eHealth (web-based behavior change programs) in the Toronto Star

February 10, 2010 · Posted in news health 


Today, the Toronto Star published an article about Web-based behavior change programs [Pigg, Susan: Monitoring your vices online. Toronto Star, 17.11.2008, URL:http://www.thestar.com/article/537988. Accessed: 2008-11-17. (Archived by WebCite(R) at http://www.webcitation.org/5cOtvqnhO)] – with a picture of me in front of my whiteboard in my office. I talked to the reporter about the pros and cons of online-ehealth programs, such as those which we are currently publishing in the JMIR Theme Issue on Web-Assisted Tobacco Interventions (the Toronto Star article has a broader scope though). I mentioned the problem of attrition – many users are starting to use these programs enthusiatically, but stop using it after a while. But there are ways to tackle the attrition problem: Social networking probably make sites more sticky and engaging, and create peer-pressure to return. In addition, personal health records (and PHR platforms like Google Health and Microsoft Healthvault), sensors, Ubiquitous/pervasive computing, smart appliances and smart home-care devices will make it easier for users to aggregate and manage automatically tracked data (rather than having to enter information in online diaries etc). Of course, this raises certain privacy issues…

As you pour that glass of wine or two when you get home tonight, you might want to think about the price you’re paying for the daily ritual of taking the edge off.

That drink – which, admit it, is usually two or three as you ease into the weekend – costs you about $2,000 a year. It’s adding up to at least 100 extra calories a day and, if you’re an average-sized, 50-year-old woman, about 15 pounds of unflattering weight over 12 months.

In the course of a year, you will have downed some 520 drinks and been under the influence of alcohol 1,161 hours. That means your throat is often inflamed, your liver and pancreas are under stress and you are boosting your chances of developing some cancers.

That’s not your doctor talking. That’s checkyourdrinking.net.

If you think you may have a problem, rest assured there are thousands of others just like you. They’re in cyberspace as well, doing online self-assessments and then spending hours in social networking sites debating with like-minded people. Their concerns? Is there a better way to cope with stress? Do their dark days now rate as full-fledged depression? Is their weight off the scales?

There has been a virtual explosion the last few years in so-called eHealth sites, which help people tackle everything from insomnia to anxiety attacks and gambling addictions. But, increasingly, they are being used by companies – usually as part of employee assistance programs – to boost productivity by reducing absenteeism, sick days and disability claims.

“None of these programs is meant to replace a physician or offer (medical) diagnoses,” says Estelle Morrison, director of program development at Ceridian Canada, which runs employee assistance programs on behalf of many major Canadian companies. “They are meant to educate people and make them more self-aware and knowledgeable so they can go to the right people and get the help they need.

“We now see employers understanding that if they don’t start to provide some very important support to their employees, they will be in quite a mess in the next few years because of aging baby boomers who are struggling with health issues, in terms of employee absenteeism, in terms of labour shortages, in terms of (the health effects of) people working 24/7.

“These are issues that are impacting the mental health, the productivity and the availability of staff – and employers are now seeing the bottom-line cost of that.”

In the U.S., companies are offering “incentives” – gift cards, running shoes, health-club discounts, cash awards of up to $1,000 – for employees who undertake “health risk assessment” surveys aimed at pinpointing and minimizing their risky habits. In Canada, Morrison says, cash incentives are more seen as “rewarding” bad behaviour, so “we’ve had a lot of iPods.”

The assessments usually include 50 to 75 questions ranging from your cultural background to whether you wear seat belts.

“They’re being very, very aggressive in the United States about getting these kinds of systems in place,” says Dr. David Goldbloom, a senior medical adviser for Toronto’s Centre for Addiction and Mental Health.

Goldbloom says he was surprised to see the number and sophistication of “behavioural health″ programs during a recent health-care conference in Arizona. “There were tonnes of examples of companies that are working very hard to make this more a part of their workplace, but also competing with each other: who’s got the healthier workplace?”

Toronto-based V-CC Systems Inc. launched its online behavioural change programs in Canada in 2000 and now offers its services to many companies. It also has partnerships with agencies such as the Canadian Cancer Society, which uses its online smoking-cessation programs, says Rachel Fournier, the company’s director of business development.

V-CC is one of the few eHealth sites that offer some free behaviour-change surveys and programs around drinking, obesity, anxiety, smoking and depression, as well as access to its online forums. (Far more comprehensive programs are available through company assistance programs for employees.)

What makes the programs so popular, say experts, is that they are anonymous and available 24 hours a day in the privacy of your home. With traditional assistance programs that offer counselling, there is always the fear the information will leak back to your boss.

Rick H., a recovering alcoholic and drug addict, uses the V-CC site most days, offering personal perspective and advice online. “I think it’s very helpful to people who are starting off and trying to find a path. It gives them some tools to get them started, but I don’t think it’s for maintaining long-term sobriety. They tend to hang around a month and then move on.

“I like to think that some of them make it, but I know, from being a member of Alcoholics Anonymous for two years, that only about 5 per cent make it to five years sober on the first try.

“But there’s always value if somebody has hope.”

What started as online self-assessments and expanded into online self-help groups is evolving in a new generation of eHealth programs. These are so tailored to individual circumstances that they could significantly reduce at least some serious outcomes, such as, say, drinking or poor diet escalating into costly diabetes and cardiovascular problems or depression – which costs an average per case of $10,000 and 40 lost days at work – spiralling out of control.

“I think it’s very important that we continue to do research and evaluate the impact of these programs,” says Dr. David Ahern, a U.S. physician who is doing just that kind of research on behalf of the Boston-based Health e-Technologies Initiative.

“But I am much more of an optimist about the benefits of these programs than the downside. I think they have tremendous potential to help improve health and the quality of health care.”

The downsides, says Canada eHealth expert Dr. Gunther Eysenbach, include getting people to stick to the programs, especially if they have to keep tedious daily online logs of their habits and behaviour. There are also the privacy risks of cyberspace, he notes.

While the smoking programs have proven among the most successful – some research shows about a 10 to 12 per cent quit rate – weight loss is trickier, says Eysenbach.

“With weight loss, there’s just an intrinsic paradox that you make people sit down at a computer to lose weight when you should actually be sending them out onto the street to do some exercise.”

A more active intervention is starting to happen, with programs that can now be used on mobile devices and “smart devices” that, in time, Eysenbach believes, will make it much easier for people to keep track of behaviour that poses a risk to their health.

He predicts it won′t be long before your car will keep track of how much you have driven and whether you should, for the sake of your heart, start riding your bike. Or your fridge will be telling you it’s time to stop snacking.

Or put down that drink.

Also mentioned – in a sidebar to the article – is JMIR:

Dr. Gunther Eysenbach runs the Toronto-based Journal of Medical Internet Research and has spent 10 years monitoring and studying the value of online health initiatives and behavioural change programs. See jmir.org.

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