Remember those interactive Choose Your Own Adventure children's books that were around during the 80s and 90s?
I used to love those when I was a kid, and would spend hours at the local library combing through them to see what new adventures I could have based on where my own choices took me. Whether the scenario was a time traveler, space explorer, international spy or creature-hunter from beyond, I had a blast getting lost for hours inside my imagination.
Well, now there's a new health app combining that choice-driven playfulness with the desire to explore healthy living, giving you the chance to examine your own decision-making based on different characters and real-life, everyday scenarios.
It's called PatientPartner, part of a new breed of mobile health apps that embrace gamification as a fun, engaging way to motivate people to make healthy behavior choices. This one was created by California-based healthcare communications company CyberDoctor, and it was introduced in early October at the big Health 2.0 Conference in Santa Clara, CA.
Check out this Health 2.0 interview about CyberDoctor with the company founder and CEO Akhila Satish, in which she talks about how they approach the patient-physician relationship aspect of their work, and have been creating tools to enhance this key relationship since 2009.
In their newest offering, PatientPartner, users choose a character to embody, and then are led through a series of scenarios in which you have to make choices about what you'd do -- first as that character, and then as yourself if you were experiencing that situation.
The app is non-disease-specific, so not aimed directly at those of us with diabetes. It's meant to encourage people with any medical condition to step back and generally think about how real-life choices each day impact their health.
Notably, there are other gamification apps out aimed directly at PWDs (people with diabetes), including the Health Seekers app created a couple of years ago by our friends at the Diabetes Hands Foundation, and the very fun MySugr logging app we reviewed earlier this year.
But PatientPartner is in a league of its own, creators say, because it's the first to have an independently-reviewed clinical study data illustrating the impact has on improving PWDs' health -- to the tune of dropping A1Cs by a whole percentage point from 10.7% to 9.7%, improving exercise routines by 14%, and increasing "adherence" (read: how well PWDs are taking their meds) by 37% -- the latter translating to the equivalent of PWDs meeting their med goals three additional days per week. Wow!
"While there are 45,000 health apps available today, there are very few that have clinical data like (we do) proving that a single 15-minute use of our app actually impacts patient behavior and biological measures, and at a consistently higher level than previous adherence interventions," Satish says.
In an interview with CyberDoc's CEO Satish recently, she told us the diabetes population was chosen for their recent study because PWDs could specifically be measured by blood glucose levels -- a reliable biomarker allowing researchers to obtain both qualitative and quantitative findings about the app's effectiveness in regard to behavior change. A hundred diabetics were involved in the clinical study at Pinnacle Health Systems in Hershey, PA -- all individuals deemed "non-adherent patients" per their docs as they had A1Cs at 8.0% or higher and were struggling to adjust to treatments or take medications. Satish was unsure of the number of type 2s versus type 1s, but said it was likely most were type 2s based on the questions and focus of the study on adherence.
Satish doesn't have any personal diabetes connection and of course this app concentrates on overall health behavior change, i.e. the whole "adherence" question. She says that too often, patients end up in doctors' offices facing questions about why they aren't following recommendations or why a particular decision was made. For us PWDs, that often even includes why a particular blood sugar was high or low at a certain time of day (grrr!).
This PatientPartner game is meant to help act out those real-life situations, so it goes deeper than just reminders or beeping sensors, but "gets at the root of a decision by allowing general observations about how choices are made" to foster what CyerDoc hopes is better patient-doctor communication.
When I went online to check out this new app initially, my heart jumped a few beats when I saw the description referencing those wonderous Choose Your Own Adventures books from my childhood. It wasn't quite like visiting Paradise Planet or being inside a UFO, but indeed, on that day I wasn't a 30-something guy named Mike who's been living with type 1 diabetes for close to three decades. Instead, I stepped into the virtual shoes of Betsy, a 45-year-old type 2 diabetic, mom of two young kids who isn't adequately following her D-Management routine because of her "impossibly busy" lifestyle at work and at home.
Suddenly, while driving my son and daughter around, I cut my arm on a sharp piece of metal while cleaning up some spilled juice in the backseat. Thanks to my less-than-ideal D-management, the resulting gash on my arm led to a puffy infection that offered me a few choices on either recognizing the emergency, improving my overall health and D-care, or just going about my life as I had been.
It may have only been for a few minutes, but I was able to at least get a glimpse of what it might be like to step into the shoes of another person, dealing with health challenges that are different, yet relevant to my own situation.
As Betsy, I was asked right after the injury what choice I wanted to make: call an ambulance, phone my husband to pick up the kids and take me to the ER, cover my wound with a napkin and then dress the cut once I get home, or just stop the bleeding and get back to what I was doing while ignoring the cut.
PatientPartner then analyzes how you make these choices and offers targeted feedback about how good you're emergency and overall health strategies are.
Since this was a free trial version, you then have the option to buy the full app for $3.99 to take advantage of up to 45 different other character stories and training modules that help you see how to make better choices in regard to your health.
In the free trial version, only three character scenarios are available initially and Betsy is the only PWD -- the others are a 55-year-old grandfather with heart failure and a 26-year-woman with a "seizure disorder controlled with treatment." Later, you unlock two more: another female character with a heart defect and another man named Joe, a 38-year-old with "uncontrolled" adult-onset diabetes who takes insulin and blood pressure meds.
I played through the two PWD characters and thought the scenarios were quite realistic, and the choices presented weren't just the typical "medical textbook or bust" type responses. With Joe, he was at a high-tension client meeting and felt woozy and sweaty, and the choices allowed you to: just eat some can and press on; turn up the conference room air conditioning; or take a break to test blood sugar and blood pressure. While I know what the right answer was, I could really picture myself just downing the candy and carrying on through the meeting -- assuming I wasn't wearing my CGM, which would of course wail until the medical situation was resolved.
Some of the other "improvement" scenarios gave quick choices about breakfast or coffee break foods and even some non-medical scenarios -- like buying a new home and analyzing how you gather information about the lot to decide if it might be the most relaxing or desired spot for your family needs. Interesting.
Now, this game app isn't going to win any awards for being "fun" or motivating me to want to spend hours playing it. No, I've seen other apps that can make boring tasks like blood sugar logging more entertaining and fun. This isn't on that level. But PatientPartner did make me think more about the daily choices I make, and when applying the scenarios and choices to my own D-life, I was reminded that there are some simple changes I can make to do better...
Like not skipping breakfast or lunch when I'm busy working, leading to lower blood sugars that cause me to treat -- and overtreat -- and then hours later get frustrated because of my Lows and Highs during the day. The wacky numbers put me in such a funk that I'd often rather skip an evening BG check and not dose insulin or carb count correctly out of pure frustration. Yikes!
Rewards & Incentives
Experts are learning these days that changing health behaviors is all about rewards and incentives (right??), so with PatientPartner, players can receive discounts of up to 45% on meds and co-pays at the local pharmacy and will in the future also be able to earn points for gift cards, possibly for other drugstore products, iTunes, or even Amazon. I haven't yet printed out the discount card I earned or taken it in to my local pharmacy (need to make the choice to do that soon!)
To me, what's most interesting about this PatientPartner app is that it does present another way to analyze the choices I make, and then through a share function I can even start a conversation on these topics with family and frieds through Facebook or Twitter. And of course, as Satish envisions, we can eventually get our docs in on those conversations too, if desired.
So, my final verdict: Yes, it's worth checking out. While it may not be quite as tantalizing as the Choose Your Own Adventure series, it certainly seems like this gamification app has the potential to help out on the health behavior change front and even save you some money. It's not yet available for Android, but Satish says that could happen soon, depending on the level of user interest. Right now, it's available in the iTunes store and works on the iPhone and iPod Touch.
Carry on, Diabetes and Health Adventure-Seekers: you never know what your choices will lead to! Hopefully, there's are some improved health outcomes and even some cash-saving coupons coming your way!