People in the United States are living more of their lives online. Increasingly, we interact socially, shop and keep track of our lives digitally. For many people, carrying around a smartphone (a phone that can provide access to the internet and act as a hand-held computer) can make busy lives easier. Health care providers are always looking for ways to inspire people to live the healthiest lifestyle possible. Researchers are finding ways to use technology to help people be healthier.
The intersection of the digital world and people’s health is called “mobile health” (or “mHealth”). It is the use of mobile devices, especially smartphones, to deliver health care information and sometimes health care. According to the Pew Research Center, 95 percent of people in the United States own some kind of cell phone, and 77 percent own smartphones. Researchers who study ways to help people monitor their lifestyle and health choices are capitalizing on the popularity of smartphones.
Lora Burke, PhD, MPH, professor of health and community systems, School of Nursing; of epidemiology, Graduate School of Public Health; and of clinical and translational science at the University of Pittsburgh, studies how to help people improve their behavior choices to decrease cardiovascular risk factors. Cardiovascular risk factors include:
• Poor diet—eating foods high in saturated fats (animal fats) and products containing trans fat
• Lack of physical activity
• Excess body fat (being overweight or obese)
• Using too much alcohol—generally defined as more than one drink a day for women and more than two drinks a day for men
• Tobacco use and secondhand smoke exposure
According to the Centers for Disease Control and Prevention, cardiovascular disease is the leading cause of death in the United States for most races and ethnicities, including African Americans, Latinx and whites (second only to cancer for American Indians or Alaska Natives and Asians or Pacific Islanders). Dr. Burke’s research has focused on how to use mHealth for one particular risk factor—being overweight.
Before the availability and popularity of digital technology, Dr. Burke ran studies where people trying to lose weight would come to the University of Pittsburgh across 12-24 months, participate in group sessions and submit paper diaries of what they had eaten and how they had exercised. Participants would get feedback on their progress and suggestions for changing behaviors at the next meeting. It could be weeks later before people received feedback on their diet and exercise records. Through Dr. Burke’s and others’ research, it became obvious that this model did not bring about lasting change for participants.
“We found that how often, how consistently and how close to eating people actually recorded what they ate was important to their weight loss,” she says. “Research reinforced that the crux of weight loss and changing any behavior is self-monitoring in real time. It makes people aware of their behaviors, able to see behavior patterns and develop ways to change those behaviors.”
Dr. Burke saw the immediacy of digital technology as a potentially more effective way for people to self-monitor behaviors. She is now conducting a study that examines how effective mHealth can be for long-term weight loss.
“In this study, we ask people to self-monitor their physical activity, weight and their diet through the use of a smartphone, physical activity tracker and a WiFi- or Bluetooth-enabled scale [all devices except the smartphone are provided to study participants],” she says. “We receive all those data immediately. We developed an algorithm that reads the data and chooses a personalized message from an extensive library we’ve developed. The messages provide immediate feedback that is always positive. The feedback also provides ways to guide people to improve their behaviors. I call it a ‘coach in your pocket.’”
Because this is a research study testing the effect of the feedback messages on weight loss, the messages are sent to participants in one of the two groups and not to the other group so that researchers can compare outcomes in the two groups.
A large number of health apps exist for smartphone users to download. However, Dr. Burke says that not much research has been done to know whether or not these apps are effective in behavior changes that result in long-term weight loss.
“We’re using strategies that have been proven effective based on behavioral research,” she says. “We designed the feedback to be specific to the users’ data and not generic messages that can become ineffective over time. Part of this study is examining what effect immediate feedback has on people’s behaviors and how long people stay engaged with this approach. Using mHealth technology has the potential to make weight loss easier than it used to be.”
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