Everhealthier women

Everhealthier.org WomenManage health tasks for you & others through mobile web and SMS

Development TeamDamien Leri, MS Ed1

Anne Teitelman, PhD, FNP-BC, FAANP, FAAN2

Marilyn Stringer, PhD, CRNP, RDMS, FAAN2

Ben Koditschek, BFA3

1Big Yellow Star, Inc. 2Univ. of Pennsylvania, School of Nursing3Designer, Civil Service

Rationale•African-African women are more likely to die from some cancers*•Latina women are more likely to get cervical cancer*•Asian women are less likely to access regular cancer screenings*•Prevention is the best way to solve this problem•USPSTF, ACS, ACOG provide recommendations but many women do not access and adhere to them. There is “too much info” and most of us have literacy and/or health literacy limitations.•Prevention and health promotion should be straightforward, almost as simple as your automotive maintenance schedule.•Everhealthier.org Women is simple, engaging, and 100% mobile *womenshealth.gov

Health 2.0 Challenge, Feb 5 2013

Features & BenefitsAccess! Mobile web site works with any smartphone model. Alternative interface uses text messaging, and automated voice calls can be added. All content in English and Spanish.

More than just reminders: interactive SMS text messaging includes decision-tree branching conversations to collect data. These are initiated according to any frequency -- daily, fortnightly, biannually, etc.

Tailored recommendations (by age, gender, pregnancy status, smoking, et al.) are automatically applied to family members which can then be tracked and/or reminded over time. These recommendations are from the USPSTF, IOM, and other official sources.

The full library of Healthfinder.gov articles (in two languages) is available for browsing, searching, starring as a favorite, and sharing by email, text, or (coming soon) Twitter and Facebook.

Tasks can be from the recommendation list or created custom. They can be shared (the same 4 channels as above) or exported to calendar (iCal .ics format which is standard).

Screening and test results can be entered and maintained with this app. Reminders can encourage follow-up of positive test results. These can be shared (same formats as above) for example with care managers or lay navigators. They can also be exported using the Blue Button format popularized by the VA health system. This exported data can then be shared with a care team or entered into a PHR or EHR.

Other relevant information and news is aggregated and available in mobile-optimized format right within the app. The nation-wide HRSA list of clinics is included in geographic format. And relevant social news is embedded within the app, including the Twitter feed and Facebook posts of Healthfinder.gov.

Used a co-design process involving multiple stages of user feedback on the features. Implemented using scalable technology: the app is powered by jQuery Mobile, Ruby on Rails, MongoDB, Nginx, and Twilio. It is hosted in the cloud using Amazon Web Services (EC2).

How It WorksLogin with Facebook to preload a list of loved ones including name, gender, and age. Or login with a Twitter account, or create an Everhealthier specific account with only an email address and choice of password.

Choose from the Facebook Friend list or add others by providing merely a nickname, age, and gender. Quickly switch among people in this “healthy circle” at any time.

Choose recommended actions from the official list, or create your own. Take ownership of these actions so you will perform them. Read the Healthfinder article for each task. Set reminders according to your preferences.

When reminded about each task by text message, reply Done or Snooze. These reminders can also be sent directly to family members if desired.

Manage the tasks for each person in your circle. View the past progress and future due dates, export to calendar, and send links to share tasks and articles with others.

Enter results from screening and other tests as you accomplish them. The system can remind you to follow up on positive lab results where appropriate. Data can be downloaded with the Blue Button approach at any time.

On the Explore tab see the latest Twitter and Facebook posts from over two dozen curated channels of cancer prevention information - in English and Spanish. This content is available right within the app, and you can click on subscribe/follow buttons to leverage these popular mobile media and stay informed.

Find local clinics: your phone geolocates you, but you can also enter a zip code or address. Click on the map to view the distance from your current location and the clinic’s website. Click the phone number to call.

All images were captured directly from an iPhone.

A Co-Designed System

Number of pilot users who gave feedback: 10.

Number of future features planned (mostly from user feedback): 14.

Co-design material is available upon request.

Theoretical GroundingThe development of this app was based on our prior research with urban minority women, in which we identified barriers for accessing preventive health services [1]. Our research is theory-based and uses the Integrated Behavioral Model [2] to guide identification of social -cognitive as well as contextual determinants of health behaviors.

1. Teitelman, A.M., et al., Social cognitive and clinical factors associated with HPV vaccine initiation among urban, economically disadvantaged women. J Obstet Gynecol Neonatal Nurs, 2011. 40(6): p. 691-701.

2. Fishbein, M. and I. Ajzen, Predicting and Changing Behavior: The Reasoned Action Approach. 2010, New York: Psychology Press: Taylor & Francis Group.