Chances are you own a smartphone. You also may be one of millions who own a smartwatch. The rise of smartphones, smartwatches and similar wearables is changing the way we live. They track many things about us like how active we are and what we eat. This is exciting because doctors could use these devices to modify behavior to help people lead healthier lives.

Our big goal is to establish a center dedicated to building and testing mobile health (mHealth) apps. If successful, mHealth apps could change patient care in remarkable ways. Consider the example of HeartSteps, a mHealth app built by our team. HeartSteps wants to make you move more. It is installed on a smartphone and paired with a fitness tracker. It monitors how many steps you take as well as your location, weather, and time of day. HeartSteps uses this information to make dynamic, tailored suggestions for physical activity. These suggestions are personalized to fit your current situation. Unlike other mHealth apps, you are not asked to walk outside when it is raining. Or to plan an exercise routine during work. We have a similar mHealth app to help you eat better called LowSalt4Life that alerts you to eat better when you walk into a restaurant.

In early studies, we found both apps change short term behavior. But we have a lot of questions that remain about their effectiveness. For example, we do not know whether people start to ignore them over time or if they lead to better clinical outcomes (like lower blood pressure).

At the University of Michigan, we have started a center to answer these questions about mHealth. Our center is the Wearables In Reducing risk and Enhancing Daily Life-style (WIRED-L) Center. It will design and test mHealth apps using the best science. We also will study them in diverse communities that include African Americans and older adults rarely included in mHealth studies. Learning about mHealth in these groups can close the digital divide between rich and poor.

Finally, we will study mHealth in a way that will let others build similar apps. It is hard to set up information technology systems to study mHealth. After finishing a study, most IT systems are discontinued and future researchers have to build them over again. We will stop this “one-and-done” problem.

The AHA wants researchers to make an “extraordinary impact” with an “equity-first” lens. We are excited because mHealth has this potential if designed well and for everyone. The WIRED-L Center will achieve this goal.

Strategically Focused Research Network

Health Technologies & Innovation

The core aim of the WIRED-L Center is to leverage rich digital data streams that are increasingly available from mobile technologies to develop a new type of mHealth intervention known as just-in-time-adaptive-interventions (JITAIs) and then to vigorously test and optimize these JITAIs through a novel study design methodology, known as micro-randomized trials. JITAIs are dynamic interventions that incorporate a broad range of real-time contextual data on user behavior (e.g., number of steps in the last hour) and environment (e.g., weather, time/day of the week) to tailor and deliver interventions when they are likely to be most effective.

Aim 1

We will adapt two previously-developed JITAIs by our group to enable delivery of culturally-appropriate, contextually-aware behavior change messages to participants with hypertension. This work will specifically target development of JITAIs for
users across diverse populations including underserved communities.

Aim 2

We will determine the effect of JITAIs on blood pressure (BP) over time through a microrandomized trial that supplies subjects with a smartwatch and wireless BP monitor. Microrandomized trials are an innovative study design allows us to assess (1) the overall effect of
JITAIs and (2) the impact of their specific subcomponents.

Aim 3

We will expand our work to develop future JITAIs within our Center and at other SFRN sites. Synergy between the WIRED-L Center and Specific Aims of the WIRED-L Project will be maximized through our innovative WIRED-L Translation Accelerator Platform (discussed below). This platform disrupts the traditional model of “one-and-done” mHealth interventions by enabling integrated, simultaneous development, testing and deployment of JITAIs.

Postdoctoral Training Program

This program will provide a unique multidisciplinary environment in which to train the next generation of mHealth scientists, providing WIRED-L Fellows with the skills to efficiently and effectively develop digital health technologies that can be used to manage a range of cardiovascular conditions. We anticipate this uniquely collaborative program also will be used by Fellows to advance additional novel mHealth interventions being developed by other investigators, including those at other AHA SFRN Centers and beyond.

Integration and Synergy through the WIRED-L Translation Accelerator

The WIRED-L Translation Accelerator will be an innovative and durable platform within which mHealth investigators can collaborate with each other and with other clinical researchers. It disrupts the traditional model of “one-and-done” mHealth interventions by enabling integrated, simultaneous development, testing and deployment of mHealth technologies through JITAIs. The process of creating the Translation Accelerator will be synergistic, leveraging the expertise of leaders in medicine, behavioral health, computer science, statistics, and health informatics that creates a product that capitalizes on the strengths of each group. The Translation Accelerator takes mHealth interventions from an “idea” to an “mHealth app,” serving as a software tool for clinical researchers. By establishing a durable platform upon which to build new interventions, investigators and articipants can engage in taking a new idea from an abstract concept to a concrete intervention, identifying barriers to translation early and leveraging the existing infrastructure to efficiently develop mHealth interventions.