Helen: Welcome to Health Literacy Out Loud. I’m Helen Osborne, president of Health Literacy Consulting, founder of Health Literacy Month and your host of Health Literacy Out Loud.

In these podcasts, you get to listen in on my conversations with some really remarkable people. You will be hearing what health literacy is, why it matters and ways all of us can help improve health understanding.

Today I’m talking by conference call by Ellen Langhans and Silje Lier. Ellen is the www.Healthfinder.gov program manager at the Office of Disease Prevention and Health Promotion, or ODPHP, in the US Department of Health and Human Services. Ellen’s role is to ensure the use of plain language and health literacy principles in www.Healthfinder.gov, along with its outreach and marketing materials.

Silje is a communication advisor at ODPHP. She manages the outreach community for www.Healthfinder.gov and supports outreach for many other ODPHP initiatives, including Healthy People 2020, Dietary Guidelines for Americans and the National Action Plan to Improve Health Literacy.

Ellen and Silje together led the www.Healthfinder.gov Mobile App Challenge. Welcome to you both.

Ellen: Thank you. Thanks for having us.

Helen: I really am intrigued about this Mobile App Challenge because I can’t go anywhere these days without seeing everyone fiddling with their phones. How did you come up with this notion that somehow we have to bring health literacy together with all these mobile apps that we’re using?

Ellen: That’s a great question. As you said, you can’t really go anywhere without seeing people on their phones. We do see a huge trend in mobile use. Sometimes people are accessing information on the web on their phones more than they are from their computers.

We always wanted to do a mobile app because part of what we want to do is reach people where they are. Part of the new digital government strategy is reaching people where they are on whatever device they’re on.

Helen: Let’s take this back a little bit. What do you mean by a mobile app?

Ellen: It’s an application that you can download on your phone or tablet and use whenever you access your phone or tablet.

Helen: You just go to the app store and get a new program there essentially. It’s like the old computer software in ways.

Ellen: Exactly. Our office has always been interested in doing that. Our office also is really big on health literacy and ensuring that everything we do is written in a way that is easy to find and easy to act on. We wanted to create a mobile app that had health literacy principles infused in it.

Helen: You know it’s relevant and timely, and you know that people are using their phones. Tell us about this Mobile App Challenge.

Silje: We knew that we wanted to create a mobile app to support our health literacy-based website called www.Healthfinder.gov, which is a consumer-oriented website that provides information about prevention and services.

We figured that we could loosen the reins a little bit and allow developers to compete to create an app that would be based on a number of criteria that we set forth, but also bring in some aspects of creativity that we might not have necessarily thought about if we were just guiding a developer in creating an app on healthfinder content.

Helen: Silje, let me see if I understand this clearly. You had this fabulous website, www.Healthfinder.gov. I’ve actually done a podcast on that. We’ll have the link on the Health Literacy Out Loud web page.

You have this great website with a lot of great content. Now you want to reach others. You’re telling me that it’s almost a federal mandate to teach people in ways they can learn, but you wanted to expand it and go beyond what the government’s doing and open it up to creativity. Is that correct?

Silje: Yes, definitely. One of the things that we really wanted to do was to get creative with it. We know healthfinder inside and out. We had ideas for what we wanted the app to be, but it’s not really about what we wanted it to be. It’s about what people would use and need.

We wanted to open it up to outside of the government and host this challenge so that we could get people who aren’t as familiar with it. We wanted to get their ideas and have them mash it up with other functionalities as other applications, which is another feature of an app.

You can mash it up with other things that have APIs, or application programming interfaces. You can take data and mash it up with other data from different sources. We have healthfinder content, but then it also includes a calendar where you can track your preventive services and medication information so you can track that for you or your family members.

Helen: When you put this challenge out there, did you tell app developers “You need to consider this or this?” or did you just say, “Show us your stuff”?

Silje: We actually put a lot of thought into our criteria because we wanted to allow creative freedom, while at the same time making sure that we were being consistent with the healthfinder brand, that things were written in plain language and that certain things were followed.

Out of our set of criteria, there were three that were really important to us and that we weighed most heavily when we gave our scoring and rubric assessment sheets to our reviewers that we selected.

The first was health literacy principles. Developers were provided guidance on how to write in plain language and resources for health literacy and understanding that. We also asked them to work with end users in developing an app.

Co-design was actually one of our main criteria. We partnered with a startup crowd sourcing company at the time called Health Tech Hatch. This basically means that Health Tech Hatch opened up their website for developers to login to a portal and submit concepts, working prototypes, or screen shots to show their ideas of what their app design or concept was.

Helen: That’s neat. You had this challenge out there. You let people know. You introduced them to health literacy if they didn’t already know about it. You said, “We want this to be co-designed with the end users.” Then did you just open it up to people who develop apps?

Silje: We did. We partnered with a healthcare technology company called Health 2.0 to actually administer the challenge because they have a huge pool of developers and networks that we can’t necessarily tap into. We worked with them to do a lot of the leg work in terms of marketing to developers.

On our end, we worked with the end user groups or people who could connect us to end users so that we could make sure that they were also populating Health Tech Hatch, logging in as reviewers, and making comments on ideas that were being submitted.

Helen: What a wonderful way. It seems like crowd sourcing in action. Move us forward. I don’t know how many of our listeners are actual app developers, but probably not too many. I’m really curious. What did you learn? What did you decide? What’s out there for all of us?

Ellen: Part of what we learned is that crowd sourcing is a really good idea, but it doesn’t just have to be done online. Crowd sourcing is essentially an online version of user testing.

The winner of the app challenge, a company called Life Channel, created our app. It’s called My Family. They went a step beyond the crowd sourcing part of it. They went to a parking lot of a very popular discount store.

They spent the day testing the app out on people who would be target users, which were essentially moms or people who would be in charge of not only their health but the health of their families.

Helen: They created the app, and then they went and tested it.

Ellen: Exactly. They got feedback on things that worked, things that didn’t work and things that could be improved. That was something huge that we learned. Involving your target audience in the testing should be part of any application development or any development of anything that’s going to be consumer oriented.

Helen: It sounds like they involved them pretty early. Did they have this polished thing ready to go and said, “Let’s just get an opinion,” or was it really in the formative stage that they said, “Let’s design this together”?

Silje: Our challenge was run in two phases. The first one did involve requiring documentation, co-design, and changes made as a result of that from Health Tech Hatch.

In the second phase, we had the three finalists compete to build out their app and make it market ready for consumers to download. During that part, the winning developer went and did further testing.

It was actually submitted to us originally under a different name, which was Chief Health Officer. Based on talking to all of these folks outside the discount store, they actually realized that it didn’t resonate with the user. They made that change in a later stage of the challenge.

Ellen: They actually commented that it changed the way that they thought about how information should be presented. Instead of just creating an app focused on providing health information, they changed it to an app that really provided health-management tools. They learned something from it as well, which was really cool.

Helen: That’s neat. The app developer learned too. In preparation for this call, I actually went to the app store and downloaded it. It’s a neat little app.

Can you tell us a little bit about what it’s like now? Here’s an app that is consistent with health literacy principles. What are some of the features we should be looking for? Also, we’re not just promoting that app, but the greater principles of what to look for in an app.

Ellen: I think first and foremost is that it has actionable information, especially if it’s health-based or health-focused.

Helen: Like what?

Ellen: Like steps that you can take. Obviously you need context, background information on what something is and why it’s important to you, but if there aren’t any action steps you can take on that, there’s not really much you can do with it. I would say that having content that’s action oriented would be a key component of any health application.

Helen: Would that be something like going for a walk, calling your doctor or something? Is that what you mean by actionable content?

Ellen: Sure, or it could be giving them resources on how to take the next step, such as, “Make an appointment with your doctor. Here are some questions you can use when you go to the doctor,” or, “You should go get tested for HIV to know your status. Here’s a clinic locator. You can put in your zip code and find the nearest clinic.”

Helen: What else did you learn?

Silje: Another thing we learned from this challenge is that at the onset of the challenge, you’re looking forward to seeing all of the submissions that these developers are going to come up with and seeing the end product. It’s also important to keep in mind early on the longevity of the product once it’s out there.

We are still seeking feedback on the app and how it’s received. We still want to hear from users, especially as we’re adapting to user needs, creating updates and adding other features.

We definitely want to continue to learn what is challenging for our users and what features they like and that we can enhance and do more of. That’s definitely something to keep in mind.

You don’t just have an app that’s out there in the store. You want to adapt to the mobile health landscape in terms of keeping up with features that are added to all of these other apps and making sure it’s something that your users would use long term.

Helen: That’s really interesting. An app lives and breathes, in a metaphorical way, and keeps growing. It’s not just static.

Ellen: Absolutely. Something else people should look for in applications is whether the app keeps them engaged. Does it allow them to share features? Does it integrate different kinds of media? Does it seek content feedback? Does it integrate into their lives pretty seamlessly? Apps that keep you engaged and encourage you to login more than once are also very important.

Helen: There was a feature in there about taking medication. I was just trying it. Maybe I’m supposed to take it every day, so I put that in. All of a sudden, I saw a reminder on my phone that said, “Time to take your medicine.” Is that the kind of feature that you’re talking about so that people will keep remembering this?

Ellen: Exactly. It’s giving them little nudges and reminders about upcoming appointments, that it’s time to schedule your yearly wellness visit, or that you have a well-child visit for your kid coming up next month. It’s definitely stuff like that.

Helen: This is great. You’re giving us a lot to think about. It’s all in addition to excellent content. Just putting the excellent content out there is not enough. That’s on the website and it’s being maintained, but you need all of these functions and things that we do about it.

Ellen: If it was just the information on the website, it would just pretty much be a mobile site that you could access from your phone. In an application, you’re really incorporating all of this other stuff to make it more usable and engaging for users.

Helen: Ellen and Silje, you’re looking at the reality of today and how people are using their phone. Let’s crank it up a notch. How do you see the world of apps or mobile technology in a few years from now?

Ellen: We’re both staring at each other.

Silje: Yes, that’s a really good question. There is one thing that came as a surprise to us. We’re not developers either. I thought we were presenting them with a huge challenge in terms of making them do a lot in a short timeline and showing and documenting that they’d worked with end users.

We did conduct a survey after we worked with Health Tech Hatch to see how it was received among developers. They loved the idea of going to that site and getting feedback.

I would hope that a few years from now all apps, if they aren’t already, are being co-designed early on in terms of knowing what the needs of the intended end users are and working with them to create something that you know they’re going to use.

There are just so many apps out there. There are thousands of health apps alone. It’s hard to break through that clutter. If money is going to be spent on developing apps and all that time that goes into it, it would be very valuable to include those end users in the whole process.

Helen: Thank you. That’s an ongoing health literacy principle. Always get feedback from your users. They are the true experts on what’s readable, engaging and actionable.

Thank you both so much for doing all you do in helping health literacy move forward with the challenges of today. Thanks for being our guests on Health Literacy Out Loud.

Ellen: Thank you.

Silje: Thank you.

Helen: I learned so much from Ellen Langhans and Silje Lier about mobile apps in health literacy. What a great combination for our times today.

Health literacy isn’t always easy. For help clearly communicating your health message, please visit my health literacy consulting website at www.HealthLiteracy.com. While you are there, sign up for the free enewsletter, What’s New in Health Literacy Consulting.

NewHealth Literacy Out Loud podcasts come out every few weeks. Subscribe for free to hear them all. You can find more information along with many important links at the Health Literacy Out Loud website, www.HealthLiteracyOutLoud.org.

Did you like this podcast? Even better, did you learn something new? I sure hope so. If you did, tell your colleagues and friends. Together, let’s let the whole world know why health literacy matters. Until next time, I’m Helen Osborne.