Sussannah Fox and Maeve Duggan at the Pew Research Center (a nonpartisan, nonprofit “fact tank” that provides information on the issues, attitudes and trends shaping America and the world) have published the long awaited (read my thoughts on Pew’s 2010 Mobile Health report here) results of their Mobile Health 2012 research.
US Mobile adoption stat uncertainty
The report states that “Fully 85% of U.S. adults own a cell phone. Half own smartphones, which expands their mobile internet access and enables mobile software applications“.
I think this is quite ambiguous eg. you could take this to mean “50% of US adults own a smartphone” OR “half of the adults that own a mobile own a smartphone”.
The first of these would be consistent with the CTIA’s data (they claim 50% of all American adults own a smartphone as of February 2012 – up from 36% the year before).
In any case you can no longer talk about Smartphone users as the “smaller group” eg. the report states: “This report will provide details about both groups – people who own a cell phone of any kind and the smaller group of people who own smartphones“.
If the CTIA stats are correct and only 85% of the population has any type of phone yet 50% of the total population has a smartphone then the smaller group is actually the 35% of the population who only have a basic/feature mobile.
If the Pew research stats are correct the basic/feature phone group is exactly the same size as the Smartphone group.
A Smartphone expands mobile internet access
I fail to see how a smartphone “expands mobile internet access” unless the authors are defining a smartphone as “a mobile with an internet connection or a web browser”, because I fail to see how the type of device itself expands mobile internet access eg can’t we all pretty much look at the same basic mobile optimised WebMD page etc?
Basic phones can (and do) run mobile software applications
The report claims that basic or feature phones can’t be used to download and run “mobile software applications” but this is very misleading and untrue eg. the first downloaded mobile health app to reach 100k downloads per month ran on very basic Nokia mobiles (back in 2005).
No significant rise in US cell phone owner numbers since 2010
I’m surprised there’s no increase reported here (“In 2010, when the same percentage of U.S. adults owned cell phones“) especially as the report is pegging cell phone ownership at only 80% and more than 4 million kids became adults in the 2 intervening years (this itself would add more than a 1% gain).
“Nearly all demographic groups report significant increases in this activity, with the exception of those over 65 and those who did not complete high school“
I think this highlights the prevalence of other means of mobile based health seeking behaviour amongst these groups and I think Pew could have found much more accurate ways of calculating how many people search for health information by just asking a mobile operator eg. in the UK 7 years ago Vodafone shared data showing that about 2.5% of their customers had called a single premium rate nurse helpline in the UK (where visits to the Doctor/ER are free) and this was strongly weighted for those over 65 especially if you compared it to other premium rate mobile services at the time.
“Few are texting for health-related purposes. Text messaging is a nearly universal activity, especially among younger cell phone owners, but it has not yet had a significant impact on the health market“
I find this very hard to understand and think it’s likely to be missing out on lots of adoption (eg appointment reminders, P2P and Carer2Carer “is mum ok?” style messages) probably because people being polled aren’t probably thinking that something like a Doctors appointment reminder SMS is “health related” because their Taxi/Plumber/haridresser are all expected to do this in 2012.
“Eighty percent of cell phone owners say they send and receive text messages. Just 9% of cell phone owners say they receive any text updates or alerts about health or medical issues“
I think this is very disappointing but fortunately it’s going to vary considerably depending on whether you’re with a modern healthcare/mobile service provider or not eg. if you’re a Kaiser, Palomar Pomerado Health or WallGreens patient you’re going to be getting those SMS reminders, if you’re a resident in New Jersey you’ve got at least one public health SMS in the last fortnight.
“Women and those between the ages of 30-64 are more likely than other cell phone owners to have signed up for health text alerts“
Of course this presumes the need for signing up (as we can see with the Sandy texts this isn’t always required) and might be as a result of marketing efforts that target these customers as key healthcare decision makers (eg. by Walgreens, Primary Care Providers, etc).
Need to define what it means to use a Mobile to search for Health Information
The biggest fault I can find with the report is that it’s authors seem to be under the impression that to use a mobile phone to search for health information you need to either (a) Download a health app to a smartphone or (b) Open the web browser on your smartphone and search the internet for health information.
This naturally leads to statistics that underestimate the mHealth opportunity eg. only “one in three cell phone owners (31%) have used their phone to look for health information”.
I think this isn’t the case and that this definition is itself very limiting because it rules out many of the most common and most useful ways society uses mobile phones to access health information.
I thought it might help to list a few of these:
Key to the widespread adoption of mobile phones by all sections of society this is an important mHealth feature that is often ignored because of it is all too frequently just taken for granted. When you appreciate the mHealth value of reachability it becomes obvious that mobile phones are the world’s number one device for PERS and that many of us are sleeping with our phones switched on in part because we are interested in finding health information (eg. that our parents are in need of help, that our children are okay, etc, etc).
When you appreciate the value of reachability the idea of “using your phone” expands and you see that it doesn’t mean even consciously using it but even just having it turned on or kept about your person has value.
2 Other ways to search for health information with a mobile
If you feel it fair to define searching for health information with your mobile = searching the mobile web, how would you explain the use of basic mobiles by millions of Doctors, Nurses and Carers. Monitor their use and you’ll see a lot of the calls and texts that they’re making are made in the search for health information eg. “is your mum improved at all from yesterday?”, “Can you send me a copy of that XRay”, etc.
3 Ways we use NATIVE mobile applications for health
A day doesn’t pass when I don’t hear about another way patients and care providers are using the conventional native apps on their mobile phones for healthcare uses eg. I recently heard about a physio who was using camera phone pics to help musicians gain body awareness, I’m astounded by the interest patients have when their Doctors share with them youtube videos about their condition, etc.
We should not discount these important uses of native applications as they are much more pervasive than downloaded apps will probably ever be and their use for health is likely to remain much higher eg. you’ll be surprised how many patients who are taking a regular pill have set up a calendar alarm entry to remind themselves to take it.
The way I see it when we ignore the use of native mobile apps (like SMS, MMS, Voice dialler, Web, etc) we’re writing off the important mHealth use cases like being able to ring your mum for advice and this is much like early internet analysts ignoring the opportunity for the internet to be used for social, domestic and pleasure uses (because of course some people only thought that the internet would be used to share important scientific research and not for sharing videos of cats with your old school friends).
4 A lot of searches for Health information on mobile actually look like social interactions
If you rang your mum at home or son at college and asked on how they are would you report to a Pew Researcher who happened to call you that you had made a routine mental health check on a loved one?
If you checked out the forecast on Weather.com and saw the pollen count reading would you report to a Pew Researcher who happened to call that you made a routine allergy check because you have a chronic health condition (hayfever)?
If you checked out a thread of opinions on a cake making topic on the MumsNet.com forum would you report to a Pew Researcher who happened to call that you made a dietary health search because you’re trying to bake a cake for your lactose intolerate child?
If you pressed the SOS button on your Doro EasyPhone to send a notification SMS’s to your carer’s mobiles would you report to a Pew Researcher who happened to call that you used a GPS enabled Health App?
5 The ability to receive a text message based on your location is a network based mHealth app
The report states that “Texting is nearly universal, but not for health” because whilst “a whopping 80% of cell phone owners say they send and receive text messages” only “9% of cell phone owners say they receive any text updates or alerts about health or medical issues“.
Stating that “Women, those between the ages of 30 and 64, and smartphone owners are more likely than other cell
phone owners to have signed up for health text alerts” also suggests that the authors thinks this opportunity is something that needs to be opted into. I would have hoped that the Japanese Tsunami or the recent Superstorm Sandy (in the USA) would have put paid to this concept eg. SMS’s were broadcasted to all mobile phone users in the regions affected.
6 It’s the law: Your phone has to have a completely free native mHealth app on it
The report states that “Half of smartphone owners use their devices to get health information and one-fifth of smartphone owners have health apps” but I think this is missing the bigger data point by a long stretch.
Every mobile phone in the USA has to have a mHealth app on it. That native software app enables you to roam onto any network to make a free call to request emergency medical assistance. Everyone in the USA has this app. It’s used a lot eg. the CTIA reports as many as 396,000 such emergency 911 distress calls are made per day in 2012.
If you don’t have this app on your mobile device it will have been recalled eg. as we saw happen with the Samsung Jitterbug devices sold by GreatCall in 2009.
It’s important in my opinion that the report recognises this as otherwise claims like “In a comparable, national survey conducted two years ago, 17% of cell phone owners had used their phones to look for health advice” will mislead readers into thinking that citizens perception of mobile for providing health information is limited when the complete opposite is actaully the case eg. >99% of these cell phone owners knew that they could use their mobile to call 911 and reach a trained emergency medical operator within seconds.
Have you read the report yet? What do you think?