Four “E”s to speed adoption of mHealth and promote cardiovascular behavioral medicine.

Abstract

Mobile health, also referred to as mHealth, is defined by the World Health Organization as the delivery of medical practice supported by mobile devices including smartphones, tablets, virtual assistants, and other wireless devices. Systematic reviews and meta-analyses confirm the effectiveness of mHealth tools at improving patient adherence to various self-care activities with downstream beneficial effects on blood pressure control and reduced health services utilization. Yet the clinical application of mHealth to cardiovascular behavioral medicine has been limited. Given high rates of smartphone ownership in the U.S., it is now possible, at least theoretically, to utilize mHealth on both a population-wide and highly personalized basis to prevent, diagnose, treat, and monitor response to therapy for a broad variety of cardiovascular behavioral medicine conditions. In keeping with the theme of this special issue of Health Psychology, we highlight the "4E" barriers of evidence, eminence, electronic health record, and economics that must be addressed to speed adoption of mHealth to promote cardiovascular behavioral medicine and improve health.

If not us, who? If not now, when? Paths forward in science, patient care, and training to maximize the impact of cardiovascular behavioral medicine.

“…We can adhere to the principles of human behavior that inform the interventions we test in clinical trials, while allowing for more flexible delivery of those interventions to also address the implementation science agenda (see Stoney et al, 2022). We see examples of this in the collaborative/integrated care intervention arms of the IMPACT trial (Unützer et al, 2002) and the COPES (Davidson et al, 2010) and CODIACS (Davidson et al, 2013) trials, in the emerging N = 1 trial models (Lillie et al, 2011), and in the potential use of personalized, mHealth interventions (see Rollman et al, 2022 in this issue). Consistent with this idea, we believe that the faculty within these training programs should be engaged in comparable science to provide the context for training the next waves of doctoral students.…”

“…However, the evidence base for successful implementation of these interventions within health care systems or communities is severely lacking. Similarly, in their commentary, Rollman et al (Rollman et al, 2022) delineate the "4E" barriers (evidence, eminence, electronic health record, and economics) slowing the adoption of mobile health (mHealth) interventions in routine practice settings. Consequently, large-scale uptake and utilization is rare.…”

Value, implementation, and opportunities for cardiovascular behavioral medicine: A special issue commentary.

“…In recent years, mHealth, or mobile technology-centric service delivery, has emerged as an essential mode of delivery for furthering the reach and implementation of CVBM science and practice. The paper by Rollman et al (2022) highlights the primary barriers: evidence, eminence, electronic health records, and economics ("4Es") that must be addressed to further CVBM mHealth research and interventions for both individual and population-based prevention and treatment.…”