Good Health
By Carol Posthumus, Wed Feb 05 13:30:00 GMT 2003

Mobility is being tested around the world as a new tonic for everything from a 'take your pill' reminder to a fertility and belly-off aid.

For techmed innovator Dr. David Green a moment of "total frustration" - due to his mother not taking her daily medication for hypertension - saw him stumbling on to what would become a World Health Organization (WHO) recognized mobile data solution.

Two years ago the Cape Town-based doctor, in despair, told his Mom: "I'm going to send you a SMS every day to remind you!" This worked wonders. Says Green: "I realized I had chanced upon something that could be very useful for many people." Since then, Green's SMS app, On-Cue Compliance Services, grew and has got the attention of a number of medical research groups and the WHO, which highlighted it this year as a "Best Practice".

Dr. Green tells TheFeature he is also working with the Texas Migrant Clinicians Network and the State of Colorado on replicating the system. Green, whose special interest is digital diagnostics, is developing with international parties a mobile option that couples a communication device with a pillbox. If the person does not take their medicine on time, it will detect this and signal the caregivers.

Forgetfulitis Panacea

Green points out that there's a huge need to remind people to comply - to get with the program, take the pill, use your inhaler, and so on. Non-compliance is serious for people's health, and for healthcare systems.

Consistent numbers and trends of "defaulters" in medical literature seem to reveal that us humans are a fairly forgetful lot. Our digital machinery's memories grow vast, packed with the details of our lives. But, truly, the size of our natural memories' capacity for numbers and dates, the tedium binary relieves, may be shrinking. Being actually able to recite phone numbers is almost like a retro 80s party trick.

Even when forgetting can impact our health, it's our nature to get extra fussy and sensitive about how we receive a reminder. Many of us will forget - if our reminder is not delivered in a personal way - with some humor, entertainment and motivating words to surprise us on some days. A tall order.

In health matters, though, an array of mobile apps, like Green's development are proving just the medicine for personalized reminders and supportive tools for forgetfulititis sufferers.

Mobile Reminders

The United Kingdom's Homerton University Hospital in London, for example, recently started a trial of SMS m-reminders to patients for appointments. While it's a first for them, reports, they predict it will become standard practice in hospitals in a few years' time.

According to the House of Commons Accounts Committee missed appointments cost the UK's National Health Services some 300 million pounds a year. A significant 30 percent of people missed their NHS appointments, says Health-News, because they merely forgot. The greatest percentage, 60 percent, said apathy was the cause (and they will undoubtedly also benefit from a text prod of encouragement to get going.)

Green feels forgetfulness is significant in non-compliance too: "Psycho-social reasons and side effects are raised as causing non-compliance. At the end of the day, a lot of people forget to take their medication."

Gadgetry reminder devices, like beeping pillboxes, exist. The problem is that these usually uncool impersonal naggers don't work for people's lifestyles. Plus they carry a social stigma, especially for groups like teenagers. A text message on a mobile's efficacy tends to be better.

Explains Green: "It doesn't help when the device beeps for the benefit of the bathroom while the person is out driving around. An SMS is a personal and private message - and we guarantee confidentiality and privacy. Also, a person's mobile is likely to be with them wherever they are. Further, mobile makes compliance services interactive. Our service is backed by a call center, so patients can call our nurses 24 hours a day."

SMS Success in Test

Notably, Green's instinctive early enthusiasm for using mobility as a compliance tool has been firmly backed by results. Late last year the concept swung into action at the Chapel Street Clinic in Woodstock in Cape Town for Tuberculosis (TB) patients. TB patients need to take a pill five days a week over six months. The City's health department sponsored the trial, with the messaging costing just over $1 dollar per patient per month. Of the 100 patients receiving SMS reminders, the success rate clocked in at 100%, with no defaulters. Green states, "this completion rate is unheard of" in TB programs.

However, sending out mass reminder SMSs to "take your pill" is not just a matter of automation. There's a fine art to it. Green recalls: "The idea almost died a horrid death due to people uniformly hating the same 'boring' message every day. We held focus groups and this became very clear."

The detested message was: "Take Your Rifafour now." Then Green added disease information, lifestyle tips and jokes, which went down a treat. Also, the messages are sent in three local languages: English, Afrikaans and Xhosa. While the concept was tested in a local government clinic setting, Green says that community health practices have been quick to buy into the service.

Virtual Friends and Sweet Talking

"Small practices see how they can improve their personal service in this way. They use it for many things - from reminding people to come in for annual flu shots to having a child's ears examined a year after surgery. People tend to forget that they should return for further treatment after a few months. By then they are feeling better and they put it to the back of their minds."

Putting health to the front of our minds and eyes with mobile is growing round the world, in many different ways. There's real interest around this kind of health support in medical and scientific circles.

The British Medical Journal (BMJ) recently published a story about a British test of a mobile reminder and support service: "Max the virtual friend for teens with asthma". GP Ron Neville reported they found in their trial that the young people developed a rapport with Max, often texting him back. Max sends messages to remind teens to use their inhaler. In the BMJ examples are given: "Yo dude, it's Max reminding you to take your inhaler."

Neville reckoned: "Text messages that are a reminder about treatment and useful tips on education may be a medium to allow people with chronic health problems to make the disease comply with their lifestyle and not the other way around."

Personal Fitness and Diet Machine

Dundee University is also testing an SMS support message service from doctors - this one for people with diabetes: "Sweet Talk." Meanwhile in New Zealand, the University of Auckland launched a test called STOMP (Stop Smoking with Mobile Phones). In their website recruitment blurb, they say that mobile messages seem to provide "distraction and support from friends and family to quit".

While doctors put SMS services through tests, the less cautious (entrepreneurial?) lay healers and fitness evangelists out there are running with public demand. Without doing any scientific research, it's clear that a lot of us may appreciate getting personalized health and exercise encouragement on our mobiles. One's mobile could almost be as good as a personal trainer, for some of us easily persuaded. After all messaging support, compared with a trainer, is cheaper, always available, on time and your partner will not be jealous of the time you spend gazing upon your mobile's muscled form in the interests of a svelte self. However, if the messages are boring, unlike a bossy trainer, they are easier to ignore too.

Club Mobile

Men's Health magazine in the UK started a "Belly-Off Club offering a "SMS weight control service" for its readers. While one television station offered viewers supportive mobile messages from its fitness and nutrition experts. Along the lines of: "Yr Lnch: 1 tuna salad sarmy/papino/cup of herbal T. Bon Appetite!" and "10 stretches, 5 sit-ups. Excellent!"

All this is probably useful - but perhaps MMS and camera phones will be better personal allies in the fight against fat and flab. I can imagine nothing more disciplining in this than receiving one of those unflattering "fatty" pictures one usually sticks on the refrigerator programmed to arrive at a "weak time" in a day. Rather as kindly motivation, suggests one friend, you could even digitally alter these pictures to "slim me" to arrive on your mobile.

Carol Posthumus is a freelance author, analyzing how mobile technology impacts our lives. She lives in Jeffreys Bay, South Africa.