Patricia Mechael and Pierre Moon: Digital self care must be approached by the health sector with eyes wide open

Information and communication technologies play an important role in the daily lives of people and there is now a new generation of digital natives who do not remember what life was like before mobile phones and tablets. Digital health is creating new opportunities and challenges for how health information and services are being accessed and delivered. Smart phones apps, wearables, and remote patient monitoring devices paired with artificial intelligence and natural language processing are leading towards personalized health and wellness services. [1]

Alongside the trends in digital health, advancements in self-administered family planning methods, self-testing and screening for sexually transmitted infections such as HIV and HPV, and self-administered abortions are leading to a new paradigm of self care interventions in the field of sexual and reproductive health and rights with particular implications for women. [2]

This year will mark a significant milestone for the World Health Organization with the anticipated release of normative guidelines addressing digital health and self care. [3,4] It will be important to harness these new opportunities and grow the fledgling evidence bases while putting into place appropriate change management and regulatory frameworks, systems, policies, and services to address potential harms.

Digital health enables self care in several ways. The first is as a stand-alone self care intervention. For example, mobile apps for better home-based care and risk assessment during pregnancy. The second is using digital technology in combination with self care commodities such as instructional videos for more effective use of HIV self-testing kits. Third, at a health systems level, digital health offers the opportunity for better continuity of care through the use of shared health records accessible to patients and health professionals.

The combination of digital health and self care is accelerating the movement towards person-centred health and shifting the centre of gravity for many health-related activities from a clinical setting to people at home or in their workplaces. [5] This takes the notion of task-shifting in health to a whole new level by enabling people to directly access and use commodities and services that have previously been entirely in the domain of health professionals or administered in a health facility. [6] Mobile apps and online ordering services have become new intermediaries with internet drug stores and pharmacies.

This shift is inevitable as people increasingly expect to manage their interactions with the healthcare system in the same way that they manage their finances – as conveniently as possible and without having to go to a bank unless absolutely necessary. In many resource-poor settings, the shift is less a matter of convenience, but one of necessity due to insufficient numbers and distribution of health professionals. In many countries providing private approaches to access information and services for highly stigmatized sexual and reproductive health issues may also lead to better health outcomes. While digital services create new opportunities to increase individual agency around health, they also enable people to bypass the healthcare system. For some conditions this may be safe, but for others not.

With tremendous hype, potential for the spread of misinformation, and hundreds of thousands of apps, it can be hard to find the signal through the noise. This is leading to questions related to safety and effectiveness by skeptical health professionals and policy makers. Neither the evidence nor the policy and regulatory environment is keeping pace with innovative products and services being directly marketed to individuals. This movement will require a greater need for health literacy among the general population as well as trusted sources of information, like the NHS Apps Library, in order to navigate the hundreds of thousands of unevaluated and potentially harmful apps and technologies. [7] The Digital Health Resolution adopted by WHO member states in 2018 outlines many of the steps needed for countries to harness technology that can improve health outcomes in a way that addresses safety, effectiveness, health data privacy and security, equity, vulnerability, and gender equality. [8]

While there is enthusiasm for the potential and inevitable changes that will come with digital health-enabled self care as a new point of access for health information and services, it must be approached by the health sector with eyes wide open.

Patricia Mechael is Co-founder and Policy Lead at HealthEnabled, where she advises on the organization’s policy and research-related initiatives focused on nationally scaled integrated digital health systems and the Global Digital Health Index. @PattyMechael

Pierre Moon is a Director of Programs at Population Services International and has worked for 20 years supporting and leading national, global and regional health programs, focused largely on increasing access to quality, affordable sexual and reproductive health products and services.

Competing Interests:

PM served on the WHO guideline development groups for Digital Health Interventions & self care Interventions for Sexual and Reproductive Health and Rights. PM has no interests to declare.

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