Publish date: Feb 2015

Mobile health (mhealth) is a rapidly expanding field in the digital health sector providing healthcare support, delivery and intervention via mobile technologies such as smartphones, tablets and wearables. Whilst mhealth refers to all mobile devices which can transmit data, mobile phones are currently the most popular platform for mhealth delivery. Ninety four percent of the general population in the UK own or use a mobile phone [1], making mobile phones an optimal delivery platform for mhealth interventions.

The term ‘mhealth’ can be used to describe a range of healthcare activities in both clinical and non-clinical populations. For example, thousands of popular smartphone apps are available to download under ‘health’ categories to help individuals improve their fitness, count calories and monitor their sleep.  However, recent research has shown that many of these apps, including both clinical and non-clinical mhealth technologies, do not contain evidence-based content and do not adhere to clinical guidelines [2]. A major problem for the mhealth industry is how to improve the quality of technologies to incorporate current research and scientific evidence (Kumar et al. 2013).

Notwithstanding this, mhealth technologies have the potential to become powerful medical tools to support healthcare delivery at all levels of care. For example, providing Skype GP appointments via  mobile phones  and wireless blood pressure and glucose monitors that link to your phone and send data automatically to your Doctor. Indeed, a key benefit of mhealth is that it has the potential to deliver personalised, interactive and adaptive health interventions in the context of an individual’s everyday life, overcoming many of the traditional barriers faced by healthcare practitioners such as time and resource constraint’s.

Mhealth in Addictions

Take up of mhealth in the addictions has been slower than other sectors and predominantly led by the United States (US). A brief review of the evidence for app, text-messaging and wearable mhealth technologies in addictions is outlined below.

A recent survey reported that  91% of patients in substance abuse populations own a mobile phone [3]. Apps are available for dependent and harmful drinking; the A-CHESS project has designed an app to support recovery from alcoholism and includes novel features such as geo-location tracking which raises alerts when a patient enters a pre-defined area of high-risk, such as their local drinking spot. A randomised controlled trial examining the effectiveness of the app reported that participants in the A-CHESS group had significantly lower drinking days than those in the control group [4].

Regarding harmful alcohol use, there is an emerging market for Electronic Screening and Brief Interventions (ESBI’s) such as the NHS One for You Drinks Tracker. Brief interventions are typically aimed at non-treatment seeking individuals as a way to offer simple structured advice and feedback on an identified health risk behaviour. A recent Meta-analysis concluded that ESBI’s (including those delivered via computer) were as effective as face-to-face brief interventions [5].

Whilst the evidence is encouraging, the development and evaluation of mhealth based alcohol technologies is still in it’s infancy. Many alcohol apps are available on the market that have no scientific grounding, and the apps that have been developed and tested with scientific rigour have only been examined in highly controlled research settings. Furthermore, the healthcare delivery system between the US and the UK is markedly different, and some of the features of mhealth products available in the US may not be feasible in UK treatment settings.   

Text-messaging (or SMS) has demonstrated promise to help patients quit smoking. For example, ‘txt2stop’ [6] is a SMS based smoking cessation intervention which sends automated text messages to users 3-5 times per day over a 31 week period; a clinical trial demonstrated that it  significantly improved smoking cessation rates at 6 months. Text message based interventions have demonstrated success in general healthcare settings for improving attendance by up to 50% [7]. SMS appointment reminders are already used in primary care settings, although not routinely in addiction services, however the evidence is promising and suggests that SMS is a viable opportunity for improving delivery of addiction services.

Wearable mhealth technologies demonstrate promise for future addictions care. Transdermal Alcohol Monitoring wearable devices are currently used in the criminal justice system (see SCRAM website). Whilst bulky and not wirelessly connected at this stage, advances in technology may support the use of such devices in the future of addictions care. Other wearable tech is still in early concept and developmental phases and no evidence currently exists on the utility of using such technology in addiction settings, although this is likely to change with the rapidly changing digital landscape.

Joanna Milward, King's College London

The opinions expressed in this commentary reflect the views of the author(s) and do not necessarily represent the opinions or official positions of the Society for the Study of Addiction.

Further resources

For an Introduction to mHealth Online Training Course and mHealth at the National Institute of Health click here.

For a list of health related apps acknowledged by the NHS available to download click here

References
1.            Ofcom. UK Commuications 2013: Fast facts. 2013  [cited 2014 January]; Available from: http://media.ofcom.org.uk/facts/.
2.            West, J.H., et al., There’s an app for that: content analysis of paid health and fitness apps. Journal of medical Internet research, 2012. 14(3): p. e72.
3.            Milward, J., et al., Mobile phone ownership, usage and readiness to use by patients in drug treatment. Drug and alcohol dependence, 2015. 146: p. 111-115.
4.            Gustafson, D.H., et al., A smartphone application to support recovery from alcoholism: A randomized clinical trial. JAMA Psychiatry, 2014. 71(5): p. 566-572.
5.            Donoghue, K., et al., The effectiveness of electronic screening and brief intervention for reducing levels of alcohol consumption: a systematic review and meta-analysis. Journal of medical Internet research, 2014. 16(6).
6.            Free, C., et al., Smoking cessation support delivered via mobile phone text messaging (txt2stop): a single-blind, randomised trial. The Lancet, 2011. 378(9785): p. 49-55.
7.            Guy, R., et al., How Effective Are Short Message Service Reminders at Increasing Clinic Attendance? A Meta‐Analysis and Systematic Review. Health services research, 2012. 47(2): p. 614-632.

The opinions expressed in this commentary reflect the views of the author(s) and do not necessarily represent the opinions or official positions of the Society for the Study of Addiction.