When Text4Baby launched in February, it was recognized as both innovative and necessary. The mobile health service sends text messages to pregnant women and mothers to help reduce the infant mortality rate in the US, which is considered one of the highest among developed countries.
Moms and pregnant women who sign up for the public health service receive three free text messages a week with tips in English or Spanish about caring for them-selves and their babies during pregnancy and the first year of their child's life.
“It was created because we have a real problem with infant mortality in this country and we're actually lagging far behind many comparable industrialized nations,” says Judy Meehan, CEO of the National Healthy Mothers, Healthy Babies Coalition.
As of September 3, more than 76,000 users have signed up for Text4Baby, with approximately 95% of users saying they would recommend the service to a friend.
The success of Text4Baby – for now, it is measured in the program's brand-name recognition, the partners that have invested, and the thousands of moms who have enrolled – has made it a leading example of how mobile technology can be used to achieve outcomes in healthcare.
“It seems to be seen as a model for what could be successful and the way mobile technology could be used in other ways,” says Stacie Paxton, VP at Hill & Knowlton, which was brought in to handle communications for the coalition in 2009.
Healthy Mothers Healthy Babies, Grey Healthcare Group (a sister agency to H&K within WPP), Johnson & Johnson, CTIA – The Wireless Foundation, and Voxiva are the founding partners of Text4Baby.
“I haven't seen anything that's been done in the US similar to what Text4Baby did,” explains Paxton. “There really wasn't a template to follow. However, there is a lot of information about the success of mobile technology to drive successful outcomes.”
Around 40% of US consumers have smartphones, said a ChangeWave Research study in December, and 64% of physicians own smartphones, according to Manhattan Research released in October 2009.
Pew reported in September that nearly 85% of Americans own cell phones – a sharp contrast to the one-third of the US adult population who do not have high-speed Internet access, according to a 2010 report from the FCC.
The divide between mobile use and Internet access illustrates how a program such as Text4Baby can be used to reach a demographic that may not have Internet access, but may own a cell phone.
The mobile health service is aimed at younger women, who are less likely to be affluent and more likely to be black or from the South. Text4Baby also targets people these women trust, such as elders, peers, or healthcare providers.
As both public- and private-sector healthcare organizations look at new ways to communicate with patients, mobile services – or mHealth – such as smartphone applications and SMS, can fill a need unmet by traditional sales, PR, advertising, and even social media.
Opportunity for growth
While PR pros agree that mobile seems to be picking up across all sectors in the US, communicators who work in healthcare say the opportunity in both private-sector healthcare and public health is a growth area, as mobile can be used to address issues such as adherence and management of chronic diseases, including obesity and diabetes.
The role of healthcare communicators in mobile and texting campaigns varies in each company, agency, and even disease category and patient audience.
Some agencies, such as Chandler Chicco Companies, have an in-house team with the ability to build mobile applications for clients. Other firms, such as Edelman, tend to work with outside vendors to develop the apps while providing strategic counsel and communications to clients.
How companies handle mobile internally differs as well, with marketing, communications, and information technology departments all playing different roles in the creation, strategy, and execution of a program.
Sanofi-Aventis worked with Chandler Chicco to develop an “AFib Educator” application. The mobile app and desktop widget is part of a broader campaign that the pharma company created to address atrial fibrillation (AFib) in the US, a disorder that puts people at risk for fatigue and stroke, as well as a new category for Sanofi-Aventis.
The company launched the app in March after research it conducted showed physicians either use their hands or drawings to explain AFib to patients. More than 50% of physicians also reported a lack of support for patients with AFib.
“So many healthcare professionals, as well as medical students, were looking to mobile technology to get information,” says Carrie Brown, senior manager for US communications at Sanofi-Aventis. “We wanted to provide a tool and a resource they can actually use in a practice with a patient.”
A team at Chandler Chicco, which has programmers and coders on staff, developed the “AFib Educator.”
Ritesh Patel, a digital and social media leader at the agency, said the firm incorporated most of the content from the campaign's website into the app and also produced animated videos that compare a normal human heart to one with AFib.
“The idea is to give healthcare professionals an app to help better explain the risks of AFib and what exactly AFib is,” says Karen Preble, director of marketing for Multaq, a drug from Sanofi-Aventis used to treat AFib.
The category is fairly new for the pharma company. Multaq was approved by the FDA in July 2009. “AF Stat,” the disease awareness initiative, launched in May 2009.
One of the ways Sanofi-Aventis has sought to raise awareness of the app is to provide an e-mail for the campaign's member associations, which includes the American Heart Association, to send out. It also used the “AF Stat” website and Twitter feed to promote the app.
Within five months of the app's launch, the company reported 5,800 downloads and more than 25,000 “sessions,” says Preble. The average time spent on the application is six minutes.
Patel says the bulk of the work Chandler Chicco is doing in the mobile space is creating education-based apps for pharma clients. The “AFib Educator” is available on both the iPhone and iPad.
“It gives them a way to continue the dialogue with the doctor, which they need to do for the disease states that their products may impact,” he explains. “And they're using education as a method to do that.”
As companies build apps to reach iPhone and BlackBerry users, many are ensuring that the apps are compliant with iPads, even though it has only been on the market for six months.
Medtronic's coronary division shelved a plan to create an iPod application to be used in its sales strategy, says Alex Nepogodiev, senior product manager of the medical device company's US coronary stent business.
Instead of giving the unit's sales team an iPod Touch, Medtronic reformatted the app for the iPad and gave each member of its 200-member sales force an iPad.
The app provides real-time images and videos of the manufacturing process and the stent that sales professionals can take into the field when they meet with physicians. WCG, which was hired two years ago to develop a new sales strategy for the coronary division, helped develop the app as part of an overall effort to bridge marketing and sales communications.
“There is a huge need, especially on the medical side of things, for how sales organizations and businesses are actually delivering content and delivering an experience at a field level with their accounts and their physicians,” says Paulo Simas, chief creative officer at WCG.
The app, he adds, has totally changed how the company is engaging with physicians.
The creation of an app and the use of mobile technology also served to help Medtronic set itself apart as an innovator, says Nepogodiev, who adds that the two new stents were recently approved, bringing up the company's competitors to four. Medtronic markets the Driver Coronary Stent System and the Endeavor Drug-Eluting Stent System.
“That created a lot of media and messaging noise from our competitors and distractions from the customer,” he explains. “We needed to bring something to them that is very technical, yet clinically relevant and simple to understand.”
During the planning process, which began in November 2009, the company researched the costs of developing similar apps. Medtronic says it spent less than $250,000, including the purchase of iPads for the sales team. The app launched at the national sales meeting in June.
Less than three months later, Nepogodiev says, “It's a daily tool for them now.”
The app also allowed the company to forgo printing and design costs for sales materials, as well as provide the most up-to-date, real-time information during sales meetings, provide immediate feedback from meetings, and customize content for physicians.
Now, WCG works with other clients, both in health-care and other industries, to address sales needs through mobile technology.
“If I'm going to put my stake in the ground for us as an organization of where we can lead and how we can really provide value to clients, it's not building another app that tells you how much weight you can lose,” says Simas. “It really is about influencing sales organizations to do business totally differently.”
As an agency, WCG has repositioned itself in recent years, diversifying its client base outside of healthcare and building out an interactive and creative team through acquisition and hires. “We're creating a horizontal skillset,” Simas explains. “Any sales organization on the planet that has face-to-face presentations with their customers can benefit from this platform.”
Regulatory concerns remain
Outside of sales communications, the pharmaceutical and the medical diagnostic and device industries still face many of the same regulatory concerns they deal with in social media.
“With pharma, the biggest hurdle is still the regulated and limited space we have for things like fair balance,” says Emily Downward, SVP of digital health at Edelman.
And, similar to social media programs, communicators must choose between building an application that is branded or unbranded. While it might be harder to show ROI for an unbranded app, FDA-weary corporate communications pros may find unbranded efforts are a safer sell.
“It also has to be appropriate for the audience to make sure they are already using mobile devices and that the mobile app is helping them achieve some goal or giving them value,” adds Downward.
Novo Nordisk is one example of a company that chose to brand the dosing app it launched in August. The app provides physicians with information about prescribing the three products that make up its insulin portfolio – Levemir, NovoLog, and NovoLog Mix.
NovoDose, a mobile insulin dosing guide, was developed specifically for physicians, says Ambre Morley, associate director of product communications at Novo Nordisk. Only users who identify as healthcare professionals can download it.
Morley points out the research the company looked at – a Manhattan Research report says 70% of the nearly 2,000 physicians it surveyed say PDAs or smartphones are “essential” to their practice. The survey also reveals 44% have used an online dosing calculator in the past.
“We are aware physicians want applications they can use just about anywhere when they're in the exam rooms with patients,” she says. “We wanted to fill one of those unmet needs for them.”
The idea came from a sales rep, who noticed that a number of physicians were using iPhones during meetings.
“It's proof we're listening to our employees, who are out there,” adds Morley. “We're listening and talking to doctors about their needs. We talked to several physicians before we helped launch it. We hope to do things in social media and this new media mobile market for physicians.”
Morley, who has a duel reporting line to marketing, helped support the communications around the app, in part by reaching out to tech media.
Diabetes is one disease category cited often by PR pros as a potential growth area in mobile communications. In August, WellDoc received the first FDA approval for a mobile app, a “Diabetes Manager System” aimed at healthcare professionals and people with Type 2 diabetes.
Nearly 18 million people in the US have been diagnosed with diabetes, according to the American Diabetes Association, and numbers are expected to grow, even as government and business increase their focus and funding on fighting obesity.
“The most we've seen have been in the diabetes category – blood sugar, diet,” says Downward. “It's a category where people are very active on mobile devices already and they need something to manage their disease everyday, unlike something such as high blood pressure, which you can't really feel.”
Sanofi-Aventis launched its free “GoMeals” app and desktop widget in 2009. It is aimed at people with diabetes, although it provides a tool for carb-counting in restaurants and at home, which is most relevant to people with Type 1 diabetes, says Lynn Crowe, senior product manager for diabetes at Sanofi-Aventis. The company sells Lantus, a diabetes treatment.
The app also provides information about international foods and restaurant chains. InTouch Solutions, a digital agency, worked with Sanofi-Aventis on the app.
“When people are thinking about or needing to make decisions about food and carb-counting, most of the time it's not sitting at their computer,” she says.
Like the “AFib Educator,” the company created a website and Twitter feed to support “GoMeals.”
“One of the main intents of the website was to build confidence in the user base,” says Crowe.
She notes that the Twitter feed acts as a tool for users to provide feedback, as well as have a conversation with the company. The communications team also reached out to diabetes bloggers to raise awareness about “GoMeals.”
Leading the mobile ‘landgrab'
Much like the “digital landgrab” that PR pros refer to when talking about which marketing discipline should lead social media, mobile asks the same questions. Should marketing lead? Should digital or even mobile companies be considered the go-to discipline? Is mobile driven by engagement?
“It's a conversation,” says Chandler Chicco's Patel. “It's not about selling something or embedding an ad in a Twitter feed. It's about engaging in a dialogue.”
Yet as the number of companies, public health organizations, and federal agencies using mobile to connect with patients grows, the role of communications remains crucial. H&K's Paxton says that while creating the strategy for the Text4Baby campaign, several people wondered why anyone was worried about using social media.
“That's what makes it so interesting because while it is mobile technology, someone is signing up for the service via text message, so we need to communicate with them through traditional and social media,” she says. “You can't ignore any form of communication, so social and traditional media are critical and need to be interconnected.”
Helping the public take care of itselfUnitedHealthcare said in September that DocGPS, an app first launched in 2009 for Apple's iPhone, would be available for both the Android and BlackBerry. DocGPS allows users to locate in-network doctors, as well as nearby hospitals.
Bayer developed the “MyBeta” app for patients who take Betaseron, a drug to treat multiple sclerosis. The app, which launched in May, tracks a patient's injections in a diary. Entries can be shared with health providers.
Mount Sinai Adolescent Health Center launched “Text in the City,” a free text service aimed at teens in the Bronx and Harlem neighborhoods in New York. Teens can text questions about health and sign up for birth control reminders.
Developing countries lead in mobile health programs
In 2009, Novartis identified a need for health clinics in Tanzania to better communicate and manage supplies of malaria medicines.
The company partnered with Vodafone, IBM, Tanzania's Ministry of Health, and the Roll Back Malaria Partnership to create “SMS for Life.”
The program aims to reduce stock-outs of artemisinin-based combination therapy (ACT) drugs and quinine injectables, which treat malaria. Novartis markets Coartem, a malaria drug it has supplied at no profit to malaria-endemic nations since 2001.
“One reason for so many stock-outs is nobody has any way of knowing how much malaria medicine is in any of the health facilities,” explains Jim Barrington, program director and chief information officer at Novartis.
Novartis has worked with Ruder Finn since 2005 on malaria efforts. For “SMS for Life,” it hoped to raise global awareness, educate stakeholders in the malaria sector, and build its reputation as a leader in access to medicine, says Ruder Finn SVP Sarah Coles.
“We had an opportunity to educate journalists in the healthcare and tech sectors,” she adds. Key placement included stories in National Geographic, The Wall Street Journal, and Time.
Kathy Bloomgarden, Ruder Finn CEO, says developing countries have been using mobile for the past few years and are, in many ways, ahead of more developed nations.
“SMS for Life” is scheduled to be rolled out nationwide in Tanzania, with tentative plans to conduct a pilot in four districts in Ghana.
“Most people have their own phone,” says Barrington. “If you can design a system that can run on the most basic, lowest technology mobile phone up to the highest technology, it eliminates the need for a special phone and makes implementation easy.”