Health fads of one kind or another have gripped the nation – or at least the health conscious – for decades, but the latest trend seems to have made itself something of a permanent fixture.
From websites and apps to wearable fitness trackers, the digital health trend offers a whole world of support at our fingertips, covering everything from diet, exercise and sleep to mental health and long-term diseases. The versatility of digital technology means that in theory, the only limits are the imaginations of the developers, which, as it turns out, seem to be quite active. Zombies, Run! is a prime example of the weird and wonderful running apps that are now available.
The downside is that anyone with the technical know-how can create a health app, whether they have the clinical knowledge or not. With that in mind, are these innovations really all they’re cracked up to be, or should they be used with a hint of caution?
According to the communications regulator Ofcom, 71 per cent of UK adults own a smartphone, meaning the potential reach of mobile health technology is vast.
The number of health apps available to download hit more than 259,000 in 2016, according to a study by market research company Research2guidance, and this is continuing to increase, as is their popularity. The study also revealed that by the end of 2016, 3.2 billion health apps had been downloaded worldwide – 57 per cent more than in the previous year. And closer to home, the NHS Choices Couch to 5K running plan, which helps exercise novices gradually work up to running five kilometres in nine weeks, was downloaded more than 1.4 million times between October 2015 and July 2016.
But apps aren’t the only examples of health tech on the rise. Wearable fitness trackers such as the Fitbit and Apple Watch are also becoming increasingly popular. According to Kantar Worldpanel ComTech data, 12.3 per cent of Britons owned a smartwatch or fitness band in 2016 and 11.3 per cent of non-owners said they intended to purchase one in the next 12 months.
Despite their popularity, research published in the Journal of the American Medical Association claims there’s no proof that fitness trackers promote weight loss and suggests they’re just a gimmick. However, for many people, fitness trackers offer a lot more than just the potential for weight loss. Just like apps, they can have a much wider positive impact on health and wellbeing.
Perhaps the biggest appeal is that they encourage healthy behaviours, allowing people to monitor and be in control of their own health. Claire McDonald, behaviour change specialist and fellow of the Royal Society for Public Health, says: “There’s a huge range of health apps available. For example, Pokémon Go – you might not naturally think of it as a health app, but does it have a health benefit? Yes it does. There are so many apps that have a tailor made approach for you, if you want it. They’re not overtly healthy, you’re just walking, but with exercise, getting healthy is a by-product. You can tailor it, make it personalised and get
it to mirror your world.”
It’s this personalisation that makes health apps such an attractive tool. This doesn’t mean that they will work for everyone, however, but as Claire says: “If people seek Couch to 5K or similar apps, they can get them to work if they want them to. I like MapMyRun, for example, because I like to know my timings and compare today’s run to last time. I’m competing with myself and that’s motivational.”
It’s all about knowing what’s out there and what might work for an individual’s schedule, lifestyle, motivations and desired outcome.
There’s more to health apps than exercise and adopting healthy behaviours. The Research2guidance study highlighted that people with long-term conditions are likely to be able to benefit the most from this technology and are the main target group for health app publishers. For instance, for patient groups with long-term conditions such as diabetes and high blood pressure, apps can be a helpful health enabler, allowing people to record and monitor important health information over time. In addition, it’s thought that treatment costs associated with managing illnesses like these could be reduced through the use of apps, meaning the benefit reaches far beyond the individual.
Claire says there is undoubtedly great potential for apps to supplement the healthcare profession, commenting: “GPs can have a conversation that is far more informed and they can see what’s happening in reality. They make diagnostics easier and give more value in the limited time that you have.”
In terms of pharmacy, Claire says that apps are “brilliant for drug adherence – it’s a wonderful opportunity. For example, apps can prompt people to take medicines throughout the day, when otherwise they may have forgotten”.
As with apps to support physical health, mental health apps can help people take control of their mental health and wellbeing and manage symptoms. Dr Iris Elliott, director of research and policy at the Mental Health Foundation, says: “Apps are a good way of putting control into the hands of the patient. They allow people to redress the power balance and take the power themselves. Often, health services are very rigid and accessible only at a certain time and place. People have extremely busy schedules, so an app is ideal as it can easily fit into their day.”
Generally, apps to support mental health are about engaging in mentally healthy activities, self-management and creating a network of support. Dr Elliott says: “Some mental health apps can provide a psychological assessment which can be reviewed by a psychologist who can then create a plan of therapeutic support based on the data that the app collected. Or if people have gone through a particularly hard time and they’ve got to the point of recovery and are leaving services, apps can be used as a form of continuing support to help them not become unwell again, or can prompt the person to seek help if they do become unwell again.”
Despite these positive aspects of digital mental health support, Dr Elliott acknowledges that there can be anxiety around its potential damage to health and wellbeing. In particular, she comments that the motivation of app developers is often profit rather than change and this “can affect the quality of the e-intervention and its impact”.
Nevertheless, Dr Elliott explains that both she and the Mental Health Foundation advocate e-mental health. She says: “Mental health apps are an incredibly beneficial resource, but it’s less of whether they’re a good or a bad thing. They exist and it’s about making them as effective as possible.”
To this end, the charity is a partner of the European Digital Mental Health Project. Running until 2019, the project will address the concerns surrounding digital mental health and take an evidence-based approach to look at these interventions and improve their quality, availability and access. “Digital mental health interventions, be that online treatment modules, apps, virtual reality or artificial intelligence, provide an amazing opportunity to deliver accessible, timely, quality assured support,” Dr Elliott says.
As much as health apps can have a positive influence on a person’s health and wellbeing, there’s an ongoing debate as to whether they can be damaging. It’s thought that there’s a risk of people relying too heavily on apps to solve their problems and, after all, there’s only ever so much help an app can offer.
“Apps have a role to play in getting fit, but to expect technology to fix everything, well, you’ll be walking down a blind alley really,” says Claire. “And generally it depends on what they’re purporting to do as to whether they’ll work. Some alcohol apps, for example, are a glorified diary and aren’t any better than writing on a piece of paper.”
In addition, there’s a chance for apps to be self-deluding – people believe it’s working when it’s actually not. Claire says that at the end of the day, an app is “only as good as the information you give it”, and adds that they therefore “need to be used alongside advice from a healthcare practitioner – you need those checks and balances”.
Regulation is another concern that comes up time and again. But regulating apps is a bit like trying to regulate the internet. You’d have to test and regulate them all, but with so many new ones being developed daily, it’s a nigh on impossible task.
Some apps with clinically-led content can be classed as medical devices. This means they gather data on things like diet, heartbeat, or blood glucose levels from a person or a diagnostic device and then analyse and interpret it to make a diagnosis or recommend treatment. The Medicines and Healthcare products Regulatory Agency (MHRA) warns that depending on an unregulated app to provide a diagnosis or recommend treatment could have potentially life-threatening consequences.
The organisation has therefore issued updated guidance to help software and app developers identify whether their health apps are medical devices, and make sure they comply with regulations and are acceptably safe. But not all developers will comply, so what does this mean for the user? John Wilkinson, MHRA’s director of medical devices, says: “We live in an increasingly digital world. Healthcare professionals, patients and the public are using software and stand-alone apps to aid diagnosis and monitor health. Where apps or stand-alone software make a diagnosis or recommend a treatment, people should check for CE marking before using their apps.”
For other, non-clinical health apps, Claire is of the opinion that it’s up to the user to determine whether it’s safe. “When it comes to regulation, if it matters to you then you can seek it out and only download something that has gone through rigorous checks,” she says.
Organisations such as the NHS have a range of health apps available that have been tested, so signposting customers to these is advisable.
The rise of digital health goes further than just being a fad and in fact the internet and digital devices are set to revolutionise healthcare. In February this year, Public Health England (PHE) announced a new digital-first public health strategy. This followed an announcement last September by health secretary Jeremy Hunt that the NHS is undergoing a digital transformation in an attempt to go paper-free, and apps are taking centre stage. Mr Hunt said the change would “put patients in the driving seat of their healthcare,” and added: “We live in the age of the smartphone and we want the NHS to reflect that.”
On 24 March, NHS England unveiled the first ever directory of NHS-endorsed digital mental health resources to help treat depression and anxiety and improve access to psychological therapies. The Mental Health Apps Library features six online tools and apps that have a proven track record of effectiveness in improving mental health outcomes, including Big White Wall, Sleepio and FearFighter.
An extension of this library of health apps covering chronic conditions such as diabetes is expected in the coming weeks and will be further developed throughout 2017. Data from these approved apps will feed directly into personal health records, allowing for more personalised care. It’s also hoped that the NHS approval will guide patient choice and ensure they are accessing reputable and effective products to monitor and improve their health.
Whether this new technological approach to health within the NHS and PHE will work remains to be seen, but the potential, combined with the Government’s commitment and investment, mean there’s a fighting chance. Who knows what’ll reach our screens next.
Claire McDonald, behaviour change specialist and fellow of the Royal Society for Public Health, has this advice for pharmacy staff recommending health apps to customers:
Apps can prompt people to take medicines throughout the day, when otherwise they may have forgotten