Eugene Farrell: Considering apps as part of a wellbeing strategy

Following a 32% growth in 2019 to 2020, there are now more than 350,000 health apps in the market, according to the IQVIA Digital health trends report published in July 2021, with Deloitte estimating more than 20% growth next year too. With one in five health apps supporting mental health, the market is left with a huge choice.

How are people using apps for mental health?

The study, Discovery of and interest in health apps among those with mental health needs: survey and focus group, by SM Schueller in June 2018, shows that those with an existing mental health condition are more likely to have an app. Data from ORCHA, an organisation that reviews health apps, shows that post-Covid, the use of apps to support depression has risen by 86% and apps that help with self-harm prevention has risen by 76%. Axa Health’s own Mind Health Index, published in January 2022, showed 34% of workers and 36% of people managers recovered via self-care.

A wellbeing app is not a quick fix for organisations concerned about their employees’ wellbeing. It needs to form part of wider wellbeing strategy with clear objectives, outcomes and measurement.

Driving workplace engagement is strategic

Helping employees to use an app for support is more than reminders; just as a wellbeing strategy needs to be nurtured, and communicated regularly, so too does an app. Regular, relevant communication is vital as is social influence. Providing guidance on how and when an app can help with someone’s wellbeing can be positive especially when given by health professionals, according to O Perski in the Perceptions of factors influencing engagement with health and wellbeing apps study, published in January 2021.

App selection will be key

How an app communicates complex health concepts and interventions is key to its design. Too simplistic, and it may appear unappealing, while overly medicalised jargon may be off putting. Employers need to pay close attention to the language and positioning of any app, as well as the robustness of the assessment tools and guidance they offer.

Workplace interventions should provide action planning, personal insight and monitor progress against goals, these are preferred factors that influence engagement and utilisation, according to Perski’s study. Increasing the personal nature of the support adds relevancy to the individual, increasing its therapeutic relationship, and positively influences outcome. Other useful features are the opportunity to rehearse behaviour change actions and practice, as cited in F McKay’s July 2019 study, Using health and wellbeing apps for behavior change: a systematic search and rating of apps, the provision of rewards, and positive tone with low cognitive load, according to D Szinay’s study Influences on the uptake of and engagement with health and wellbeing smartphone apps, published in May 2020.

Sensitivity to risk is critical. When someone presents risk to themselves, it is essential that the app is able to refer to support or connect directly to help.

Remaining relevant in the market creates a development burden not associated with the clinical efficacy of the app itself, but rather on user experience. Employers need to ensure they are working with providers which ensure their app does not go stale.

Chosen apps must utilise behavioural change modelling such as capability, opportunity and motivation. Opportunity through its availability every day, motivation through encouragement, stigma reduction and social influence and capability through training and instruction. However, workplace interventions should not just be there for when times are difficult. Like all good wellbeing strategies, it is about creating wellness for every day: helping improve health literacy, insight and self-regulation.

Aggregated employee data, over time, can be used to assess trends informing strategic progress and pace toward objectives. But an app alone is just one set of data; value and insight comes when combined with other data to form a complete and meaningful picture.

Looking onwards

The future for health apps may be the ability to share patient’s data with clinicians to have shared decision making. Discussing outcome data in a digital form can be a very different conversation to discussing mood or emotions. While this may be considered perhaps reductionist in some ways, for some patients this may provide a new way for them to relate to, and understandm their mental wellbeing.

Apps are here to stay, at least for now, and digital therapeutics will be part of wellbeing and treatment.

Eugene Farrell is mental health consultancy lead at Axa Health