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A good pedometer encourages physical activity - but not for everyone

eHealth can improve our lifestyle without the involvement of a healthcare provider. Talia Cohen Rodrigues investigated the possibilities for people with cardiovascular diseases. ‘People with a low socioeconomic status may be more difficult to reach with eHealth.’ She will defend her doctoral thesis on 14 March.

‘You have 1563 steps left to reach your step goal for today, would you like to take a stroll?’ When a smartwatch provides such feedback, there is a much greater chance that you will take more steps than with a pedometer that does not. It also helps if an app teaches you something about health: ‘It’s good that you drink coke zero, it doesn’t contain sugar. But it does contain caffeine, which raises your blood pressure.’ In addition, effectiveness increases when an app is interactive: if you can choose your own step goal and set at what time you receive feedback.

Better results with a cycling test

Social psychologist and communication scientist Talia Cohen Rodrigues wanted to know to what extent eHealth can be successful without additional guidance from a healthcare provider. For this, she analyzed the results of 104 previous studies on the effectiveness of eHealth. She discovered that automatically generated feedback can be just as successful as feedback from a healthcare provider. ‘A good eHealth application without human intervention can really help improve someone’s eating or exercise behaviour and health outcomes, such as the results of a cardiological cycling test or exercise behaviour.’ Examples of such applications are Headspace, for stress reduction, and My Lifestyle Coach from Albert Heijn. ‘Health insurers like Zilveren Kruis and A.S.R. also offer apps with automated support.’

It’s precisely the high-risk group of older men who resist

Cohen Rodrigues interviewed sixteen healthcare professionals and conducted a questionnaire-study with 650 people with cardiovascular diseases about their opinions and expectations of lifestyle interventions and eHealth. ‘It was striking that healthcare providers thought their often older patients would prefer to see a healthcare professional because they may not be very adept with technology. Patients thought differently and often preferred to work independently on their lifestyle. Without eHealth and without a healthcare provider.’

However, this does not apply to everyone. ‘Women and younger patients more often want to be guided by an app or a coach to improve their lifestyle. Older men, who are the most prevalent risk group for cardiovascular diseases, think they can do it by themselves.’ Wrongly, as experience teaches us. Cohen Rodrigues believes that we need to offer these patients alternatives. ‘Current rehabilitation programs after a heart incident are rather one size fits all. People often receive group sessions and a fixed content. An app offers the opportunity to create a tailor-made program and give patients autonomy in improving their lifestyle.’

Cheap eHealth sounds appealing...

Making literal and figurative strides forward with eHealth without human intervention sounds very appealing. Especially in times when healthcare costs are rising. Are such eHealth tools the solution for increasing obesity and other lifestyle problems? Cohen Rodrigues fears not, for two reasons. ‘If you drank tea instead of coke thanks to your app, it doesn’t help if the supermarket keeps offering cheap coke.’ Secondly: ‘eHealth can make many people aware of their behaviour and help change it. But there are vulnerable groups with whom we need to be cautious with such solutions, such as people with a low socioeconomic position.’

... but it can increase health disparities

It areis precisely  thoese people who live five years shorter than others, and fourteen years less in good health: these are significant big socioeconomic health disparities. Cohen Rodrigues: ‘People with a low socioeconomic positionstatus are the ones who need to improve their lifestyle the most.’ Illiteracy or lower digital skills make eHealth less effective. Additionally, there is another reason why behavioural change is particularly difficult for these people. ‘Due to concerns about, for example, a lack of money, these people often have no mental space to work on their health.’ That’s something we as a society should address, the doctoral candidate believes. ‘Otherwise, successful eHealth will only increaseexacerbate health disparities.’

Text: Rianne Lindhout

Ecosystem for a healthy lifestyle

Talia Cohen Rodrigues’ research is part of the BENEFIT program. Within this program, a public-private consortium supports patients with cardiovascular diseases in their own home environment for a healthy lifestyle in the long term. Partners include ZonMw, LUMC, Hartstichting, and Medical Delta.

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