Health IT, MedCity Influencers

Is digital health a behavioral science?

Dr. Brennan Spiegel, a physician-scientist at Cedars-Sinai Medical Center, has cited his own experience of attempting to build health technology whilst not addressing behavioral factors like patient motivation, engagement, and long-term adherence.

A recent Fortune article on big data in healthcare quoted Dr. Brennan Spiegel, a physician-scientist at Cedars-Sinai Medical Center as saying, “Digital health is not a computer science or an engineering science; it’s a social science and a behavioral science,” in the context of a discussion on the hype-evidence gap in digital health. He tweeted the same line back in August, eliciting hundreds of retweets and shares.

Spiegel has cited his own failure experience from attempting to build health technology whilst not addressing behavioral factors like patient motivation, engagement, and long-term adherence. He has elaborated, “Creating the tech isn’t the hard part. The hard part is using the tech to change patient behavior.“ As behavioral scientists, we are encouraged to see increasing value placed on behavioral science in a space that has generally been a slow adopter of it—after all, chief behavioral officers in digital health companies are still unicorns.

In opposition to this emphasis on social and behavioral sciences, John Nosta penned a Forbes piece titled “Digital health isn’t a social science.” He suggests digital health is a technological endeavor that is supported by the social sciences, citing the lack of social and behavioral scientists in his laboratory and the plethora of “engineering, medicine, chemistry, material science, computer science and many of those with techy-type degrees.” This would seem to imply that the technology fields lead while behavioral and social sciences play a secondary role. He states, “I don’t think that social science is the defining aspect of digital health, but (and here’s the key point) an essential element to its success!”

As behavioral scientists, we wholeheartedly agree that behavioral science is not the defining aspect of digital health. We do not view digital health as belonging wholly in our disciplinary silo; in fact, our efforts have been toward the opposite—behavioral scientists are voraciously exploring opportunities to blow the lid off of the silo to embed behavioral science into other disciplines and sectors including STEMmedicinedigital health, and policy.

As a thought experiment, consider inserting any discipline (e.g., engineering, computer science, materials science, biology, robotics, human-computer interaction) into Nosta’s statement, “I don’t think that [insert discipline] is the defining aspect of digital health, but an essential element to its success!” You will quickly see that no discipline is the defining aspect of digital health and all of them are essential to its success. There is no lead actor in this movie—only an ensemble cast.

We fear that Nosta’s piece misses the point of what digital health needs to be: a transdisciplinary pursuit. The first step towards this endeavor is recognizing all the fields that need to be at the table. Transdisciplinary teams bring all disciplines relevant to a problem together and devise solutions via shared goals, respect for differences, communication, and an openness to conflicting opinions and approaches. Transdisciplinary work is hard. The hardest part is letting go of tribalism. In the digital health space, teams have been just as Nosta described and Spiegel lamented—technology lopsided. If “transdisciplinarity” can be accomplished, more effective innovations will emerge that no single discipline could have conceived of on its own. In science, it is well documented that transdisciplinary approaches produce the biggest breakthroughs.

If the digital health space does not start embracing transdisciplinarity, it risks further widening the hype-evidence gap. When one discipline tries to tackle a problem alone they often ignore crucial aspects of the problem they cannot see. Far too often we see digital health tools that produce one desired effect only to fail at being useful because the tool does not attend to equally important indicators of success. For example, one might design and optimize a technology to measure a biomarker with little consideration to patient engagement. The result is a tool rarely used long enough to produce any actionable insights or meaningful impact.

The true defining aspect of digital health is our common mission to improve health by advancing our ability to effectively and efficiently diagnose, treat, and prevent disease via digital technologies. The success of that shared mission will hinge entirely on our ability to create the right teams to solve the right problems–together.

Photo: Getty Images


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Sherry Pagoto and Eric Hekler

Sherry Pagoto, PhD, is a Professor in the Department of Allied Health Sciences at the University of Connecticut. She is also a licensed clinical psychologist and Director of the UConn Center for mHealth and Social Media. She is also the President of the Society of Behavioral Medicine. Her research focuses on leveraging technology in the development and delivery of behavioral interventions targeting diet, physical activity, and cancer prevention behaviors. She has had federal funding for her program of research for 14 consecutive years, totaling over $11 million, and has published 184 papers in peer-reviewed journals. She has received several awards for her work including the UMass Medical School Women in Science and Health Achievement Award in 2015, The Obesity Society Pioneer in mHealth/eHealth Award in 2014, Society of Behavioral Medicine Early Career/Young Investigator Award in 2006, and the Western Michigan University Distinguished Alumni Award in 2011. Her work has been featured in major news outlets including CNN, NPR, NBC News, ABC News, and Good Morning America.

Eric Hekler, PhD, is an Associate Professor in the Department of Family Medicine & Public Health in the University of California, San Diego (UCSD), the Director of the Center for Wireless & Population Health Systems within the Qualcomm Institute at UCSD, and the faculty member of the Design Lab at UCSD. His research focuses on individualized and “precise” behavior change for fostering long-term health and well-being. For example, his NSF-funded work focused on developing algorithms for guiding an intervention that determines an individualized “ambitious but doable” daily step goal to strive for each day; with the long-term goal to develop a comprehensive intervention that provides the right type of support for physical activity only when it is needed. Eric’s Robert Wood Johnson Foundation grant focused on developing a method for the more rapid collective development of technology-delivered behavior change strategies, a process he and his colleagues have labeled Agile Science. Prior to UCSD, he was a professor at Arizona at State University. Eric completed his postdoctoral training at Stanford University and received his Ph.D. in Clinical Health Psychology from Rutgers University.

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