Read below to discover what research says about digital health technology, and how it can help manage our health. Take our quiz to test your knowledge - what do you know about digital health tech?
You probably use digital health technology as part of your daily life. You might have an app to track your daily step count, or have shown your ‘vaccination passport’ on the NHS App. The pandemic has accelerated our use of digital health tech. Remote GP appointments have become routine, and many of us were pinged as ‘close contacts’ by the COVID-19 App.
Digital health technology aims to boost our health and wellbeing, or to improve health systems. It includes smartphone apps, wearable devices (such as step trackers), and platforms that provide remote healthcare (telehealth). Software to help track symptoms, online tools to diagnose conditions, and programmes that analyse data from medical devices such as blood pressure monitors - these are all digital health technologies.
The benefits of digital health technology are enormous. It is convenient, and can be used anytime, anywhere. Virtual care can reach more people than face-to-face, and is often cheaper. It can empower people to manage their own conditions, and even has environmental benefits in terms of reduced travelling and emissions. ‘Digitising’ the NHS and social care is a Government priority.
However, there are also concerns. New tech can be challenging to use. Can an app really help you manage your condition? Does online therapy actually work? Who will have access to your electronic health records and all your personal data? Are all these apps and tools trustworthy; have they been properly researched and evaluated?
The NIHR funds world-leading research that aims to improve health and social care. We want everyone to be able to make best use of this research, to manage their own health and wellbeing. In this Collection, we explore recent NIHR research on the impact of digital health technology. Read below to discover what NIHR research can tell us about using digital health tech to manage our health. But first - how much do you know about digital health tech? Take our quiz to test your knowledge and find out!
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In this section, we draw on NIHR research that explores how digital health tech can help us to manage our health. We cover research ranging from games to help children exercise, to tech for care home residents to ward off loneliness. The NIHR research explores whether apps can help us remember to take medications, how sharing access to electronic medical records can benefit us, and whether online therapy is effective. Read below to find out what the research says about the current state of digital health tech.
A large review of studies found that text messages can help people quit smoking. Automated text reminders alone increased quit rates by 50% to 60%. Adding text messages also made other forms of support (such as counselling or advice from a healthcare professional) more effective. Smoking is the world’s largest cause of preventable death, and most smokers say they want to quit. Text reminders can provide convenient and simple support.
The review also looked at smartphone apps. It found that apps did not increase quit rates. However, few studies (or poor quality studies) looked at apps, so the findings were uncertain. Further high quality research is needed to assess app use, the researchers say.
Apps can remind people to take their medications on time. Researchers reviewed several studies looking at relevant apps. People were twice as likely to say they took their medication as prescribed if they used an app. Taking medication as prescribed is important to ensure it works correctly, and to maximise its benefits.
All studies found that the apps were helpful, but some showed only a small (not meaningful) effect. This could be because the review included only a small number of studies, and looked at a wide range of apps, illnesses, and study designs. Some apps may be less effective than others, or some groups of people may be less interested in using them.
People may consider using currently available apps, the researchers say. However, before apps can be officially recommended, they need to be assessed using a consistent method. The features which make an app successful need to be identified.
The NHS stores patient medical records electronically. Giving people access to their own records could have health benefits. It may help people understand their conditions, and empower them to take an active role in managing them.
Researchers assessed the impact of sharing medical records with people. They reviewed studies looking at various conditions including diabetes, cancer, and high blood pressure. Over half of the studies found some benefits. Medicine safety (spotting the potential for side effects or interactions) was improved, and in some studies, people needed less healthcare. Some of the studies also found that people were less anxious, had fewer heart symptoms, and lower cholesterol (fatty substance) levels in the blood. Many of the studies looked at people with type 2 diabetes. Sharing electronic records helped people to reduce their blood sugar levels.
NHS England now enables everyone to access their GP health records. This can bring benefits but the researchers say that more research is needed to assess the impact, and to improve the experience, of accessing records. For example, platforms need to be easy and pleasant to use.
Improved access to electronic health records among more healthcare professionals could also be of benefit. In one study, researchers looked at how people receiving end of life care at home access medicines. Many people prefer to die in their own homes, but it can be difficult to get the prescription medications they need (such as painkillers and anti-sickness medicine). Their quality of life can suffer without timely access to these medicines.
Almost 40% of pharmacists, nurses and other health professionals were not satisfied with their access to patient records. Professionals who did not have access to records estimated that their patients had significantly more pain, than professionals with access to records. The research suggests that broadening access to medical records could improve prescribing and patient wellbeing.
In another study, researchers developed an interactive electronic dashboard to identify people at risk of unsafe prescribing. The web application searches electronic patient records and flags up a list of people who are potentially at risk. This could include people who have received repeat prescriptions for a long time without a check-up, or those on a complex mix of medications that could interact. The dashboard successfully prompted GPs and pharmacists to check people’s medication and reduce any unnecessary risk.
Several studies have shown that digital therapy is effective. One study looked at a phone app combined with face-to-face therapy for people with psychosis. Participants had delusions, such as thinking that someone wanted to harm them. The app reduced paranoia and worry, and improved their wellbeing. People enjoyed using the app, even if they had not previously used a smartphone. The results are as good, or better, than traditional cognitive behaviour therapy (CBT, therapy that helps people change the way they think and behave) for paranoia. The online therapy showed benefits in fewer sessions than are recommended for traditional CBT (8 sessions instead of 16).
Another study found that an online education programme, and online CBT with phone support, reduced anxiety and depression. Carers struggling with mental health issues may have little time to attend in-person support groups. An online programme (to help people learn about and understand mental health and wellbeing) improved mental health symptoms in carers of people living with dementia. Online CBT with phone support was also effective (though it was more expensive and took more therapists’ time).
Online therapy can also help children. Online behaviour therapy, supported by therapists, improved tic symptoms in children aged 9 to 17. Tic disorders, such as Tourette Syndrome, are sudden rapid movements or sounds that are difficult to control. In this treatment, children worked through self-led activities, with remote access to a therapist, as needed. The 10-week programme led to improvements, which lasted for up to 6 months. Online CBT has also shown promise in reducing anxiety in children (as detailed in the following section ‘How can games help young people manage their long-term health conditions?’).
Researchers wanted to assess the value for money of digital interventions for a range of mental health conditions. They looked at a variety of interventions (accessed via computers, phones, virtual reality) across all age-groups. They found that digital interventions can offer good value for money as an alternative to doing nothing, or giving someone general information. But their added value compared with medication and face-to-face therapy is still uncertain. The value of digital interventions was driven by how good they were, rather than how much they cost. There is a need to develop digital interventions that are more effective, rather than just cheaper, the researchers say.
Research has investigated whether games, apps, and e-therapy can help children and young people manage their long-term conditions. Studies have assessed interventions for children (5 to 12 years old) with conditions including obesity, anxiety, diabetes, asthma, and cerebral palsy.
Some studies had promising results. These included online CBT to reduce anxiety, and an Xbox game plus Fitbit, to encourage children to exercise more.
However, several interventions did not show promise. These included motivational texts aiming to reduce obesity, and a video game on bullying. The most promising interventions used engaging games, were personalised, included support from healthcare professionals, and involved parents.
There were few studies in this area. People can consider using these games and apps, the researchers say, but the tech needs further review and evaluation.
As became clear to many during the COVID-19 pandemic, technology allows us to connect with others without being physically together. Socialising is important; it can reduce loneliness and social isolation, which are linked with depression and worse health outcomes. Many technologies are available to connect people. But older people may be less familiar with these technologies, and less confident using them.
Research looked at simple low-cost video technology to allow residents in different care homes to take part in virtual quizzes. The quizzes helped residents to feel more connected and less lonely, and to regain a sense of self and purpose. They enjoyed the interaction and the competitive element of the quizzes. Residents living with dementia, with no prior experience of video calls, and with difficulties seeing, hearing, and speaking, were able to take part.
Loneliness and social isolation are common in older people. Virtual socialising, using simple digital technology, could help elderly people both to connect with loved ones, and to meet new people.
As described, NIHR research is exploring how digital health technology can help us quit smoking, stick to our health goals, and reduce loneliness. It can help people self-manage their long-term conditions, and help professionals provide joined-up care. There are likely to be future benefits that nobody has yet thought of.
But much of the current research is early-stage. Better methods are needed to assess new technologies such as health apps, so results can be evaluated thoroughly. Further research will make tech as effective as possible, which could mean tailoring apps to suit individual preferences. Research will be needed also, to ensure that new developments are safe.
The NIHR is continuing to fund research to address these questions. For example, work is ongoing on how best to assess digital health technology, and to evaluate the impact of the NHS App. Researchers are investigating whether GP appointments should be remote by default, and how to improve remote care. Other work is exploring how people adopt digital health tech, and how this can be encouraged.
Digital healthcare is an NHS and Government priority, and the Government has recently set out plans to develop digital health tech to address many of the current challenges. These include stricter regulations for medical tech devices, working with local communities to tackle digital exclusion, and looking into how best to safely use health data for research.
Involving patients and the public is the only way to ensure that new digital health technologies are suitable, effective and user-freindly
What is beyond doubt, is that the people who use these technologies need to be at the heart of their development. People need to be able to say what they want, how it should work, and what standards are acceptable. Alternatives to digital care should be available. In some of the NIHR studies highlighted here, people with lived experience were involved in developing the interventions. For example, people with paranoia and their carers helped to develop digital therapy to address paranoia. Their involvement resulted in a user-friendly, engaging, app, which the study participants enjoyed using. In another study, children and their parents said that they would prefer health apps to be more personalised to reflect their preferences.
Involving patients and the public is the only way to ensure that new digital health technologies are suitable, effective, and user-friendly. If you would like to get involved in helping with research, more information and opportunities are available via the NIHR website.
How to cite this Collection: NIHR Evidence: What is digital health technology and what can it do for me?; September 2022; doi: 10.3310/nihrevidence_53447
Disclaimer: This publication is not a substitute for professional healthcare advice. It provides information about research which is funded or supported by the NIHR. Please note that views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
Digital Medical Devices
The tools of trade are changing rapidly and being placed in the hands of patients, primary care physicians and emergency physicians on the front lines of care. Our office’s goal is to have our students engage these technologies early in their training to increase their familiarity. We also employ an approach that stimulates discussion of how these devices will be integrated in their future practices.