Plans in India, parts of Africa, and some South America countries have very low allowable data usage (approx. 500mb per month)

• Phone and text features are more likely to be used in these regions over data-heavy use

• Blackberries and phones with compressed data are more important in these countries

Localization

• Recognize the wealth of regional difference impacting design, language, and content.

Agenda• Designing a mobile health intervention to increase diabetes adherence in India: Fiona Akhtar• Global Health: Lisa Gualtieri• In person meeting discussion: June 21/22?• Team presentations: Personas and scenarios

– What did you learn about the design of your app?• Conducting a competitive analysis

– Questions about Lisa’s video and/or handout: http://www.youtube.com/watch?v=whpK-MXcnxI&feature=youtu.be

• Example of competitive analysis: helpful?• Another video?

– What do you want to know about health app wireframes and development? (Next slide)• Team assignment (due June 12)

– The first steps in conducting a competitive analysis are determining how your personas would look for or learn about apps and any search terms they would use. Create a list of apps they might find. Which are closest to what you plan to do?

• Team assignment (due June 12)– Laurel Leslie, MD, MPH, joins us on June 12. Do you specific questions for her related to your app design?

• Individual assignment (due June 12)– Read The Death of Reflection and Why I Run: A Reflection at the “Action Stage” at http://lisagualtieri.com

/– Final slide – familiar or new?

Questions about development

1. If you are designing an easy to develop health app, what do you need to know?

2. What is especially complex to ex in a design from a development perspective?

3. How do I create wireframes? What are the best tools to use and who on a design team should be responsible for wireframe development?

4. Can you conduct formative evaluation with wireframes?5. Are wireframes necessary before development?6. Why develop an app instead of a mobile website?7. How do I develop an app? When do I develop myself and when do I

outsource?8. How are developing health apps different than other types of apps?