Digital therapeutics adoption and psychology

Digital therapeutics: Why human psychology is key to adoption

The healthcare system is running at its limits in many countries worldwide. One reason is the growing demand for healthcare, largely driven by the rise of chronic diseases. COVID-19 has further underscored just how stretched the system is today. Is there any solution to the twin challenge of managing costs while extending capacity?

We believe that digital technologies are an important part of the answer. Although still in early stages, it is poised for broader adoption thanks to recent technological advances. While digital won’t help solve all the problems in our healthcare system, it will significantly contribute to easing the cost and capacity burden.

One particularly promising area in this context is digital therapeutics. Based on the analysis of individual patient data, patients receive personalised medical recommendations – through an app or a digital platform – without the need for physician intervention. Digital therapeutics can help patients stick to treatment plans and/or better understand what triggers critical situations. Digital therapeutics are already available for different indications including diabetes or asthma and are being developed in many other areas as well.

The ‘therapeutic alliance’

Unfortunately, most patients stop using these solutions after only a short time even though the benefits are often obvious. But to achieve true value in the system, sustained adoption is pivotal.

A major obstacle is the psychology of the patient. Most digital therapeutic solutions are essentially self-management tools that require the patient to consistently add his or her data and follow the suggested actions. Without high levels of self-discipline and motivation, patients often lose interest. Thus, we need to focus on how we can improve sustained patient engagement with these digital therapeutics.

Let’s take a closer look at the relationship between the physician and patient. According to Accenture Research, trusted healthcare professionals ranked highest in motivating consumers to take a more active role in managing their health¹. How is this trust created and why do patients stay engaged with the instructions they receive from a physician? According to leading behaviour psychologists we have interviewed, one key concept explaining the bond between patient and doctor is ‘therapeutic alliance’.

This concept, which was already described forty years ago by Bordin et al², seeks to explain why and how this bond is established. Evidence from various studies shows that a strong therapeutic alliance does positively influence treatment outcomes³.

Four key factors contribute to a high-quality therapeutic alliance from a patient’s perspective:

1. Relatedness: The patient and physician connect on an emotional level; the patient has the feeling that the physician really cares
2. Agreement on goals: The patient and physician jointly agree on and support the outcomes they want to achieve
3. Agreement on interventions: The patient and physician jointly agree on the necessary steps to achieve this goal
4. Perception of competence and ability to help: The patient sees the physician as a qualified authority who, based on his professional experience and knowledge, will make appropriate treatment decisions.

What does this mean for the development of digital therapeutics? By their very nature, digital tools cannot build emotional bonds with patients. However, the four factors outlined above can be replicated in digital solutions in various ways:

1. Relatedness: Instead of asking for entering and providing data alone, the digital therapeutics solution must communicate with the patient in an engaging and personalised way. For example, personalised messages and motivational feedback via a chatbot help the patient overcome challenges and continue the digital therapy

2. Agreement on goals: The digital therapeutic needs to highlight the defined goals to the patient in a comprehensive and relatable way back to the patient. The goals are personalised to the context of the patient based on, for example, a survey

3. Agreement on interventions: The proposed interventions must always be linked back to the agreed goals. It is important that patients understand how cause and effect are connected. This link needs to be constantly reinforced along the treatment journey

4. Perception of competence and ability to help: The patient needs to believe the app is trustworthy. There are different ways to drive this trust; one way is for a physician to endorse or prescribe the digital therapeutic, another is having a trusted organisation, such as a leading health institution, being visibly involved in the development of the solution.

The hybrid model: digital meets human

Today, most digital therapeutics do not manage to effectively apply these concepts of replicating the human component and thus struggle to create a strong therapeutic alliance. But without this ‘human touch’, digital therapeutics struggle to sustain engagement with patients, especially as many patients still don’t trust diagnosis and treatments determined by an intelligent machine or artificial intelligence – as a recent Accenture study revealed⁴.

A promising approach to overcome this is to combine both digital and human in a hybrid model for digital therapeutic solutions. This can be achieved by designing regular human touchpoints with a doctor or a nurse when certain milestones are either achieved or missed based on the data from the digital solution. The role of the healthcare professional is to assess and feedback the therapeutic progress and give personal coaching and additional advice to the patient based on data from the digital tool. This reinforces the health actions already recommended by the digital therapeutic solution.

One successful realisation of such a hybrid model is Migraine Care from Novartis. The programme focuses on helping migraine patients better manage their condition through a combination of a mobile app and human health professional. This allows users to keep track of their symptoms and actions. The healthcare professional has access to the data from the app and can therefore base recommendations on these insights. This provides a highly personalised and emotional experience with individual objectives and actions for the patient instead of the more general advice a user would receive from standard migraine apps.

The Migraine Care team, led by Leonhard Schaetz from Novartis, published results of a six-month study that demonstrate the therapeutic value of such a hybrid model⁵. More than two out of three participants completed the programme and the number of working days lost due to migraines was reduced by almost two thirds. Participants said they were encouraged by their personal conversations with the nurse and therefore felt an obligation to follow the recommended care plan. These conversations not only focused on recommending specific actions – based on the personal data on their wellbeing and symptoms they had entered into the app – but also left enough room to discuss symptoms more generally and establish an emotional bond.

We expect more of these solutions, which combine the strengths of digital technology and human interaction, coming to market in the next years. A similar hybrid approach is used by Liva Healthcare, which has developed an app for learning healthy lifestyle habits in connection with a personalised coaching programme. The solution focuses on patients with or at risk of getting chronic diseases. While the app is built for daily interaction and tracking health habits, users also have access to a human health coach through the Liva platform.

Hybrid digital solutions provide an effective way to emphasise the ‘human touch’ at key moments in the therapy where patient behaviour can be influenced. In the (distant) future, the human touch can increasingly be provided by a virtual health assistant powered by AI. But the speed of this happening depends on the developments in the field of machine learning and neural networks which are still at early stages.

The hybrid human-digital approach is a great way to build trust in digital therapeutics solutions today. With this approach, we can create truly meaningful solutions that not only engage patients in the long term but also lead to sustainable changes in their health outcomes. This should increase adoption and help to free up capacity and bring down costs in the healthcare system.

References

¹ Accenture “Digital is Transforming Health, So why is consumer adoption stalling?” 2020 Digital Health Consumer Survey – US
² Bordin E. The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research and Practice. 1979;16(3):252-260
³ Hall A.M. et al. The Influence of the Therapist-Patient Relationship on Treatment Outcome in Physical Rehabilitation: A Systematic Review. Physical Therapy 2010
⁴ Accenture “How can leaders make recent digital health gains last?” Re-examining the Accenture 2020 Digital Health Consumer Survey – US
⁵ Schaetz et al. Employee and Employer Benefits From a Migraine Management Program: Disease Outcomes and Cost Analysis. Headache 2020

Boris

Dr Boris Bogdan, medical doctor by training, is a partner at Accenture Switzerland and globally leads Accenture’s Precision Oncology and Personalised Healthcare Practice. His passion is to envision the future of healthcare. Prior to joining Accenture, Dr Bogdan was an entrepreneur and part of McKinsey. He has published numerous publications on the pharmaceutical industry and is author of the books Valuation in Life Sciences and Medrevolution.

Dr Sandra Dietschy-Künzle is a senior principal in Accenture’s Life Sciences practice with more than 10 years of experience in the healthcare industry and in-depth expertise on drug development. Prior to joining Accenture, Dr Dietschy-Künzle held positions at a biotech company supporting the development of several assets from early research into late clinical development. She has worked as an equity analyst for the healthcare sector and holds a PhD in Natural Sciences from the University of Zurich.

Oliver Schmid

Oliver Schmid is a business designer and the life sciences lead at Fjord Switzerland. His work focuses on applying human-centered design principles to redefine and shape business strategy to realise innovative value propositions. He has led multiple projects in the healthcare industry focusing on developing beyond-the-pill solutions, innovating patient and care services and establishing multi-stakeholder health ecosystems.

Accenture is a leading global professional services company, providing a broad range of services in strategy and consulting, interactive, technology and operations, with digital capabilities across all of these services. We combine unmatched experience and specialised capabilities across more than 40 industries — powered by the world’s largest network of Advanced Technology and Intelligent Operations centres. With 509,000 people serving clients in more than 120 countries, Accenture brings continuous innovation to help clients improve their performance and create lasting value across their enterprises.

For more information about Accenture’s Life Sciences technology platforms and consulting, strategy and consulting services, visit www.Accenture.com/LifeSciences.

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Digital therapeutics: Why human psychology is key to adoption

The ‘therapeutic alliance’

The hybrid model: digital meets human

About the authors

About Accenture