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Interesting Question Raised

by John Moore | July 27, 2009

question-markAttending the last day of the Aspen Health Forum, I was asked a question by Esther Dyson who is getting ready to take the stage to discuss the evolution of technology, its use and future impact on health and behaviors.  She was invited, somewhat at the last moment, to participate in one of the final panel sessions.

In advance of her talk, Esther asked me if I would be a willing audience for her test run.  For her talk, she’ll discuss the evolution of the Internet. First, it was seen as a technology to manage our recipes, our tasks, activities and the like. As we became more comfortable with the technology, we allowed it to manage more intimate aspects of our lives such as purchases, finances, our retirement funds, etc.  The next step-up is using the Internet to manage our relationships with others, whether they are professional with LinkedIn, or personal with Facebook or any of the other online social network communities.

For her talk, Esther will state that intimacy and the Internet is now moving to the most intimate aspect of our lives: managing one’s self, our bodies, our personal health – and this is where I was stumped when Esther asked if I had any concrete, quantifiable examples of how the use of Internet-based personal health solutions has had a demonstrable change on behaviors leading to better health.  Sure, there is plenty of anecdotal evidence out there, but for the life of me I can not think of any study, any report, any website or service that has such evidence.

So my question now goes out to the ether of the Internet, to you dear readers:

Do you know of any such evidence, have read any reports, can point Chilmark in the right direction to answer this question that Esther has asked – Is there quantifiable evidence of the use of Internet-based tools that have led to the healthy behavioral change of its users?

Looking forward to the feedback/answers.

13 responses to “Interesting Question Raised”

  1. Michael Yuan says:

    Checkout this wired article on Nike+.


    I think it demonstrates that the awareness of data (via online and mobile tools) does change people’s behavior. According to the article:

    “A 2001 study in the American Journal of Health Behavior showed that personalized feedback increased the effectiveness of everything from smoking-cessation programs to interventions for problem drinkers to exercise programs. Feedback is important and powerful; it works.”

    You just need to find that journal article. 🙂

    On a side note, John, we met in the NHIN CONNECT event in DC a couple of weeks ago. I am the guy who talked to you about Glassfish. 🙂


  2. Shelley Myers says:

    I have MANY more but here are a few to start. Hope this helps. Let me know if you’re interested and I can send more. I’ve worked on projects and reports around eHealth tools for diabetes and chronic disease prevention and mgmt.

    A review of eHealth interventions for physical activity and dietary behavior change
    American Journal of Preventive Medicine
    Volume 33, Issue 4, October 2007, Pages 336-345.

    Web-Based Smoking-Cessation Programs: Results of a Randomized Trial
    American Journal of Preventive Medicine, Volume 34, Issue 5, May 2008, Pages 373-381.

    Expanding the Reach and Impact of Consumer e-Health Tools, June 2006

  3. Josephine McMurray says:

    Another article to kick start your search:
    The Effectiveness of Web-Based vs. Non-Web-Based Interventions: A Meta-Analysis of Behavioral Change Outcomes
    Dean J Wantland, MS, RN, MSN,1 Carmen J Portillo, PhD, RN, FAAN,1 William L Holzemer, PhD, RN, FAAN,1 Rob Slaughter, PhD,2 and Eva M McGhee, PhD1,3
    Journal of Medical Internet Research 2004 Oct-Dec; 6(4)

  4. Hal Amens says:

    Not an answer, but a related thought. If non-medical health related information can be added to HealthVault or Google Health we may find a whole new window on a number of issues.

    As an example, if a chain of yoga centers were to post information about a participant’s participation or a gym were to do the same (at the participant’s request, of course), we would begin to gather a lot of data that would allow studies to find correlations, if any, with related medical conditions and interventions. Do people who go to a gym at least once a week respond better to a change of medication than those who have no record of participating at a gym?

    The value here is not from a reports from a few isolated instances, but a large enough pool of data that new correlations can be explored.

  5. lodewijk bos says:

    Maybe you find something in this overview:

  6. The Health e-Technologies Initiative funded technology-based research on eHealth from 2002-2007 and has a portfolio of published articles, measures, and reports on its website, http://www.hetinitiative.org. Many of our grantees demonstrated the impact of internet and other technology-based programs to enable and support behavior change. The work of Kate Lorig and the Chronic Disease Self-Management Program is one example of successful evidence of impact.

  7. Bob Coffield says:

    John, a fascinating case study is occurring here in WV (well known for its unhealthy population) as we speak. Part fitness, health care, social media, perception and health care behavioral change.

    The effort is a viral health movement as a result of a blog post by a marketing/PR blogger colleague of mine, Skip Lineberg, here in Charleston who wanted to shift the perceptions of fitness in WV and influence behaviors.

    The initial thought lead to a discuss among a few of us on twitter about using twitter as a vehicle to carry the message and resulted in the creation of the hashtag “fitwv”.

    It is an example of people sharing their personal healthy behaviors to others as a way to promote behavior change.

    Read these two blog posts as background:

    Pushing Fitness Toward the Tipping Point in West Virginia

    A Fitter West Virginia

    Then look at the ongoing posts via twitter by searching #fitwv:

  8. This is a really interesting conversation. Since others above have cited evidence, I would like to add a quick comment about the evolution of record keeping in the context of weight loss. In my very humble opinion, it is the evolution of record keeping that is facilitating so many interesting new approaches to online lifestyle products.

    According to NIH, “Record keeping is one of the most successful behavioral techniques for weight loss and maintenance. ” (NIH, Obesity Education Initiative, http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/diary.htm)*

    While using the Internet itself does not, of course, facilitate weight loss and improved maintenance, the platform *has* allowed public and commercial health vendors an extended reach into the life-flow of would-be dieters by bypassing time, language, geography, and expertise barriers.

    What’s more, food journaling on the Internet (as opposed to face-to-face w/ authority) allows evolution away from a potentially awkward, cumbersome, downloadable (and stigmatized) paper-based tracking system of Web 1.0 (complete w/ lags in reinforcement), toward the light-touch, depersonalized yet customizable agile array of Web 2.0 “wherever” record keeping products we see today.

    We text, we track, we think. It’s looking more like play and less like hard work. The web has certainly improved record keeping.

    Now, with dozens of mobile apps and web tools we can access an integrated product with exercise calculators, food and nutrition databases searchable by brand or portion size, we connect with buddies and remote partners with similar goals, as well as, in many cases, earn incentives for our contributions and efforts within tribes and teams. We are also often given the opportunity to visualize our raw data in real time.

    So, I’ll remain curious to learn *specifically* which just-in-time prompts and alerts sync-up with the highest level of record keeping on the consumer side. Until then, I’ll watch as the soul of the machine evolves.

    * interesting to note that the record keeping system available through NIH link above is still paper-based…

  9. Carlos Leyva says:

    If societies always waited for “quantifiable evidence” there would never be progress. Who believed that the Internet would turn into what it did? What about search? Blogs? Twitter?

    Innovation happens, the evidence will follow. I don’t believe that this question is all that relevant, with apologies to Esther who I am a big fan of!

  10. Judy Phalen says:

    Check out PubMed (www.ncbi.nlm.nih.gov/sites/entrez) or the Journal of Medical Internet Research (www.jmir.org).

  11. […] 29, 2009 by John On Monday, a quick post was made in response to Esther Dyson’s question to me: “Is there any quantifiable […]

  12. There is already a lot of evidence. In October there will be a conference in The Netherlands: the ‘First International E-Mental Health Summit’ (http://www.ementalhealthsummit.com/). On this website they wrote: ‘The results of the most recent evidence-based developments, research studies and implementation projects in the field of e-mental health will be presented by prominent international experts’.

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