By John Elder
Mobile health apps – or mHealth apps – are everywhere. But they’re not that sticky – research shows that people abandon them after 6 months. The thing is, the technology that goes into these apps has so much potential to help people lead healthier lives. So what’s a health app gotta do to get some love? More to the point, what’s a health app gotta do to help people change their behaviour for the better?
A self-help book is like a piece of chewing gum: there’s always another one to be had when the flavour runs out. There are just so many out there. Broadly speaking, the health and fitness app sector is currently working much the same way. mHealth apps — as they are collectively known — have been downloaded billions of times worldwide.
But this hasn’t necessarily translated into billions of people celebrating elevated fitness and health for the simple reason that apps – and we’re speaking here about fitness and sleep trackers, heart monitors and dietary advisers – more often than not lose their flavour and are abandoned after about six months.
This was first reported in January 2015. A month later, an editorial in The Journal of the American Medicine Association said that fitness and sleep trackers and such were increasing in popularity but weren’t living up to their promise of affecting change in people’s behaviour around their health. The journal concluded that – at that time – the technology worked to ‘facilitate’ change (meaning to make it available) but wasn’t driving it.
Meanwhile, the mHealth market is being flooded with literally thousands of gimmick merchants. As one app fails to engage and is discarded, there are plenty more to fill the hole, with developers chasing a piece of a very big pie.
Wow, that’s a lot of money!
Consider this. Self-help is an US$11 billion market in North America. Elsewhere the numbers are not so crazy, but more than respectable. UK publishers pull in more than 10 million pounds a year. And the ‘luckiest’ people in the world – Australians – are said to spend millions of dollars a year on becoming wonderful and believing in themselves.
Compared to the mHealth app market, though, which is still in its infancy, self-help is chump change. By 2020, it’s believed that the mHealth market will be worth nearly US$60 billion – more than five times bigger than the self-help circus.
Scrambling for a piece of the action are an astounding 318,000 mHealth apps to choose from. At least half of those have come on to the market in the last two years – at a time when news media have reported a slackening in consumer interest and app marketers are struggling to stand out in an over-crowded marketplace. Case in point:
Right now, in 2018, health apps have a total of 3.2 billion downloads – a 7% increase from the downloads in 2015
From 2014 to 2015, there was a 35% increase in downloads
And in a survey of health app developers:
53% of respondents said their app generated fewer than 5,000 downloads in 2015
23% said their app generated between 5,000 and 50,000 downloads
It's clear that as more apps come onto the market, the rate of growth of consumer downloads is slowing. Or, in other words, supply is well and truly out-stripping demand. Needless to say, many publishers aren’t pleased with their overall success.
But wait a minute! Common sense demands that even though the phenomenal early growth of the sector couldn’t be sustained, downloads are far from going backwards — and those dollar bill predictions for 2020 aren’t exactly discouraging.
So what’s an app gotta do to feel the love? Fight human nature.
Academic research into mHealth app efficacy and overall potential is growing at an astonishing rate. Why? Because mHealth apps promise to help patients actively measure, monitor, and manage their health conditions, which has the potential to improve health outcomes for millions of people.
For this reason, the researchers of this particular study – undertaken at Bond University and published in Nature – set out to determine how many mHealth apps were of a high enough standard to be ‘prescribable’ by GPs to their patients. (In practice this is already happening – and I cite here personal experience of having my doctor suggest I download the same app he’s using for weight loss!)
The researchers sought out only those apps that had undertaken random controlled testing – which is close to the level of testing that applies to pharmaceuticals. And they ended up reviewing hundreds of apps – but keep in mind that this is a relatively small number compared to the 3.2 billion out there. From these, they found that only a couple of dozen had undergone random controlled testing. And most of those trials were found to be biased or otherwise flawed.
This study was widely reported in mainstream media and the health sector – and a lazy reader of those reports could easily conclude that mHealth apps in general fail to improve health or fitness. Indeed some of the apps tested in the study seemed to create problems instead of solving them – a Swedish app designed to prevent drinking was somehow found to encourage it.
The reality here is that human beings will always seek to undermine what we might call ‘goodness strategies’ for a plain old good time. It is this more complex, self-defeating, cheating dimension of human nature that mHealth app developers must contend with.
But the benefits are there.
Despite the fact that consumer download growth appears to be trending down, studies from early on in mHealth development have shown that there are benefits to be had. While the self-help industry was founded on woo, ooger-boogery and the laws of attraction, the fundamentals of mHealth appear to be scientifically sound – and exciting.
In 2012, a Northwestern Medicine study found that an app tracking calories and activity helped people lose on average seven kilos - and keep it off for at least a year! But the technology only aided weight loss when its users also attended regular classes about nutrition and exercise. The app alone didn’t help.
The lead investigator of the study, Bonnie Spring, stated that what the app helped people do, was regulate their behaviour – which can be very difficult to achieve. She explained that most of us have no idea how many calories we consume and how much physical activity we get. So when an app can give you this type of feedback, it helps you make smart decisions in the moment.
Slow and steady wins the race.
A lot has changed since 2012, at least at the research level. Apps have become more sophisticated and capable of measuring a greater range of functions (app cardiograms are super-hot right now). But at the same time – as the Bond University study shows – too much less-than-stellar technology has been rushed to market as publishers scramble to jump on the bandwagon.
On the other hand, developers who are in it for the long haul, and want to be part of the genuine revolution, already know what’s required. mHealth apps are more effective when they’ve been properly tested in a non-biased way and:
Time for HeadUp to stick its head up.
At HeadUp we can safely say that we have ticked all of these boxes. From January to August 2018, we ran an Insiders program – an experiment we designed in order to test the algorithms we’ve now built into our app.
Over the last 8 months we've tested and reviewed our processes to ensure that when we collect our users' data, we can offer them something valuable in return: personalised, evidence-based and entertaining insights. And just quietly, we think we've become pretty good at this! For two reasons: first of all, people actually stuck with us for 8 months (!!) and second of all, we discovered a change in user behaviour. Let us explain...
While other apps on the market put a laser-like focus on physical health, we aim to move beyond the body to look at mental health too. Research shows how intertwined the body and mind are – the health of one truly does depend on the other – and so we built our Insiders experiment and our app around this idea. In short, we created a mood check-in feature that was a part of our test program and is currently being built into the app too. We used our users’ check-in data to explore the impact of mood on lifestyle and vice versa. And when our Insiders’s experiment came to an end, we reviewed the numbers.
Between the 18th and 25th of July, we ran a series of ‘love’ insights. In them we revealed an interesting finding based on our users’ check-in data: when you’re feeling ‘in love’, you’re 6x more likely to feel grateful. And feeling grateful makes you happier. So we encouraged users to think of all the people in their lives they love in order to promote feelings of gratitude, and ultimately, happiness.
Before we ran these insights, Insiders selected ‘in love’ at mood check-in only 7.5% of the time. After the love insights ran, this went up to 14%. THAT’S what we’re talking about! That’s why we’re here. We want to help people change their lives for the better. Mentally, physically and emotionally.
Our app is still in its early stages. It's our little tech baby. We know we've still got a lot of work to do, but we're proud of what we have created so far and we're ready for the long road ahead of us. This is only the beginning!
HeadUp beta is currently being tested by a small group of our loyal Insiders - a very exciting milestone for us! If you’d like to join the party and gain early-bird access, then please register here. We can't wait to show you what we've made.
John is a Melbourne journalist and writer. For 21 years he was senior writer for the Sunday Age newspaper and Fairfax Media, with a special interest in science, medicine and health research – and in philosophical questions facing modern society. He continues to be a life-issues columnist for The Sunday Age, science and health contributor for The New Daily and is an editorial advisor for the Clueless Economist.
*Please note: header image was found here: https://bit.ly/2wEDQue