As I was reading through my Twitter feed last night I came across a series of tweets relating to the effectiveness of text messages as a modality to increase patient engagement.  Apparently, sending patients encouraging messages about taking the medicine on time, quitting smoking, losing weight, and other lifestyle changes really works.

When we focus on the world of smart phones it’s easy to forget that simple enabling technologies from decades ago can be extremely effective.  It’s all about the message and the psychological subtext, namely, somebody cares enough about your condition to send you a message.

If we can achieve these kind of results with baseline technology then the bar for mobile health needs to be set much higher. Simply displaying on-screen alerts instead of text messages is a waste of an extremely powerful new healthcare tool. There is so much more that can be done to motivate the patient.

I think one of the keys here is to focus on the patient support group. Notice that I did not say social media as I believe indiscriminate use of Facebook or Twitter doesn’t really get us very far.  Do people really want to track their weight on facebook?

Some medical forms of social media are more effective. I’m quite fond of Patients Like Me because when I’m using that service I’m talking to people who understand my condition and have a frame of reference with which to sympathize or provide support. However, the anonymity of the service works against it to some degree. I believe the most effective messages will come from those who care for me and know me as a real person.

Let me describe the ideal mobile health app for helping someone manage hypertension. It would obviously be able to collect measurements and store them. In addition, the app would allow me to pick a collection of people who are in my community of care. That could include my doctor, my wife, members of my family, close personal friends, and so forth. It would send each caregiver messages asking them to enroll and allow them to enter some canned messages of encouragement that could be sent to me when it’s time to take a blood pressure reading or swallow some medicine.

The textual component could be enriched with voice recordings that are obviously more intimate and compelling.

“Hey honey, don’t forget to take your blood pressure. The kids and I love you.”

On a similar note adding music or pictures of your family could make the reminder even more interesting and less likely to be filtered out as background noise from the myriad of apps on your phone.

To conclude, text messaging has been a great initial approach to patient engagement, but there is so much more to that can be done to motivate through a multimodality approach of messages created by the patient’s circle of care.

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