The need for an MHealth Impact Laboratory

How researchers and clinicians can benefit from The mHealth Impact Laboratory

The mHealth Impact Laboratory of Colorado will be a resource for researchers and clinicians to:

  • Access online panels of potential end users who can:
    • Quickly organize and offer reactions to new ideas for eHealth
    • Beta-test prototypes to ensure they function as intended
    • Pilot-test prototypes to establish estimates for efficacy
  • Rapidly generate pilot data to include in a larger scale trial application
  • Contribute to and subsequently access a growing database from pilot
    initiatives to identify:
    • Types of content that are preferred by end users
    • Whether/how preferences vary by consumer demographics
      (e.g.. boys prefer games; patients prefer links to video endorsed by a clinician)
    • Comparative data on desired behavioral outcomes consistent with the Behavioral Risk Factor Surveillance System (e.g. nutrition,physical activity, smoking and sexual risk behaviors)

At the end of a three year start up phase, this laboratory will function as a self-sustaining, fee-for-service enterprise that will incubate cutting edge innovations in eHealth promotion and disease prevention.

 Technological innovations outpace research on their efficacy and effectiveness

  •  The chronic problem of poor translation of effective health interventions into practice is exacerbated by the rapid pace and evolution of technology. Estimates of a 17-year times period between concept for an effective intervention and widespread utilization of the same essentially ensures technological obsolescence and renders frustrating efforts to conduct traditional efficacy trials on eHealth innovations. A recent call for white papers indicates that "traditional methods of evaluation needed to address efficacy ... in mHealth are not well aligned to the pace of technological development."
  • There is a critical need to shorten timeline and consider alternatives for efficacy trials to improve widespread dissemination of promising technologies for health promotion. This is consistent with IOM calls for "rapid learning systems", and a call for attention to identification of diverse evaluation methods such as models and simulation, data sharing, and prompt modeling to focus more appropriately on translational research to improve health outcomes.

 Social and mobile media offer substantial promise for health promotion and care delivery

  • Technology has revolutionized opportunities in the delivery of health promotion and care to unprecedented numbers in diverse environments and settings. Research has revealed substantial promise in using tools for health promotion. Meta-analysis of such programs indicates their efficacy for facilitating improvements in knowledge and behavior change, and have also demonstrated that computer and Internet-based interventions for sexual health education are effective.
  • While web-based initiatives are indeed appealing, other eHealth innovations such as social media and social networking sites ("social media") on the Internet along with the widespread adoption of mobile technologies such as cell phones and tablets ("mobile media") highlight a new frontier for health promotion. We have unprecedented opportunity to effectively utilize social and mobile media in eHealth. We can take advantage of the "ecological moment" to communicate with individuals, their networks, and care providers using mobile media.
  • Emerging literature on the use of these moralities for health promotion shows it has promise and even efficacy for behavior change, but we lack compelling evidence of efficacy for impacting health outcomes through multiple clinical trials, replication studies and meta-analysis; we also lack examples where evidence based innovations have been scaled to realized their potential for impact.

We have yet to realize the potential of using technological innovations for upstream structural and environmental interventions for health promotion and community resource utilization

  • There has been a convergence of attention across federal agencies focused on the need for translational research that can widely disseminate effective, simple to adopt and easy to maintain health interventions. The National Institutes of Health (NIH) launched their "Roadmap" initiatives to foster interdisciplinary collaboration to accelerate the pace at which scientific and medical innovations are adopted.
  • The Veteran's Administration (VA) has pioneered a system wide user-accessible, interactive and collaborative electronic medical record, and the director of the Center of Disease Control and Prevention (CDC) has called for greater attention to public health interventions that maximize impact, i.e. those requiring less individual investment for maximal benefit.
  • We have opportunities to achieve this, e.g. by generating support for healthy behaviors within online social networks; extending clinical care in remote settings and via 24-7 triage and by tailoring information on self-care through automated systems on multiple primary determinants of health. 

This work is centered within theoretical frameworks guided by pioneers in dissemination and implementation (D&I) science, including the RE-AIM Framework. RE-AIM stand for Reach, Efficacy /Effectiveness, Adoption, Implementation and Maintenance, and emphasize the need to shift our focus from a more narrow emphasis on efficacy to ensuring our health interventions can reach large numbers of out intended audiences and tat they can be easy for organizations to adopt and implement; and that they can be easily adapted and maintained over time.