UF Pediatrics Grand Rounds talk given on May 16, 2013 at UF/Shands Hospital in Gainesville, Florida USA

1. @jaybernhardt
Pediatrics 2.0:
Digital Health
Promotion for
Behavior Change
Jay M. Bernhardt, PhD, MPH
Professor and Chair, Department of Health Education and Behavior
Director, Center for Digital Health and Wellness
College of Health and Human Performance
Pediatrics Grand Rounds, May 16, 2013
University of Florida College of Medicine
http://nicolehowley.visionsmartnews.com/post/images/000/005/110/original_250x1000_0.jpg

2. @jaybernhardt
Pediatrics 2.0 Grand Rounds Overview
• New media trends among youth
• Digital health innovations for pediatric
health promotion research and practice
• Learning Objectives:
– Summarize trends in new
media use among youth
– Identify applications of
digital health to pediatrics
footage.shutterstock.com

3. @jaybernhardt
• “Web 2.0”
“…a set of economic, social, and technological
trends that collectively form the basis for the next
generation of the Internet – a more mature,
distinctive medium characterized by participation,
openness, and network effects.” (Musser &
O’Reilly, 2006)
• “Health 2.0”
“The use of a specific set of tools by actors in
healthcare including doctors, patients, and
scientists, using principles of open source and
generation of content by users, and the power of
networks in order to personalize healthcare,
collaborate, and promote health education.”
(Hughes et al. 2008)

4. @jaybernhardt
New Media
Youth Trends
www.journalreview.com

5. @jaybernhardt
Internet Use by Age, 2000-2012
Three in four teens
access the internet
on cell phones,
tablets, and other
mobile devices.
50% of parents of
online teens have
used parental
controls or other
means of blocking,
filtering, or
monitoring their
child’s online
activities
http://www.pewinternet.org/Reports/2012/Teens-and-Privacy/Summary-of-Findings.aspx

6. @jaybernhardt
http://www.pewinternet.org/Infographics/Generational-differences-in-online-activities.aspx

7. @jaybernhardt
http://www.frankwbaker.com/mediause.htm
http://www.radio-info.com/new-media/connected/the-class-of-2011-how-teens-interact-with-media

8. @jaybernhardt
http://www.arbitron.com/downloads/infinite_dial_2011_presentation.pdf

9. @jaybernhardt
http://www.arbitron.com/downloads/infinite_dial_2011_presentation.pdf

10. @jaybernhardt

11. @jaybernhardt
http://www.deseretnews.com/photos/midres/web-637477.jpg

12. @jaybernhardt
http://saasuserexperience.wordpress.comhttp://blog.clicktale.com/2011/05/29/analyzing-the-impact-of-the-digital-fold
http://www.digitaltrends.com/mobile/vuzix-previews-its-revolutionary-smart-augmented-reality-glasses-technology-video
Screen Ubiquity & Proliferation
http://living.msn.com

13. @jaybernhardt
http://manhattanresearch.com/Images---Files/Infographics/Taking-the-Pulse-US-2012.aspx

14. @jaybernhardt
Overview of Youth Media Trends
• Television remains dominant platform
– With media multitasking increasing
• Significant increases in social media use
– Facebook, YouTube, Twitter
• Significant increases in mobile use
– Texting, Gaming, Photos/Videos, Apps
– Growing use of mobile tablet computing

15. @jaybernhardt
designmind.frogdesign.comwww.iphoneincanada.ca www.apartmenttherapy.com www.socialfirefly.com
New Media for Pediatric Health Promotion

16. @jaybernhardt
Pediatrics 2.0: Health Information Seeking
• Searches start at Google
• Searches via mobile growing
• Stories > Data & Facts
• Participation = Engagement
• Search Engine Optimization
• Mobile-enhanced design
• Narratives, Videos, Games
• Allows users to contribute

17. @jaybernhardt
Pediatrics 2.0: Health Information Seeking
Promising areas for research and practice:
• ePatients & “Patient Engagement” with Electronic
Medical Records and Personal Health Records
• Health Information Rx to credible and “accessible”
sites based on literacy, language, culture, etc.
• Deeply-tailored health messages delivered via
web and other communication platforms
• Programs to enhance health and eHealth literacy

18. @jaybernhardt
Pediatrics 2.0: Social Networks
• Users: Facebook > 1B, YouTube > 800M, Twitter > 500M
• Health & Patient Social Networks (Patients Like Me, SmartPatients)
• Aggregation tools (e.g., Hootsuite) help organize data streams
• Data mining tools and algorithms facilitate audience analysis

19. @jaybernhardt
Pediatrics 2.0: Social Networks
Promising areas for research and practice:
• Social network effects on health behaviors,
prevention, and medical decision making
• Creating and leveraging social networks of
caregivers, patients, and/or parents
• Mining “big (social) data” for health trends,
predictive patterns, emerging risks, norms

20. @jaybernhardt
Pediatrics 2.0: mHealth (m=mobile)
http://www.technobuffalo.com/mobile-devices/phones/the-all-in-one-conundrum-a-delightful-rant/
SMS* or MMS
Voice & Video
(calls, IVR)
Email or
Instant Message
Secure data
transmission
Video files
(M4V, etc.)
Audio files
(MP3 etc.)
Mobile Web
Geo-Location
Tracking &
Monitoring
Custom
application
program (“apps”)
*More than 2,000,000,000,000 SMS messages/year and growing!

21. @jaybernhardt
mHealth Intervention Opportunities
mHealth Applications:
• Call Centers
• Emergency Alerts
• Appointment Reminders
• Patient Records
• Health Surveys
• Monitoring & Surveillance
• Treatment Adherence
• Health Promotion
• Mobile Telemedicine
• Community Mobilization
• Decision Support Systems
mHealth Channels:
• SMS or MMS
• Voice (human,
recorded, IVR)
• Email or IMs
• Audio files
• Video files
• Mobile Web
• Monitoring
• Custom apps

22. @jaybernhardt
Location Based mHealth Programs

23. @jaybernhardt
http://mobihealthnews.com/13368/report-13k-iphone-consumer-health-apps-in-2012/
Consumer Health Apps (2012)

24. @jaybernhardt
Mobile Apps & Games
(and Developer Challenges)
DoctorCalc VaxTrax SwineFlu
The Game

25. @jaybernhardt
Mobile Tracking (“Quantified Self”)
http://www.diabetesmine.com
http://sleepzine.com
http://fitbit.com
http://nike.com

26. @jaybernhardt
Don’t forget your
multivitamin! Baby’s spine
and brain are developing
now. Getting 400
micrograms of folic acid
daily is key to help prevent
birth defects.
Reply Back
http://text4baby.org
SMS (Text-Based) Mobile Interventions

27. @jaybernhardt
Hasvold & Wooton (2011) Use of telephone
and SMS reminders to improve attendance at
hospital appointments: A systematic review.
Journal of Telemedicine and Telecare.
• Reviewed 29 studies with 33 interventions
– Study sizes: n=325-2864
– Study durations: 2-7 months
• 32 of 33 interventions showed benefits of
sending patient reminders prior to appointments
– Manual calls more effective than automated
reminders (39% vs. 29%) but higher cost
– No differences on reminder timing

28. @jaybernhardt
Cole-Lewis & Kershaw (2010) Text messaging as a
tool for behavior change in disease prevention and
management. Epidemiologic Review.
• Reviewed 12 studies (17 articles) using SMS
– Intervention length ranged from 3-12 months
– Sample sizes (n=16-126, + 1,705)
– Disease management: Diabetes, Asthma
– Disease prevention: Medication adherence,
Weight loss, Physical activity, Smoking cessation
– 8 of 9 powered studies found
evidence of significant behavior change

29. @jaybernhardt
SMS for Vaccine Promotion Studies
• SMS reminders to promote HPV vaccine
(Kharbanda et al., 2011)
– 52% of girls of parents who opted in and received up to
3 weekly SMS reminders received next vaccine dose
compared to 35% who did not receive SMS messages
• SMS to promote flu vaccine in low income urban
pediatric/adolescent pop. (Stockwell et al., 2012)
– 43.6% of children of parents who received up to 5
weekly SMS messages received flu vaccine compared
to 39.9% who did not receive the SMS messages

30. @jaybernhardt
Pediatrics 2.0: mHealth Intervention
Promising areas for research and practice:
• SMS-based interventions to improve care, such as
vaccines, treatment adherence, prevention, etc.
• Mobile health promotion apps if theoretically-
informed, science-based, rigorously-evaluated
• Tracking quantified-self devices if they utilize data
for personalized messages and motivation
• Multi-platform 360˚ tailored interventions with
right-place, right-time, right-platform messages

31. @jaybernhardt
Conclusions: Advantages of Pediatrics 2.0
• Increased and Sustained Reach/Repetition
• Stronger Patient Relevance/Involvement
• Deeper Audience Engagement
• Scalable and Affordable Interventions
• Facilitates Measurement and Evaluation

32. @jaybernhardt
Conclusions: Challenges for Pediatrics 2.0
• Privacy of data and regulatory restrictions
• Access and understanding among professionals,
patients, and priority communities
• Research and evaluation to determine and
disseminate evidence-based best practices

33. @jaybernhardt
jaybernhardt@ufl.edu
jaybernhardt.com
@jaybernhardt
http://www.flickr.com/photos/kenleewrites/4770359099/