Tools for sustaining the support of health professionals: the example of MyPace

Background: the NHS needs to do more with less. Suggested solutions are many and various but they invariably involve decreased contact with health professionals. Yet continued trust and confidence is desired in healthcare systems where 10 minute appointments might turn into 60 second consultations. Monitoring increasingly means being remote.

In the face of a tide of initiatives that seek increased patient participation in the context of decreasing engagement with health professionals, is it possible to develop cost effective interventions that enhance and sustain the value of face to face interaction? In the first instance we chose to explore this in the context of obesity and more particularly in the context of the relationships between dietitians and patients.

Obesity continues to pose a serious risk for chronic diseases and wellbeing in many parts of the world as well as a significant resource burden on health systems. Weight management is particularly challenging when addressed, as it increasingly is, in the context of long-term or chronic co-morbidities.

In this context, sustained lifestyle changes leading to weight loss and/or maintenance are often driven, administered and monitored through face to face contact with health professionals. Such contact represents a significant use of resources. How might its influence and impact be enhanced?

Objectives: the aim of this project was (a) to design and develop web and mobile based applications that would enhance the value of the face-to-face consultation and (b) to conduct an initial evaluation of how both dietitians and patients engaged with these.

Method: A programme of qualitative research with dietitians and their clients informed the conceptualisation, design, development and evaluation phases. Data collection in five European countries (France, Germany, Hungary, Portugal and the United Kingdom) included face-to-face interviews, a qualitative online study, early prototype evaluations and a small in-practice evaluation.

Results: The web and mobile app myPace (http://mypaceapp.com/) was developed. It connects dietitians and clients between face-to-face dietetic consultations. myPace supports a scalable, integrative, ‘small steps’ approach to weight loss, incorporating monitoring and motivation. It incorporates relevant tenets of the behaviour change literature into its design. The tool provides a conduit for expert, relationship-based, on-going care that can be shaped to match individual needs and adjusted as required. The client and the dietitian can together decide the role they wish the tool to play within and between consultations. The tool’s functions are fully customisable, and the degree of technological integration with established practice can be changed to match different patient and dietitian preferences. Both users can access performance data in aggregate or detailed form. myPace maps layers of data alongside each other to build an overall picture of eating, weight and mood patterns for each client.

Conclusions: We have developed and evaluated a tool that can be integrated into the interface between health professionals and weight management clients. Progress has also been made in developing the business model by which this and similar applications that seek to maintain and enhance the value of the face-to-face consultation in health care can operate.