mHealth: Challenges Remain to Enable Providers to Address Public Health-The HSB Blog 11/5/23

Our Take:

Mobile Health (mHealth) apps have emerged as a transformative force in the healthcare industry, significantly impacting public health in various ways. These applications leverage the ubiquity of smartphones and the power of digital technology to improve healthcare access, patient engagement, and health outcomes. Addressing privacy concerns, and health inequalities, and ensuring regulatory compliance are essential steps in maximizing their benefits while mitigating potential risks. The ongoing integration of mHealth into healthcare systems holds great promise for the future of public health.

Key Takeaways:

Almost 40% of Americans aged 65 and older still do not own a smartphone and approximately ⅓ of Americans who have smartphones do not have high-speed internet connection within their homes (Pew Research Center)
The least dense areas of the United States pay upwards of 37% more for broadband than the densest centers with the lowest-income households tending not to have a home broadband subscription (Benton Institute for Broadband & Society)
65.6% of Primary Care Health Professional Shortage Areas (HPSAs), which are defined in part by having a provider-to-patient ratio of 1:3500 were located in rural areas (Rural Health Innovation Hub)
Almost half (49%) of lower-income households (i.e., those whose annual incomes are $50,000 or less), live on the precipice of internet disconnection in that they could lose connectivity due to economic hardship (Benton Institute)
For lower-income households (i.e., those whose annual incomes are $50,000 or less), half (49%) live near the precipice of disconnection in that they have lost connectivity due to economic hardship (Benton Institute for Broadband & Society)

The Problem:

While Mobile Health (mHealth) apps have made significant strides in improving public health, they also come with several challenges and problems that need to be addressed. First and foremost is unequal access and the exacerbation of existing disparities, often referred to as the “digital divide”. For example, while according to the Pew Research Center, across developed economies, “a median of 85% say they own a smartphone, 11% own a mobile phone that is not a smartphone and only 3% do not own a phone at all” this is not synonymous with broadband access particularly for the underserved and elderly. For example, according to the Pew Research Center, almost 40% of Americans aged 65 and older still do not own a smartphone and approximately ⅓ of Americans who have smartphones do not have high-speed internet connection within their homes.

Although many will argue that just having a smartphone will give their owners access to a broadband hotspot, this argument fails to take into account that broadband access via a hotspot is quickly “throttled down” by cellular providers and many of those who own smartphones may not have unlimited data plans necessary to make that a viable option. Moreover, many in rural and underserved areas often pay more for broadband access. For example, according to the Benton Institute for Broadband & Society, the least dense areas of the United States pay upwards of 37% more for broadband than the densest centers with the lowest-income households tending not to have a home broadband subscription, citing price as the problem”. Importantly this could lead to an exacerbation or racial disparities in rural populations which are showing patterns of increases in BIPOC populations. In 1990, one in seven people in rural areas identified as people of color or indigenous, in 2010 one in five rural Americans identified this way. Many of those families also sit at the precipice of what is called “subscription vulnerability” For lower-income households (i.e., those whose annual incomes are $50,000 or less), half (49%) live near the precipice of disconnection in that they have lost connectivity due to economic hardship (during the pandemic), live at or below the poverty line, or say it is very difficult for them to fit broadband service into their household budgets.

There is also the problem of low digital literacy and low user engagement for those who do have access. This was particularly evident during the COVID pandemic. For example, an article from WIRED magazine entitled, “Telemedicine Access Hardest for Those Who Need it Most” found that “as many as 41% of Medicare recipients don’t have an internet-capable computer or smartphone at home, with elderly Black and Latinx people the least likely to have access compared to whites”, while another study in JAMA found “approximately 13M elderly adults have trouble accessing telemedicine services, and approximately ½ of those people may not be capable of having a telephone call with a physician due to problems with hearing, communications, dementia, or eyesight, including 71% of elderly Latinx people and 60% of elderly Black people.”

Moreover, many apps lack the ability to customize to their users and may be of questionable quality. Most mHealth apps offer a one-size-fits-all approach, failing to adapt to individual user needs, preferences, and goals or limitations. Without personalization, users may not find the app relevant to their specific health concerns, which can lead to disengagement over time. In addition, as the authors note in “Mobile Health Apps and Health Management Behaviors: Cost-Benefit Modeling Analysis”, “It is evident that situational effects create some kind of general perception of risk because they inhibit the effective impact of mobile health apps on lifestyle behaviors, such as weight loss or physical activity [while] some apps may provide inaccurate information or unreliable health advice, potentially putting users' health at risk.”

Privacy concerns and the slow pace of passing policies and regulations for data protection adds to consumers’ uneasiness. For example, as we noted in “Health App Regulation Needs A New Direction-The HSB Blog 4/12/22, “while the markets and technology are moving at a rapid pace, policies and efforts around regulation move extremely slowly and have generally lagged behind advancement.”

The Backdrop:

The impact of Mobile Health (mHealth) Apps on public health occurs within the context of several overarching societal and technological trends that have shaped the healthcare landscape. Understanding this backdrop is essential for comprehending the significance of mHealth apps in improving public health. One of these has been the proliferation of smartphones and users' ability to capture, store and transmit large volumes of health data on these devices. As noted in , “The Impact of Using mHealth Apps on Improving Public Health Satisfaction during the COVID-19 Pandemic: A Digital Content Value Chain Perspective” “mobile health apps effectively promote information exchange, storage, and delivery, and they improve the ability of patients to monitor and respond to diseases.” With billions of people carrying smartphones, these devices have become ubiquitous and readily accessible tools for healthcare management and information.

The maturation of mHealth also facilitate the delivery of remote care and remote patient monitoring (RPM) allowing care delivery for underserved urban communities as well as broad swaths of rural communities. For example, according to the Rural Health Innovation Hub, 65.6% of Primary Care Health Professional Shortage Areas (HPSAs), which are defined in part by having a provider to patient ratio of 1:3500 were located in rural areas. Given the lack of providers in these areas many countries [including the United States] have begun to use mHealth apps on a large scale to provide consultation, monitoring, and care services for patients.” These mobile health apps, encompass both telehealth, virtual care and RPM allow for the exchange of two-way data between patients and healthcare personnel to realize remote medical consultation, psychological consultation, health education, and obtain medical protection thereby facilitating virtual consultations, monitoring, remote diagnostics and escalation to in-person visits when necessary.

Given their ubiquity, and ability to constantly measure users' health data with relatively inexpensive technology, mHealth has demonstrated an ability to help reduce the cost of healthcare delivery. Not only has this been achieved by an increase in the delivery of basic preventive care it has also moved the delivery of care from episodic and reactive to continuous and proactive. As noted in the aforementioned “The Impact of Using mHealth Apps on Improving Public Health Satisfaction during the COVID-19 Pandemic: A Digital Content Value Chain Perspective“, “the emergence of mHealth apps has changed the supply mode of health services and brought about benefits for both healthcare providers and recipients. On the one hand, doctors use mHealth apps to process patient information and monitor patient health. On the other hand, individuals use mHealth apps to obtain health information for immediate diagnosis." As a result, these apps can reduce the burden on traditional healthcare systems by enabling remote care and self-management of a number of health conditions.

Implications:

As noted above mHealth apps have a number of positive implications for the delivery of healthcare and public health. mHealth apps can help promote healthy lifestyles, track fitness and nutrition, and create an opportunity for early intervention. As noted in the article, “Mobile Health Apps and Health Management Behaviors: Cost-Benefit Modeling Analysis", “chronic diseases, but not health crises, often manifest in the form of health management routine. [In situations like this] the use of mobile health apps helps to address the health concerns of individuals who are already aware of their health condition.”

MHealth can also provide opportunities for continuity of care in public health, particularly for communities that lack transportation or the ability to take time off from jobs to seek treatments. This can be magnified during times of crisis like pandemics or natural disasters when in-person visits are challenging. As noted in, “The Impact of Using mHealth Apps on Improving Public Health Satisfaction during the COVID-19 Pandemic: A Digital Content Value Chain Perspective’, ”Mobile health apps effectively promote information exchange, storage, and delivery, and they improve the ability of patients to monitor and respond to diseases. They can also be used for training, information sharing, risk assessment, symptom self-management, contact tracking, family monitoring, and decision-making [as they were] during the COVID-19 pandemic.“

Perhaps most importantly, mHealth can help reduce costs and address workforce shortages associated with physical infrastructure, including travel, time off and geographic barriers making healthcare more cost-effective for both patients and providers. As the authors note in “Mobile health app users found to be more content with public health governance during COVID-19”, “Smartphone apps can partly eliminate the shortage of medical resources and improve the quality of medical services for high-risk groups and [those] residing in remote locations.”

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