From deployment to sustained usage: challenges faced by mHealth application developers

Mobile health, or mHealth, technology is on the increase. In this article, Ashish Rishi discusses the current trends in mHealth apps and the differences that need to be taken into consideration with deploying an app in developed countries as opposed to developing countries.

Increasing availability of mobile communications technology has created a tremendous opportunity to improve healthcare services for people all over the world. Within the healthcare community, the term "mHealth" has been coined to describe initiatives to use mobile technologies to provide better healthcare. Industrialised countries in general already have extensive healthcare infrastructures. Innovative and sophisticated mHealth applications have the potential to make high quality care even better. In contrast, developing countries currently are under served, particularly in rural areas with limited resources. Fortunately, in recent years mobile infrastructure has been widely deployed, and mobile devices have become more available. Those trends are likely to continue. mHealth solutions hold the promise of significant improvements for those populations.

Types of mHealth applications

mHealth applications can augment existing processes, or enable application that was never before possible. Here are some areas currently receiving attention:

• Maternal, infant and child health: Preventable complications of pregnancy and childbirth lead to the deaths of many women in certain parts of the world. Another serious concern is mortality of children under five due to preventable causes. Mobile technologies can help reduce these outcomes by delivering educational information to women, and through increased and more timely access to community health workers and regional facilities.

"Innovative and sophisticated mHealth applications have the potential to make high quality care even better."

• Mobile telemedicine: For some patients, travelling to regional facilities is difficult or infeasible. Mobile technologies can enable these patients to communicate with expert practitioners by voice, text, digital photos or even digital video.

• Training for healthcare workers: Local front line health workers can benefit from easy and immediate access to educational materials and specialised information.

• Crisis management: Mobile technologies can assist regional, national and international authorities to collect information and track epidemic outbreaks or other public health emergencies.

• Remote monitoring: Sophisticated mobile devices can track a patient's condition and report any anomalies to the patient's doctors in real time, enabling rapid response to a time sensitive health crisis.

Satisfying the stakeholders

Numerous stakeholders need to embrace a mHealth application for it to be adopted and deployed. Anyone developing a mHealth application should take into consideration what concerns motivate these stakeholders.

Particularly in developing countries, individual patients may have limited financial resources. For cultural reasons, some may be uncomfortable with certain treatments or suggested behaviours. Some may be ashamed of their illnesses. In areas with low literacy rates, text-based applications will be problematic. The languages spoken by the target population must be supported, unless perhaps an easily learned, simple set of symbols can be used instead.

Local caregivers often serve widely spread rural populations. If they are overburdened, they may appreciate any help which improves their efficiency and responsiveness to patient needs. On the other hand, they may be uncomfortable with new procedures that deviate from their existing work flows or are in conflict with local customs.

"Numerous stakeholders need to embrace a mHealth application for it to be adopted and deployed."

A regional facility, such as a hospital, has well educated caregivers, advanced equipment, and sophisticated procedures. Many professionals participate in decision making. A regional facility focuses primarily on the health of its community, but financial, political and numerous other considerations factor in to its decision to support a new public health initiative.

Local, national and international governments and quasi-governmental bodies impose regulations and other restrictions on medical initiatives. They can also provide funding. When developing a mHealth application, it is essential to consider any problems or opportunities in complying with governmental requirements.

Creating enduring solutions

It is a major accomplishment for a mHealth application to obtain the approval of the interested parties and achieve deployment. But what can be done to avoid declining usage after deployment? Try to predict possible reasons for declining usage and reduce vulnerabilities to those threats. Here are some reasons usage might decline:

• The application is too difficult or inconvenient to use.

• After a period of time it becomes clear that the application is not as effective as hoped.

• Promotional efforts are insufficient, essential participants lack awareness of the application, and they do not use it.

• Initial financing from supporting institutions cease, and the application is not financially self sustaining.

"But what can be done to avoid declining usage after deployment?"

• Technological advances make the solution obsolete.

• The application depends on technology that does not scale well and becomes technically or financially infeasible for a larger user base.

• Public health improves or worsens for external reasons, and the application is either no longer necessary or no longer effective.

• Although the initial deployment is successful, attempts to deploy to other populations are unsuccessful due to different requirements or lack of need.

• Essential participants find the application to be too disruptive to existing work flows or previously existing programs.

Mobile technology enables new ways to improve healthcare. The possibilities are limited only by the imaginations of application developers. Sustained usage of new mHealth applications can be achieved by understanding the needs, concerns and motivations of all interested parties, and by anticipating and adjusting for possible future problems.

About the author:

Ashish Rishi is the CEO of COUCH., a digital agency based in London. Ashish has over 9 years experience in Pharma Marketing. Ashish has experience working on pharma marketing activities across UK, Europe, US and Latin America. His area of expertise include, branding, communications, stakeholder development and digital marketing. Ashish is also the founder of a new pharmaceutical marketing community on Google +. You can reach Ash at Ash@wearecouch.com or follow him on Twitter @We_Are_Couch and @Ash_Rishi.

How can mHealth app developers sustain usage?