The Promise of Mobile: Connecting to Underserved Populations

ASTHMA IN CALIFORNIA

From area to area, the health challenges of underserved populations differ. While communities in the Midwest and South may have a higher propensity for diabetes, as Samet says, the folks in Sacramento, Calif. are dealing with asthma, thanks to various environmental problems. In addition, the city’s burgeoning Latino population faces language barriers.

Dignity Health, a 42-hospital, multi-state health system, decided to team up with the California Healthcare Foundation and tackle this problem by monitoring asthmatic patients on a daily basis through the use of a sensor on an inhaler and mobile app from startup app developer, Asthmapolis, Madison, Wis. Through it, physicians are able to determine how much medication patients are using, when they’re using it, and when they might be having an asthma attack.

For the region’s Latino population, the app was made available in Spanish as well, says Rich Roth, vice president of innovation at Dignity. More than being available in multiple languages though, Roth says it worked for them because it was simple.

“There are a lot of things out there that require you to do a lot of stuff, which you not might be able to do because you are trying to live a normal life. You don’t go online and do banking 50 hours a week. You do it on a transactional basis. That is the lesson for mobile health. With Asthmapolis, you use the inhaler as you normally would,” says Roth. “The direction we’re going to see over time is that if you make it simple, mobility has such tremendous opportunity to improve care.”

In terms of connecting with a population that doesn’t speak English, a comparable solution was cooked up by the Columbia Valley Community Health (CVCH). Dealing with a monolingual, Spanish-speaking patient population that primarily lives below the poverty line, CVCH’s leaders invested in a smartphone app from WellFX, a Petaluma, Calif.-based developer. The app provides diabetes patients with interactive resources such as educational videos, digitized support groups where they can communicate with others that share the same disease, and text message-based reminders.

UNIQUE CHALLENGE AND OPPORTUNITY

If there is a recurring lesson in the way providers are attempting to connect with underserved patients through mobile devices, it’s essentially the question CVCH’s medical director, Malcolm Butler, M.D., asked when he first came up with the idea that would lead to his organization’s own intervention efforts.

“There’s no way I can communicate everything that needs to be said on the management of diabetes in the course of 15 to 20 minutes a year. But what if every morning, while they’re waiting for the bus, they get on their phone, go to [an app], and see a post from Dr. Butler on how their diabetes works?” Butler recalls asking before the app was created.

Fitting mHealth interventions into the everyday lives of patients is the unique opportunity and challenge inherent in engaging underserved populations. In the Txt4Health program, Hamilton County Public Health’s Mike Samet says the organization had to figure out the right amount of text messages to send before it became a nuisance for people. “One of the drawbacks to the program was that there was a high dropout rate,” he notes.

As providers, advocacy groups, and other stakeholders look to empower socioeconomically disadvantaged patients through the use of mHealth, while improving the quality of care in those areas, healthcare leaders are finding that they must first work to understand the population. Only then, they say, can they begin to change behaviors.