Digital technologies in health change

The University College London Centre for Behaviour Change has hosted its first-ever conference, around the theme of digital technologies in health behaviour change initiatives. The two-day event, at Senate House in London, drew speakers from an array of disciplines, from psychology and medicine to computer science and game design.

During an enlightening session on the 'gamification' of behaviour change initiatives, game designers and behavioural scientists spoke of some of the ways they have sought to encourage behaviour change. Psychologist Professor Pam Kato (Coventry University), Director of Research at the university's Serious Games Institute, spoke about the development of Re-Mission – a game aimed at young cancer patients. The main character of the game travels through the human body carrying out missions in different parts of the anatomy. Kato explained that in a trial of 374 young cancer patients, in those who used the game there was an improvement in cancer knowledge and self-efficacy, as well as adherence to medication.

Games developer at PlayLab London, Simon Fox, told the assembled audience about a new game app that aims to help people with anxiety and panic disorders. The game gives players tasks to complete while being guided through structured breathing exercises. Fox said he had been inspired to develop Flowy after experiencing a severe panic attack himself six years ago, adding that although effective treatments are available on the NHS only 15 per cent of people are seeking such treatment. The app has been through a randomised control of 63 people with help from psychologist Quynh Pham, finding a decrease in self-reported anxiety and hyperventilation scores as a function of the time Flowy was used for, as well as an increase in self-reported quality of life.

During a session on mobile health, psychiatrist Andreas Fonseca (Virtually Free Ltd) spoke about his development of an app to help people tackle arachnophobia. He said he wanted to develop an app to deliver a proven form of exposure therapy – systematic desensitisation. He said he had been frustrated by meeting patients who could not access therapies they needed. The app shows gradually more realistic spiders to users, ending with a tarantula shown in augmented reality, by which while looking through the phone screen it seems a tarantula is on your hand or in the room.

Closing the first day of the conference was keynote speaker Bonnie Spring (Northwestern University), a clinical health psychologist. She spoke about the 'tortoise vs. hare' speed difference in the evolution of technology and the evaluation of behaviour change apps: although there are thousands of weight-loss apps available, very few have been evaluated for their effectiveness. Spring said that in a recent review only six out of 21 were found to have a significant benefit as a health intervention. She also argued that, in digital approaches to changing behaviour, it is not the 'widgets' that make the difference but the behaviour change principles themselves – and such principles may work very differently in a digital environment. In one of her own weight-loss interventions, Spring found that although technology could be used as a novel way to encourage healthy behaviours, self-efficacy decreased when participants were actively trying to lose weight. Spring concluded: 'We have apps that make [losing weight] engaging and reinforcing, but the reality doesn't always translate into a health benefit and it's demotivating for people.'

To begin the second day of the conference, the Centre for Behaviour Change launched its new venture with Bupa, the Global Institute for Digital Health Excellence (GLIDHE: see p.191, March issue). The initiative aims to bridge academic and private company worlds to test behaviour change theories on a larger scale. GLIDHE was developed following research collaborations between Bupa's Group Digital Director Alan Payne, UCL Professor of Health Psychology and Associate of the Centre of Behaviour Change Robert West, and UCL Professor of Computing Science Philip Treleaven. Professor West pointed to the disparity between where research is most heavily focused (Western English-speaking countries) and where it is most needed (Africa and India). He said that, with Bupa's connections with the World Health Organization, behaviour change initiatives developed at UCL could benefit these countries. West added that smoking prevalence in India was much higher than America and Europe and that people in such countries were being greatly under-served. Initially GLIDHE will look to test smoking cessation initiatives, following positive trials with West, whose work in developing SmokeFree 28 (SF28) formed the basis for the first GLIDHE project, BupaQuit.

The final sessions of the conference discussed what academia can learn from industry and vice versa, how behaviour change initiatives can inform policy, the ethical dilemmas sparked by new technologies, and wearable devices and the internet of things. In this latter session many different wearable devices that monitor biofeedback were discussed, including a set of heart and blood pressure monitors, designed by Quardio, which were encouraging more people to stick to regular self-monitoring of heart conditions. Another company, TicTrac, has developed a comprehensive system to use information from wearable technologies to give feedback for behaviour change.