Just because ‘there’s an app for that’, doesn’t mean anyone is going to use it. Responding to the promotion of another simplistic app that purports to challenge young people about the impacts of their drinking, UnitingCare ReGen CEO Laurence Alvis considers what works in supporting people to change their behaviour and some of the challenges for service providers in providing meaningful interventions online.
Recent coverage of an American photo-based online tool in Australian media (‘Facing up to alcoholism with new photo tool’) serves as a reminder of the glut of well-intentioned but largely ineffective health-based apps that have been published in recent years.
Initiatives such as ‘Your face as an alcoholic’ (there is also a partner ‘Your face on meth’ tool, echoing the controversial and highly stigmatising ‘Faces of Meth’ campaign) are unlikely to be effective with young people, even if they are based on selfies. While these two examples are not particularly well realised (see the comments by people who have used either of the two tools), other similar initiatives such as the Scottish ‘Drinking Mirror’ fail on the same grounds: they don’t reflect the lived experience of their apparent target audience.
Anyone with experience in working with (or caring for) young people knows that warning them of possible consequences in ten years’ time is unlikely to change their behaviour, particularly when that behaviour is associated with enjoyment and seen as being a natural part of their social life. Young people in particular have a keen eye for detecting patronising or agenda-driven campaigns and are typically resistant to scare tactics.
If we’re serious about changing behaviour, we need interventions that are holistic, treat people with respect, support informed decision-making and build resilience. Health advice that ignores the reality of young people’s experience is unlikely to be heeded, regardless of the medium for its delivery.
The prevalence of web-access via mobile devices provides a wide range of opportunities for service providers to extend the potential reach and increase the accessibility of their services, not just with young people, but all those at risk or experiencing harm. However, the development of an app, social media activity or other online initiative should have the same level of critical consideration as any other new service initiative. It should be informed by an understanding of the medium and the target audience, as much as by practitioner knowledge and efficacy research.
All too often, health-based apps miss the mark. They either offer little practical utility or rely too heavily on gimmicks (such as the above examples). While data about utilisation varies, we know that once downloaded, the great majority of health apps are rarely used. Gimmicks might be good for generating media coverage, but are unlikely to lead to behavioural change.
In addition to being expensive and ineffective, poorly considered initiatives have the potential to expose service providers and (more importantly) the people who use their services to unanticipated risks, particularly in areas such as alcohol and other drugs, family violence, homelessness and mental health.
Stigma has a powerful and enduring impact on many people’s lives and there are many reasons why people choose not to be publicly associated with services like ours. Concerns about privacy and potential harms to people engaging with service providers online are common (e.g. recent research indicates that young people do not want their associations with mental health service providers intruding on their personal social media profiles) but often not fully understood by individuals or service providers.
A good example of the challenges and opportunities for service providers is the recently launched ‘Samaritans Radar’ Twitter App. Designed to monitor the feeds of followers for indications of suicide risk and support people to intervene, the app highlights the potential for recruiting social networks to prevent harm. While it was soon suspended due to a range of privacy concerns, the concept (similar to that of other content monitoring initiatives) shows real promise. Our own very brief experience of using Samaritans Radar has alerted us to one Twitter follower who was at risk. Without the app, we would have missed their postings and would not have responded to their immediate concerns.
There is much to be considered, but also much that can be gained.
Understanding the risks should not dissuade service providers from being active in this area, but inform their own endeavours. Our own experience in integrating web-based approaches and social media activity with treatment and support programs highlights the potential of future online initiatives. We’re committed to exploring the opportunities to help reduce alcohol and other drug related harms, support behavioural change, build communities of support and challenge stigma.
We might not always get it right, but we’re open to the possibilities.