The document discusses the MEMOTEXT mobile health experience and methodology. It describes MEMOTEXT as a methodology for designing condition-specific interventions using iterative assessment and individualized communications. The methodology integrates behavioral models and persuasive methods with patient education and support. Outcomes data shows improved medication adherence and patient outcomes. Challenges include patient recruitment and adoption of new technologies. The key is providing evidence-based personalized interventions to drive behavior change.

1. The MEMOTEXT® mobile heath
experience.
From product to methodology…
Amos Adler M.Sc.
MEMOTEXT Personalized Adherence Solutions

2. From product to methodology
– Problem/issue
– Methodology
– Outcomes/Results
– Best practices
– Challenges

4. The Problem:
Technology ≠ behavior change
Patient Adherence / Medication Compliance and technology interventions
• Systemic Adoption
• Patient Adoption
• Everyone is different + people change
• Does it scale?
1. How patients interact between health and
technology
2. How marketing must meet with health
3. How academia interacts with commercialism to
become ‘agile’
mHealth is a series of intersections.
~Roni Zeiger

5. Adherence is a
discipline, MEMOTEXT is a
methodology
1. Systemic
Adoption
2. Patient
Adoption Analysis & CATWOE
2. Everyone is Stakeholder
different + Visioning
people
change
3. Does it scale? Intervention Evidence Base
Validation
Design
Deploy
Iterate
Requirements Intervention

6. Methodology  Condition specific intervention design
Condition/ Literacy Self Efficacy Depression Knowledge Test
Medication Barriers Barriers Barriers
Type II Adams et Sarkar et al., 2006; (Katon et al., Depression screen
Diabetes al., 2009; Aljasem et al., 2009). Likewise,
Jeppesen 2001; Kavanagh et Moreau et al. Anxiety/Distress
et al., al., 1993). (2009) Scale
2009
QoL SF36/12
Anticoag/AF (Higgins & Chu; Kim; Kwang;
Regan, Park, 2009) Self Efficacy Scale
2004).
Hx
…integrating with individual patient needs for
education, incentives, interactive coaching,
motivation, reminder cues and
stakeholder/peer support.

7. Assessment + Intervention
Iterative Assessment  Individualized communications
Understand needs, motivations, behaviours.
• Iterative screening instruments used to determine personal
Patient Recruitment barriers to adherence.
engage patient populations via
• Patients assessed throughout program.
partners, HCPs and
communications planning. • Individual Assessment Segmentation & Re-Segmentation every
6-12 weeks. Determines intervention content
RECRUITMENT ASSESSMENT INTERVENTION ANALYTICS
Depression screen
Knowledge Test
Anxiety/Distress
Self Efficacy Scale
Scale Stage Medicines
of Literacy
QoL SF36/12
Change
Hx
Self
Depression Efficacy
Condition
Literacy

8. Speech, Social, Mobile. What is MEMOTEXT?
Listen, guide, motivate.
Phys. Lifestyle
• Self-learning, multi-media trusted health Activity
10%
2%
interventions tailored to customer Med Lit.
22%
MI 30%
segment and individual need. Diet Lit.
CBT 25%
Behavioral Economic 8%
and Intervention Models:
• Health Belief Model
• Irrational Health Beliefs
• Theory of Planned Behavior
• Theory of Reasoned Action
RECRUITMENT ASSESSMENT INTERVENTION ANALYTICS
- Medicines Education
- Side Effect Information
…integrating persuasive
- Tailored Condition Literacy methods with individual patient
- Inspirational/Motivational needs for
- Automated Motivational education, incentives, interactive
Interviewing
coaching, motivation, reminder
cues and stakeholder/peer
support.

9. Outcomes
I have not failed. I've just found 10,000 ways
that won't work.
~ Thomas A Edison

10. The numbers tell the story
>20 ongoing programs/trials
3Years avg. duration of a program
85-95% program retention rates
67% average DAILY patient participation rate. Program Type Voice SMS
Contraception 12% 88%
(N.America)
Multiple 64% 36%
Sclerosis
(Canada)
Bone Health 36% 64%
(US)
T2 Diabetes 18% 82%
(UK)
Media selection is condition, demographic and
geography specific.

11. Randomized Clinical Trial MEMOTEXT & Johns
Hopkins University
• Monitor • Poor • MEMOTEXT n= 428
Adherence Adherence group glaucoma
• Good • Control group patients
Adherence treated
with once
3 months Randomize 3 months daily Presented MHealth2011:
therapy. What Really Works
Stanford University May
Johns Hopkins University: is using the MEMOTEXT® platform to provide an 2011
automated, customized and interactive adherence solution for glaucoma -
a study entitled "The Impact of Automated Dosing Reminders on Presented at Kaiser
Medication Adherence using HealthVault". Permanente – Gallery of
Innovation October 2011
Launched: June 2009
Recruitment Channel: JHU Research / Wilmer Eye Clinic March 2011 annual meeting
Scope: Reminders for Travatan of American Glaucoma
Society.
Results:
Automated reminders linked to a personal health record are a practical This project received
option to improve adherence funding from the
Microsoft
Significantly improve adherence with daily medications: Intervention HealthVault Be Well
group increase adherence from 51% to 67% adherence p. 0.003 Fund.
(Electronic Monitoring of Dosing)
Control 49-50% p 0.83 11

12. The numbers tell the story
79% of patients rate programs very
highly
17% + change in patients rating
confidence in self management (over 18
months) Effect on Medication Average Change in
Possession Ratios 3X daily Total Number of
76% of patient self-report feeling regimen medications Dispensed Records
%
better, healthier and happier since
starting a T2 Diabetes program (over 18
High Medication Possession Rate + 1.5 - 3%
months) (MPR) >80%
Medium MPR 33% to 80% +20%-25%
Low MPR <33% +50%

13. Best Practices
1. Everyone is different
2. Different conditions require different
behavioral interventions. Commonalities are
emerging though.
3. People change over time, they learn, they
ebb, they flow
4. The most appropriate technology for the user.
Fit the solution to the problem, not the other
way around.
5. Relevant, intense, interactive guided
dialogues throughout the course of
treatment can positively modify behavior.
6. Health Belief Model and other health The Health Belief Model
communication models help create emphasises that health
personalization. behaviours are influenced by
i) perception of the
7. Personalization creates RELEVANCE. individual’s susceptibility to a
Relevance keeps the conversation going. health problem,
ii) perception of the severity
8. Evidence based personalization is required for or seriousness
white-coat credibility. iii) perception of the
effectiveness and tolerability
of the treatment
iv) cues to take action.

14. MEMOTEXT Methodology – Stakeholder
buy-in
No silver bullet – just plain old hard work
Analysis & What works:
Stakeholder
Visioning • Distribute and situate recruitment
• multipoint/multichannel
Intervention • Cross-organizational buy-in
Validation
• front-line champions
• Internal communications rigour
Design
• Measure, monitor, pivot
• Time to measure results
• Ability to iterate
Deploy
• Stakeholder Communications Planning
mHealth to MEMOTEXT means:
Iterate
• Organizational change
• Systems thinking
• Medical Science
• Behavioral Science & Behavioral Economics
• Informatics
• Technology = 30%
RECRUITMENT ASSESSMENT INTERVENTION ANALYTICS

15. The challenges
• The biggest challenges in mHealth
are not necessarily intervention
efficacy.
• Although
– Current evidence is stronger for texting
than apps in improving clinical
outcomes/QOL indicators, but
numerous studies are underway
• The biggest challenge we have seen
is not:

16. Although…
Bad “Most technology needs to go
to finishing school”
Design ~ David Rose

17. Lessons learned
The biggest challenge is: Behavior Change Ground ZERO
RECRUITMENT/ADOPTION
We Want YOU to:
- Comply
- Download our app
- Like our page
- Sign up to our program
- Buy more stuff
- Give us your data
- Admit that you need help!

18. - Competing for MindShare with
- Professional Marketing
- Overwhelmed and overloaded
by apps and technology

19. RECRUITMENT/ADOPTION hierarchy
Despite best efforts to enrol patients in
mobile/text programs, patients get
defensive when approached.
Perceived
as medical advice
by the patient
“I think you
should consider
this support
program - try it
1:5 recruitment ratio by Physican/Clinician out ”
Perceived
“I think you should as “what are
1:20 recruitment ratio by Pharmacist consider this
support program -
you trying
to sell me?”
try it out ”

20. Evidence based personalization and
gamification of healthcare interactions.
Call me maybe?
amos@memotext.com
Twitter: @MEMOTEXT
www.memotext.com
1.877.Memo.txt