Three reasons your app won’t work: Learning from underserved end users

While reading a recent blog in MobiHealthNews I was fascinated by what seems an obvious yet fairly recent acceptance that health care is about patient engagement. A few months ago, a start up founder pitched his idea about enabling access to his product in a low-income community. When I asked about customer feedback, he said he didn’t know how to reach them. Unfortunately, it wasn’t my first time hearing about an entrepreneur creating a solution for underserved populations without obtaining direct input from end users. As I discuss in a previous blog, people from low-income communities are not hard to reach. Understanding their perspectives on engagement requires face time, intentional listening and openness to designing solutions that incorporate the solicited information. The value in these interactions can not be overstated because the solutions may be non-traditional and counter to our own impressions about how health care services should be delivered.

Since I wrote that blog, I have had numerous face-to-face conversations about health and health care with low-income, underserved people. We’ve talked in grocery stores, libraries, on public transportation, a shopping mall, a Metro PCS outlet and in my role as a clinician and medical director of DC Medicaid. The goal of these conversations is to hear their perspectives on health care, understand if and how they use technology, specifically phones, and their receptivity to using it for health-related engagement. These conversations are a first step toward building a series of sustainable and scalable solutions to address the health needs of low-income, underserved populations on their terms, not ours. Our work is just beginning but in the meantime, here are the three most important things we’ve learned thus far:

1. Apps won’t cure all that ails us. A recent article in MobiHealth highlights the astonishing volume of recent financial investments in health solutions. Many, if not most, require an app. While research shows cell phone ownership is at an all-time high in low-income communities, reliance on apps to reach consumers will not achieve our desired level of health care engagement. We learned many people with prepaid phones connect to the Internet via 1G and 2G networks, have less phone memory and therefore, often forego apps. We also verified the least common tech communication denominator is a tremendously underutilized digital health tool — texting.

2. Confusion and mistrust are driving low patient engagement. Many perceive our health care system as unfriendly, marginalizing, intimidating and disrespectful. Health care facilities are to be avoided. Consequently, they are satisfied with situational care like visits to the emergency room (ED). A visit to the ED minimizes their engagement with the health system, is perceived as on-demand, comprehensive care and allows them to access care on their terms when they decide a health issue warrants intervention. Foremost, an ED visit is not accompanied by the attachments, expectations, time or energy involved in maintaining a steady provider relationship. As discussed in a recent Washington Post article, unnecessary ED usage is among the most relentless and costly pain points in our health care system. Yet the latest solutions like varieties of integrated care coordination, while effective for some, rarely address the motivations, beliefs and distrust that discourage consumers from engagement.

3. Failure to effectively communicate exacerbates low health literacy. Many spoke about the language of health care and how difficult it is to understand provider instructions. Hence, people often seek health information elsewhere. As I discussed at a TEDx MidAtlantic, the ‘go to’ and trusted source for health information is often friends, family, television and conversations overheard in public places — the grapevine. Some use their phones to seek health information but these inquiries often inflame rather than mitigate confusion and lead them right back to the grapevine.

Overall, these conversations on the street suggest we are building things people don’t want, for engagements and relationships they have little interest in. This is likely a tough pill to swallow for those who believe better care coordination, clinic and hospital-based technology and greater fluency with and use of “big data” will ultimately lead to health care transformation, cost savings and improved health outcomes. Based on our discussions it seems many in the health tech community are are missing the mark.

In the year ahead PPH, Inc. will seek collaboration to apply the lessons we are learning from the community. We believe it is possible to build and test health literacy and engagement solutions that deliver health care the way people want it — not on our terms, but on theirs. If you’d like to explore partnership with us we’d love to hear from you. Alternatively, just follow along. Sign up for our newsletter and we will keep you updated about our progress in 2018.