A mobile health technology workshop to evaluate available technologies and their potential use in pharmacy practice

Abstract

The objectives of this workshop were to characterise the use of mobile health (mHealth) devices among second year pharmacy students, discover perception of their potential use in practice and obtain workshop feedback. The workshop consisted of two sessions. The first session introduced the concept of mHealth and allowed for hands-on experience with wireless mHealth devices such as blood pressure cuffs, scales and smart body analysers, personal health devices and glucometers. The second session consisted of a facilitated discussion and lecture that addressed these concepts. Students completed a preworkshop and postworkshop survey. 106 students completed the preworkshop survey and 96 students completed the postworkshop survey. 22% of the class owned an mHealth device and a majority of students reported increased knowledge of mobile health devices due to this simulation. The workshop was successful in introducing mHealth technology. The change in students’ perception that such devices could be useful in practice or easily incorporated could be due to technical difficulties and cost of the devices.

Introduction

Digital health combines the powers of computer hardware and software with the power of genomics and health informatics to provide advancements in the prevention, management, prediction and diagnosis of diseases. Specifically from this area, mobile health (mHealth) has become a new area of medicine targeting the use of mobile technology to engage patients in their care.¹ The recent surge in mHealth technologies and applications has given unprecedented opportunity for patients to self-manage their health by using wearable devices and their smartphones. Today, it is estimated that 64% of Americans own a smartphone and of those who own a smartphone, 62% have reported searching information about a health condition.² This is a major increase compared to a 2011 report that cited 35% of Americans owned a smartphone.³ This increase in smartphone ownership has the potential for patients to play a larger role in their care, thus, promoting shared decision-making.

Text messaging, an early form of mHealth, was found in a systematic review to improve medication adherence.⁴ This is evidence that such a simple intervention had benefit and allowed for interprofessional collaboration between different areas of healthcare. From 2008 to 2012, a majority of mHealth technology and application evaluations were geared towards chronic disease management and preventative care.⁵ A number of studies involving mHealth have been published, including studies using mHealth for the self-management of diabetes,^{6 7} hypertension⁸ and HIV.⁹ A study conducted in Canada showed lower annual healthcare costs associated with visiting physicians for patients receiving Internet Blood Glucose Monitoring (IBGM) by sharing their self-monitored blood glucose data with their providers through a variety of platforms such as: Carelink (Medtronic), report-generating metres (Bayer Contour USB, Abbott Freestyle Insulinx, and Sanofi iBG Star), a customised spreadsheet (Microsoft Excel) and an online-reporting platform (Western Canadian Insulin Pump Centers).⁷

It is important for practitioners to be familiar with applications and technologies designed for self-management. This also requires being able to assess whether applications are reputable, which would require hands on training. Ideally, this training and exposure would occur during the didactic portion of the professional curriculum.

Pharmacy education has not yet addressed these mHealth opportunities nor any possible issues that may arise with the integration of such new technology in healthcare. With the rapid growth of mHealth, pharmacy students may be exposed to various wireless devices during their professional practice without the appropriate attitude or knowledge.¹⁰ The introduction of mHealth topics within the pharmacy curriculum would better prepare students for its significant role in the pharmacy profession. Some of these topics may include appropriate use of mobile technology through evaluation and use, integration of mHealth technology into pharmacy practice and potential professionalism issues associated with their use.

Methods

The pharmacy programme is a 4-year doctorate programme consisting of three didactic years comprised of the following sciences courses: basic biomedical, pharmaceutical, social/behavioral/administrative pharmacy and clinical. The fourth year of the programme is for advanced pharmacy practice experiences (APPEs), allowing students to practice in such areas as community and institutional settings. Owing to the nature of the topic, the workshop was incorporated into the Medical Informatics and Technology course that occurs during the spring semester of the second year (P2). The focus of this course is to emphasise the roles and responsibilities of the pharmacy profession and individual pharmacist in the implementation and utilisation of informatics and technology. This course is part of the required curriculum and provides pharmacy students with a brief overview of related selected topics, affording all students exposure to mHealth.

The workshop consisted of two sessions that were 2 weeks apart. The first session included a 30 min introduction on mHealth by the course coordinator. The lecture defined key terms of mHealth and its history. A worksheet was developed and provided to student groups to complete during the workshop. This worksheet had several questions that guided students through the evaluation of specific mHealth devices such as comparing and contrasting devices, initial setup ease, potential use in practice, and professionalism issues. This study was reviewed and determined not to meet the definition of human subjects research by the University of South Florida Institutional Review Board.

Prior to the workshop, students were instructed to download Withings Health Mate and iHealth MyVitals apps on their smartphones and/or tablets that supported the devices used during the workshop. During the planning session, there was a concern about Bluetooth connectivity and range, so students were instructed to bring USB connectors and battery chargers.

After the lecture, students worked in their academic groups to rotate through four different stations. Each academic group consisted of five students and groups spent 20 min per station. Students worked with wireless blood pressure cuffs, wireless scales and smart body analysers, personal health devices and wireless glucometers figure 1. An additional faculty member, pharmacist and two APPE students in their last year of pharmacy school were present to assist with any logistical issues.

Figure 1.

mHealth devices used during workshop. From left to right, top row: Withings Wireless Blood Pressure Monitor, Qardio Arm Blood Pressure Monitor, and AliveCor Heart Monitor. Second row: Misfit Shine Fitness and Sleep Monitor, iHealth Wireless Blood Pressure Monitor, iHealth Wireless Wrist Blood Pressure Monitor, and Fitbit Flex. Third Row: iHealth Scale and iHealth Wireless Body Analysis Scale. Bottom row: Withings Wireless Scale and Withings Smart Body analyser.

For the second session, students were asked to submit their worksheets online via the Canvas learning management software prior to class for credit and participated in a facilitated discussion conducted by two faculty members in class. Afterwards, students received a 30 min lecture that summarised current research and possible impact on patient care. Before leaving class, students were instructed to complete the postsession survey. The survey was conducted through Qualtrics. Responses were analysed using the Wilcoxon Sum Rank test (two-sided α set to 0.05).

Results

One hundred and four students completed the preworkshop survey and 96 students completed the postworkshop survey (table 1). A Likert scale was used (5=strongly agree, 1=strongly disagree).

Table 1.

mHealth workshop survey results

	Preworkshop (N=104) Postworkshop (N=96)	Student responses (in percentages)					Wilcoxon Rank Sum (p value; α=0.05)
Survey questions		Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree
I am familiar with mobile devices	Preworkshop	6.7	16.3	29.8	40.4	6.7	<0.001
	Postworkshop	3.1	2.1	12.5	64.6	17.7
I believe mobile devices can be useful in practice	Preworkshop	0	1	7.7	47.1	44.2	0.006
	Postworkshop	2.1	1	8.3	64.6	24
I believe mobile devices can be easily incorporated into practice	Preworkshop	1.9	9.6	21.2	46.2	21.2	0.003
	Postworkshop	5.2	16.7	26	43.8	8.3
I believe mobile devices will benefit pharmacy practice	Preworkshop	0	0	6.7	56.7	36.5	0.014
	Postworkshop	1	1	8.3	69.8	19.8
I believe mobile devices will influence pharmacy practice	Preworkshop	1.9	1	11.5	51	34.6	0.021
	Postworkshop	2.1	1	14.6	59.6	17.7
I believe general lack of knowledge is a barrier to using mobile health devices	Preworkshop	1.9	1	7.7	54.8	34.6	0.342
	Postworkshop	0	1	10.4	57.3	31.3
I believe technical difficulties are a barrier to using mobile health devices	Preworkshop	1	1	6.7	48.1	43.3	0.469
	Postworkshop	0	1	6.3	51	41.7
I believe purchasing a device is a barrier to using mobile health devices	Preworkshop	1	4.8	9.6	46.1	38.5	0.057
	Postworkshop	0	1	8.3	41.7	49
I recognised when appropriate to use is a barrier to using mobile health devices	Preworkshop	0	12.5	15.4	48.1	24	0.393
	Postworkshop	2.1	8.3	16.7	53.1	19.8

Only 22% of students owned a mobile health (mHealth) device. Agreement (combined strongly agree and agree) regarding students’ familiarity with mHealth devices increased from 47% to 82% (p<0.001) after the workshop. Fewer students strongly felt these devices could be as useful in practice (24% responded with strongly agree vs 44%, p value <0.007), easily incorporated (8% vs 21%, p value <0.004), benefit pharmacy (20% vs 37%, p value <0.02) or influence pharmacy practice (18% vs 35%, p value <0.03). Students were also asked to respond with a ‘yes’ or ‘no’ answer as to whether mHealth devices should be used in pharmacy practice. A majority of students agreed that mHealth devices should be used in practice both before and after the workshop (95% and 97%, respectively).

Discussion

Undoubtedly, the role of mHealth is making substantial strides in the realm of healthcare worldwide. While many clinicians and organisations have been apt to recognise the potential benefits of incorporating such technology into practice, the overarching issue is training healthcare professionals and staff to be ready to integrate such devices into their workflow and practice. By preparing pharmacy students for this, they may eventually be better prepared for the future healthcare environment.

While the workshop demonstrated students’ interest and allowed them to practice briefly with a few digital devices, their responses were at odds with the expected outcomes. Many students had a higher expectation of the role of mHealth in clinical practice, which diminished after the workshop. This could be due in part to the fact that the students were P2s and had minimal clinical experience. This would be worth future investigation to determine whether perceptions change after their last academic year involving clinical rotations.

This workshop demonstrated the feasibility of a live workshop to demonstrate how such devices work and engage students in discussions regarding their roles in healthcare. This hands-on experience could also be integrated in other health professional schools. The required equipment would be the actual materials and devices utilised. Educators could adjust the selected devices to fit student needs in their professional environment. Most mHealth devices are geared towards ambulatory care and were selected due to prevalence, rather than relevance in practice. A future direction would be to include additional devices that may be seen in a more specialised setting, such as devices that can take an EKG.

There were several limitations to the workshop. The number of devices available was limited due to the cost and the need to frequently update the equipment to meet modern standards. Therefore, the device to student ratio restricted the amount of individual interaction with each device and reduced the quality of the experience. Subsequent sessions will have students in smaller groups throughout several session days to allow for more hands-on time. Several Information Technology challenges were encountered during the workshop, such as limited knowledge with the use of devices, issues with spacing the devices far enough from each other to prevent pairing with the wrong iPad or smartphone, rapid battery drainage of the devices and long setup time. Future iterations will plan for a larger area, backup battery sources and tablets specifically paired to the devices to reduce time lost to initial setup.

Conclusion

The workshop was successful in introducing mHealth technology. The change in students’ perception that these devices could be useful in practice or easily incorporated may be due to technical difficulties and substantial cost of the devices. Future plans are to create a simulation utilising these devices.