Multiple health startups in the US are developing self management services and programmes to help patients better monitor their condition. A review of such programmes in adults with type 2 diabetes, however, show no clear evidence of long-term effectiveness.
Interview with Kingshuk Pal - eHealth Unit, Department of Primary Care and Population Health, University College London (UK). Kingskuk Pal led the Cochrane Systematic Review of Computer-Based Self-Management Interventions for Adults with Type 2 Diabetes.
L’Atelier: While we’ve seen a surge in the development of computer-based self-management tools and services...
Kingshuk Pal: Indeed, in the commercial world and the academic world alike, the landscape is changing. We must distinguish 3 types of computer-based interventions. Remote monitoring, remote case management, and self-management, which refers to any interactive computer based programme that patients can use themselves and interact with. The application takes a patient’s input and uses communication or processing technology to deliver a tailored response to the patient, and facilitates self-management regarding their chronic condition. Those programmes can take the shape of touch screen computers placed in clinics and hospitals, online programmes users can access from home, or through a mobile phone for instance. Old interventions were typically touch screen based, but the landscape is changing. The big revolution is online interventions, and the newest ones often have a mobile component as well (apps that use mobile phones to communicate with patients - sending them reminders and prompts.)
However, your Review seems to show the effectiveness of such computer-based self-management interventions is pretty limited... What are they missing?
Those interventions have indeed limited effect on blood glucose control, and didn’t show evidence of helping patients lose weight, cope with depression or change their habits in the long term. Interventions using mobile phones were slightly more effective than others. When looking at short term effects on blood-sugar control, interventions using mobile phones seemed to be twice as effective as the average intervention, and almost as effective as starting a new medication. However, we need to be cautious about making definitive conclusions. Overall, the study suggests that we don’t necessarily understand how to help people change their long-term behaviors (taking medication, eating habits, activity.) Basically, we’re asking people to change habits of a lifetime; and that’s quite hard. Such a change asks for relatively intensive and ongoing support. We also need better designed interventions, and that better understand patients’ needs.
What do you think the role of technology is in all this?
Technology has a huge potential, for many reasons. First, in terms of accessibility. Education and self-management programmes are often very poorly attended. With the Internet and mobile phones, patients have better ways to access those programmes outside of clinical or professional settings. On a theoretical level, computers can tailor information: as we understand better what people need, we can develop and tailor targeted information, which is then more relevant to each person’s condition and context-aware. Now, you can give people information that is relevant to them, but also when it is relevant. Giving them information in a classroom is one thing, but being able to give it to them when they need it is different. Interventions where people used text messages to get immediate feedback on their actions proved pretty effective. And finally, automated interventions are potentially cheaper than traditional face to face ones.
Your study focuses on diabetes; to what extent those findings be generalized?
There are definitely some areas of overlap, especially with other chronic conditions. In terms of engagement, everyone responds better to tailored interventions. There will be commonalities in terms how to keep people engaged, and the principles of how to educate people. And there may be common techniques to support effective behaviour change in different conditions. One thing to keep in mind, however, is demographics. A condition that predominantly affects children for instance, will call for different answers than one affecting adults. The patient remains at the center of it all, and different population groups with different needs will need different types of interventions.