PAGB Digital Week, Day 5: Challenges And Opportunities For Digital Self-Care

Session 1 – Changing Attitudes To Self-Care With Dr Sarah Jarvis

Opening the final day of PAGB’s Digital Week, Dr Sarah Jarvis spoke about the “essential” need to continue to educate consumers about when it is appropriate to self-care to reduce the burden on overworked general practitioners. A key element of this was helping people to find reputable information, Jarvis noted, particularly given the rise of health misinformation which has spread across social media during the pandemic.

The patient.info website was one trustworthy source for general health information, as well as self-care advice, she pointed out, which was already visited by millions of UK consumers. The information on patient.info – where Jarvis serves as clinical director – was written by GPs and peer reviewed, Jarvis noted, and was a more comprehensive resource than the NHS website.

Along with increasing access to factual health information there was also a need to make better use of the skills of pharmacists, Jarvis argued, through the expansion of the NHS Community Pharmacist Consultation Service. The CPCS enables referrals for minor ailments to be made for consultations with pharmacists, who can then give appropriate advice and treatment.

Jarvis said in her view, one silver lining of the pandemic was the rise of the role of the pharmacist as an essential member of primary healthcare team.

Session 2 – Understanding Human Behavior In Digital Self-Care

Digital technology can help people to self-care, began Hamell Communication’s Dr Alison Carr in the second session of the day, defining self-care as “any action we take independently to support our physical and mental health.” 

However, digital self-care technologies like apps and wearables had a high abandonment rate, continued Carr, who is an epidemiologist and Hamell’s clinical director. 

“We get bored, and get bored quite quickly,” she explained, pointing to people’s use of the Pokemon game app as an example. Despite high levels of initial engagement, after a year, four out of five users of the app dropped off, she noted. 

The lesson, Carr argued, referring to the behavioral science techniques that underpin many digital self-care technologies, was that “one nudge is rarely enough to change behavior.” 

The most effective interventions, she said, were those “based on multiple insights” that “target more than one behavioral driver.”

In terms of consumer behavior, COVID-19 had been a real game changer, Carr continued. The introduction of health measures to self-track COVID symptoms, along with increasing interest from consumers in their personal health and wellness during global lockdowns, had been responsible for a significant increase in wearable and app use, she explained.

The global smart wearable technology market was set to surge to $81.5bn in 2021, she said, while sales of vitamins and minerals had boomed, with US dietary supplement sales jumping by 18.7% to $781m in the four weeks to 11 July 2020. 

Consumers have increasingly turned to apps to manage their mental health. Use of mindfulness app Headspace grew by 90% during the pandemic, she pointed out, while meditation and sleep app Calm saw 3.9m downloads in April 2020 alone. In the UK, over half of consumers now used some form of health technology, she added. 

Will this trend for digital self-care be sustained after the pandemic? Some challenges remained, Carr warned. 

Firstly, consumers were concerned about their privacy, she said, a fear reinforced by stories in the media and a skepticism towards digital technology among healthcare professionals. 

Secondly, there was a danger of “digital overload,” she continued, especially for people trying to manage chronic health conditions with digital health apps and wearables 

According to studies, consumers using wearables to manage diabetes, improve fertility, or monitor heart arrhythmia could sometimes feel like they are being watched and judged, especially if they weren’t meeting their goals.

The lesson for companies designing apps was to be transparent, she advised, and to reassure people regarding what is being done with their data and that the information that they are providing can be trusted. 

If industry can get the balance right, digital self-care can “facilitate access to high-quality, accurate and appropriate information and services with flexibility to fit a user’s lifestyle within a system of safeguards and support,” Carr concluded. 

Session 3 – Is Health Misinformation A Barrier To Self-Care?

Kicking off the session, Bill Morgan, a founding partner at Incisive Health, noted that although health misinformation was not a new phenomenon, society had become very aware of it as a result of the pandemic. The consumer healthcare industry had been directly impacted by misinformation at the start of the COVID-19 outbreak, Morgan pointed out, when ibuprofen was falsely linked to worsening symptoms of the disease.

Bruce Charlesworth, Reckitt’s chief medical officer for its Health business, explained how the company had found itself in a lead role battling against this misinformation, which had implicated its leading Nurofen ibuprofen brand.

A tweet from the French health minister had gone viral, he noted, “and before we knew it expanded out of all control.”

Rather than simply dismiss the information as false, Reckitt’s response had been carefully formulated to be factual, Charlesworth said, and based on the evidence. In cases like this, industry had a “massive role to play,” he argued.

While eventually, thanks to work by the company and the intervention of agencies like EMA and WHO, the misinformation was quashed, it nevertheless “led to huge amount of confusion, Charlesworth admitted.

Addressing why people were vulnerable to health misinformation, Dr Bertram Vidgen, a research fellow in online harms at The Alan Turing Institute, said there were a number of factors at play.

Rather than it being related to age, gender or ethnicity, research had shown that those who were more digitally and health literate, had a greater trust of institutions and better cognitive skills and were less susceptible to misinformation. As these were things that could be addressed, Vidgen said the findings presented “lots of positive opportunities to think about how we tackle this problem.”

For Vidgen there were two key issues that needed tackling: how to make individuals more robust so they were less susceptible to misinformation, and how to create online spaces that were not spreading misinformation to large numbers of people.

A possible answer to the second question was presented by Dan Wills, quality mark manager at the Patient Information Forum (PIF). Wills introduced delegates to the PIF tick, which can be displayed on numerous online and offline platforms to indicate that an organisation’s health information has been through a professional and robust production process. Organisations that have received a PIF tick include Macmillan Cancer Support, mental health charity Mind and Heathily.

Along with launching the PIF tick, Wills noted his company was also working with external organisations to create an online resource dedicated to help people spot bad health information online. For consumers, it was really hard to understand which sources to trust online, he noted, adding that, regrettably, there would never be a “one stop shop” for all reputable health information.

Giving the patient perspective, general practitioner Dr Nisa Aslam said COVID had heightened people’s health worries, around treatments and vaccines, and also caused confusion due to the overwhelming amount of information available.

Aslam noted that she always pointed her patients in the direction of the NHS website as it offered “clear, simple, precise, and concise information.”

However, when it came to recommending further reading or even mobile health apps to help support patients manage conditions, Aslam said she relied on tips from colleagues as there was no guidance on this from the NHS. There was a need to collect all the different sources of reputable sources of self-care health information in one “hub” so it would be easier for patients to find and know what they could trust, she argued.