Welcome to the Bitjam medical health app blog series. Last week we discussed the increasing number of apps available on the market, how HCP’s are dealing with conformance and compliance and the effects of app technology on interoperability in healthcare today. If you missed it or want a chance to refresh your memory you can find part one here.

Part two will investigate the technology designed to help patients change behaviours based on Prochaska & DiClemente’s ‘Stages of Change’ model, and the difference between informing and changing – striking the balance between giving accurate and useful information

Many of you reading this article will have first hand experience of trying to change certain behaviours, whether that’s by exercising more, eating more healthily or spending more time relaxing. We know that these changes in behaviour don’t happen overnight, but over a period of stages beginning with precontemplation and ending in action maintenance. As we know, maintaining the changed behaviour so that it becomes normalised day to day rather than short term is very tricky, and in many cases relapses occur, that’s if the idea even makes it beyond the precontemplation stage.

The Stages of Change Model

Different to a theory, this is a model and highlights the various stages and states of behaviour change. It’s also known as the Transtheoretical Model.

• Precontemplation –  the earliest stage of change consideration. It can take around another 6 months to take any action during this phase. More often than not people will emphasise the cons here rather than the pros
• Contemplation – also known as the recognition stage, this is when people start to see how adopting healthy behaviours could have an positive impact on their wellbeing and might consider action in the next 6 months, but are perhaps likely to still feel ambivalent to the idea of change
• Preparation – people are ready to take action within the next 30 days, perhaps by taking small determined steps to assist behaviour change. They start to realise that healthy changes could make them happier
• Action – people have recently changed their behavior and intend to keep moving forward with their healthy habits
• Maintenance – people have sustained their behavior change for more than 6 months and intend to maintain the behavior change going forward. This stage is where the work to prevent relapse occurs
• Termination – this is the final stage of the model, in which people are sure they will never return to their unhealthy lifestyles. This stage is very elusive, as most people will always stay in the maintenance stage, working continually to manage their healthy behaviour but still at risk of relapse.

How Technology Can Assist Behaviour Activation

The role of technology not only aids the initial action stage but can support maintenance and deal with potential relapses. As the model in figure 1 suggests, during the stages of change, relapse, exit and re-entering between Determination and Maintenance is a common occurrence. People need as much support as possible to stay – or return back to – the track.

Yet it’s not about how sophisticated the tech is, the key to success is in cracking the psychological obstacles indicated in the Transtheoretical Model, changing the mindset of the person and supporting then offering continual support during maintenance.

Technology is offering a new fix for one of the most confounding health-care challenges: getting patients with chronic disease to take better care of themselves.

Wall Street Journal

This quote perfectly demonstrates the challenge faced by developers of digital health apps. As well as the technical complications – such as data privacy, regulations and synchronisation with older systems – the developer has to present the user (who will now be in the preparation stage”) with compelling language and data that will convince them to move forward into action. The developer will need to have a thorough understanding of the difference between informing and changing, depending on the intention of the app.

The Transition from Informing to Changing

Informing is simply passing useful information on to somebody that’s relevant and beneficial to their treatment, but changing is the act of using this information, implementing the learnings and actively applying the treatment in order to provoke positive and longer lasting behaviour changes. Changing is the activation of positive behaviours. The app must strike the balance between giving accurate and useful information in the most appropriate way and at the right time. This is why understanding the Stages of Change Model is crucial to the performance of a digital health app, the developer must know where their user currently sits in the model.

How Apps Can Actively Assist in Behavioural Activation

• They are more readily available to the patient, using device platforms that they are likely to carry around in their pockets
• The user has 24 hour access
• The user can monitor their progress, which can stimulate positive mentality towards healthy changes
• Accessibility promotes patient empowerment, provided the developer has also considered the challenges of accessibility to those with disability, lack of computer skills etc. Inclusivity needs also to be at the forefront of development

In part three we will be talking with Lisa Sharrock, CBT therapist and registered mental health nurse for North Staffordshire Combined Healthcare NHS Trust, and Bitjam partner to discuss our project BeAble – a post-discharge app currently in phase two of BETA testing designed to assist with relapse-prevention support.

To find out more about digital health apps or discuss your own healthcare technology project, you can make an appointment here to pop and see us at our new location at Keele Science and Innovation Park.