There is excitement in the air about how mobile phones are the breakthrough technology for changing health behavior. Last Saturday, I was convinced this must be true. In two short hours, I:
- Skimmed the NYTimes op-ed, You Love your iPhone. Literally, that (questionably) claimed that functional MRIs show that our brains react to our iPhones the same way they do to the proximity of someone we love.
- Received an email on my iPhone from NYC Health Business Leaders inviting me to come to a meeting: Is Mobile Health the Next Killer App?
- Came across this podcast on how mobile technology is going to vastly change care for seniors with chronic conditions.
- Read a beautiful review of the behavior change literature that asks the question Is Mobile the Prescription for Sustained Behavior Change?
- Received a text about the highly anticipated release of the iPhone 5.
- And came across the entire kitchen crew of a fancy restaurant staring into/talking on their mobile phones.
Now I'm sure that the seductive power of our mobile phones hasn't escaped your notice. Certainly, if you are concerned about people engaging more fully in their health and health care, you have seen the thousands of apps that intend to exploit the combination of widely available mobile phones with advances in Web-enabled technology as the new best way to spark and sustain health behavior change.
I love the optimism that has driven the development of these apps to date. The theoretical reasoning of the behavioral scientists that finds mobile apps to be a potential game-changer -- this is why this technology is different and what it offers above all other technologies and approaches -- is subtle and compelling. And I love imagining the personalized guidance and support that will be possible to deliver to us once these theories are transformed into more sophisticated apps for our mobile devices.
I also love it because this health and lifestyle behavior change stuff is really hard for us whether we are individuals or caregivers or clinicians and it is really important: it's necessary for many of us to act differently if we are going to become or remain active and healthy.
We love our phones. They distract us when we are lonely or bored and inform us when we are lost or curious. They allow us freedom of place and space. And the rewards they offer are immediate, efficient and entertaining. But we mostly love them because we like what they do for us.
My friend Lou has early Alzheimer's and her caregivers have set up a locator app on her iPhone to track her when she goes out. When her resentment about being spied on builds up, she hides her phone in her house and heads for the door, almost always forgetting where she put it or that she hid it at all. Even in her confused state, she's willing to let go of that treasured phone 'which is her main link to the people she loves when she associates it with negative emotions and experiences.
I am trying to gain weight. I want to eat and know I should eat every hour and I have a full array of tempting snacks by my side at all times. And I have carefully set up an app to deliver a different alarm every hour to prompt me to eat. Yet I reliably delay my response to each alarm and then forget to eat the nuts and even the cookies. You cannot imagine how easy it is to turn that little sucker off and promise myself that I'll eat as soon as the conference call is over, when I finish this paragraph, or when I get off the subway.
Two small examples but telling ones.
While mobile phones can do so much and will soon be able to do much more to monitor our movements, tailor information to our interests, send us strategic messages, and remind us with alarms, our will is still our own. When the device becomes the driver of change, rather than us, it becomes an electronic substitute for a nagging clinician or spouse, a voice that reins in and confines, bringing out our worst adolescent tendencies: mischief; defiance; disobedience. I'm not sure that an app exists that can wrangle that impulse into submission in most of us most of the time.
We prefer fun, enjoyable activities and avoid irritating ones. If an app becomes the source of unwelcome advice or beeps, or we feel intruded upon or our response to some app brings unwanted attention to us, we will have no problem circumventing it.
As much as we depend on the convenience of our mobile devices, they are only tools. While my mobile phone can link me to information, advice, friends and support, I don't confuse it with them. I can get to these valuable resources via my phone when I want them. But I know that when I am sick, the disease is located in my body, not my phone. Regardless of what is going on with my phone, I'm the one who has the cancer and I'm the one who takes the chemotherapy drugs, pleased as I would be to delegate that responsibility to an inanimate object. When the alarm goes off that your mom has fallen, it is your hands or the hands of the EMR technician that help her get up, not the mobile device. When Lou gets lost, even when she has her phone with her, it is her caregivers or the police who find her and bring her home.
I am convinced that behavioral scientists and app developers will be successful in getting those mobile phones to do what they want them to: deliver clever tailored behavior change strategies directly to us through our mobile phones. And I am equally confident that many of us will try those apps. But if they don't do what we want them to, if they become a burden, an intrusion or a bore we will ignore them, delete them, or, when all else fails, carefully place our beloved phone in the vegetable drawer of the refrigerator and head out the door.