News Column

The Connected Age: Mobile Apps and Consumer Engagement

May 1, 2014

Skiba, Diane J

According to the Pew Research Internet Project, three driving forces have brought us into the Connected Age: 1) greater access to broadband, 2) mobile connectivity and the concept of anytime/anyplace, and 3) the presence of social media and social networks in all our lives (Pew Research, 2014). Consider some recent statistics about American adults, young adults, and teenagers:

* 87 percent of adults use the Internet (Fox & Rainie, 2014).

* 90 percent of adults have cell phones, with 78 percent having smartphones (Pew Research, 2014).

* 52 percent of adults have tablet computer devices and 32 percent e-reader devices (Pew Research, 2014).

* 70 percent of teens (ages 13 to 17) and 79 percent of young adults (ages 18 to 24) own smartphones (Nielsen, 2013).

* 73 percent of adults use social networking sites, Facebook being the most prevalent (Duggan & Smith, 2013).

* 42 percent of adults also explore other social networking platforms such as Pinterest, LinkedIn, and Twitter (Duggan & Smith, 2013).

* 64 percent of social media users log in at least once a day (Smith, 2014), with almost 50 percent using smartphones to log into their social networks (Nielsen, 2014).

Just imagine what this means in terms of our students!

McCoy (2013) found the following when he interviewed 777 students at five different universities:

* Students use their devices in class an average of 11 times per day.

* During class, 96 percent of students text, 79 percent check the time, 68 percent check email, 66 percent connect to social networks, 38 percent surf the Internet, and 8 percent play games.

* 70 percent use their devices in class to stay connected; 55 percent use them to fight boredom; only 49 percent use them for class-related work.

So, how can we as faculty (who, of course, would not dream of using a smartphone or tablet in faculty meetings) capture the attention of our students? How can we get our students to use their devices for some meaningful purpose?

This article offers a simple lesson plan that you can use to engage your students as active participants, in a particular course over several sessions or even across the curriculum. By sharing the plan with colleagues, you can use it to thread patient-centered care and informatics across a number of courses such as public/community health, fundamentals, professional issues and research, or courses with clinical content.


This plan, which focuses on consumer engagement, will allow students to put their mobile devices to good use in class while preparing them for the patients and families they will encounter as part of the e-patient revolution. It will help students understand how the patient and family need to be collaborative partners in their health care. I have previously written about the need for consumers, patients, and their families to become more engaged in their health care decisions (Skiba, 2013). Both the Health IT Pledge (Skiba, 2012) and the Blue Button Campaign ( can be used to encourage providers and patients to access their health data to make better decisions.

I highly recommend having your students read "A National Action Plan to Support Consumer Engagement via E-Health" (Ricciardi, Mostashari, Murphy, Daniel, & Siminerio, 2013). The article points out that while patient-centered care is an integral feature of "a high performing, high quality health care system" (p. 376), patients and families have limited access to their health information. They need tools to enable them to access information, including patient portals to electronic health records (EHRs), personal health records, mobile apps and Internet access for health education information, and peer support and advice.

The Ricciardi et al. plan focuses on Access, Action, and Attitudes. "The three prongs of the strategy are to increase patients' Access to their health information; to enable consumers to take Action with that information; and to shiftAttitudes so that patients and providers think and act as partners in managing health and health care using health information technology" (p. 378). Here are two good sources to share with your students:

* HealthIT Website for Patients and Families at www.healthit. gov/patients-families has a video on gaining access to one's health record as well as information on privacy and security, the Blue Button Campaign, and patient stories.

* American Health Information Management Association's My PHR ( aspx) offers a wealth of patient resources, including a video called "Understanding My Medical Record."

The concept of connected health is integral to the notion of providing accessible health information for patients and families. According to Caulfield and Donnelly (2013), "Connected Health encompasses terms such as wireless, digital, electronic, mobile, and tele-health ... designed around the patient's needs ... in such a way that the patient can receive care in the most proactive and efficient manner possible." In essence, patients, families, caregivers, and providers can share timely information "regarding patient status through smarter use of data, devices, communication platforms and people."

As a part of connected health, you should introduce students to the concept of mobile health (mHealth), defined by the World Health Organization (2011) as "medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices. [It] involves the use of voice and short messaging service (SMS) as well as more complex functionalities such as 3G systems, global positioning systems (GPS), and Bluetooth technology." (For additional resources, see Figure: Support for the Instructor.)


Start with a Contest

Have a contest in class. Ask students to use their smartphones, tablets, and laptops to find articles and examples of mhealth. Ask them to explore who uses smartphones to access health information. Ask them to see how many health apps they can find at the iTunes or Android stores.

After they find resources, ask students to dialogue about health literacy, disparities among segments in the patient population, their role in promoting the use of mhealth apps, and benefits and challenges for patients and providers. Set up a debate about the pros and cons of using mobile apps.

Accessing Apps

Have students access free health care apps from the Department of Health & Human Services at ( mobile/mobile-apps.html). This site offers apps from various agencies including the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), National Cancer Institute, and the National Library of Medicine (NLM). The apps are available for multiple operating systems across multiple devices and can be used in numerous classes. There are games, patient-related apps, and apps that provide instant access to resources and evidence-based preventive services for primary care patients.

Have students make recommendations for new apps or perhaps conduct a simple survey, posting the results to the webpage. Following is a just a sample of the apps that are available:

* 52 Weeks for Women's Health (NIH)

* Solve the Outbreak (CDC)

* Talking Glossary of Genetics (National Human Genome Research Institute, NIH)

* Prevent Group B Strep (GBS) (CDC)

* NLM Native Voices (NLM)

* MyFamily (

* MyMedList and Embryo (NLM)

* CDC Health-e-cards and FluView (CDC)

* Electronic Preventive Service Selector (ePSS) (Agency for Healthcare Research and Quality)

Judging Apps

After apps are downloaded, ask students to think about criteria they might use to judge an app. Remember how, in the old days, we would ask students to judge websites using certain criteria? Are there standards for assessing the quality of a mobile health care app for patients or for providers? Perhaps students, working in small groups during class, can adapt or develop criteria, test the criteria, and judge the apps they find for consumers.

The Digital Strategy website offers a wealth of information about strategies to meet the needs of people for better care, with numerous examples of websites and social media campaigns that can easily be used as classroom exercises. By bringing apps into the community, students can engage in service-learning projects and demonstrate the power of health IT tools to promote consumer engagement in personal care.

Here is one more exercise for mobile apps. Certain medical apps must be approved by the US Food and Drug Administration (FDA). As there are numerous parameters distinguishing apps that are regulated from those that are not, students can research the regulations, discuss the pros and cons, and debate whether or not the FDA or some other regulatory body needs to regulate all health care apps. This exercise will help students understand legislation and policies regarding regulatory bodies.

To learn more about the FDA and mobile apps, visit ConnectedHealth/MobileMedicalApplications/ucm368743.htm. To review a list of mobile medical apps approved by the FDA, go to ConnectedHealth/MobileMedicalApplications/ucm368784.htm.

I hope I have given you some useful ideas about engaging your Connected Age students as active and interactive participants in their learning. By putting mobile devices to good use in the classroom, students will spend less time on their social networks and more time on learning. Please let me know about the interactive work you are doing with mobile apps and devices in your classroom and I will compile a list to be shared in a future column. Write to me at Diane.Skiba@


Caulfield, B., & Donnelly, S. (2013). What is connected health and why will it change your practice? QJM: An International Journal of Medicine, 106(8), 703-707.

Duggan, M., & Smith, A. (2013, December 30). Social media update 2013 [PewResearch Internet Project]. Retrieved from

Fox, S., & Rainie, L. (2014, February 27). The Web at 25 in the U.S. [PewResearch Internet Project]. Retrieved from

IMS Institute for Healthcare Informatics. (2013, October). Patient apps for improved care: From novelty to mainstream. Retrieved from: Content/Corporate/IMS%20Health%20Institute/Reports/ Patient_Apps/IIHI_Patient_Apps_Report.pdf

McCoy, B. (2013, October). Digital distractions in the classroom: Student classroom use of digital devices for non-class related purposes. Journal of Media Education, 4(4), 5-14.

Nielsen (2013, October 29). Ring the bells: More smartphones in students' hands ahead of back-to-school season. Retrieved from www. in-students-hands-ahead-of-back.html

Nielsen. (2014, February 10). What's empowering the new digital consumer. Retrieved from whats-empowering-the-new-digital-consumer.html

Pew Research Internet Project. (2014, January). Mobile technology fact sheet. Retrieved from mobile-technology-fact-sheet/

Ricciardi, L., Mostashari, F., Murphy, J., Daniel, J., & Siminerio, E. (2013). A national action plan to support consumer engagement via e-health. Health Affairs, 32(2), 376-384. doi:10.1377/ hlthaff.2012.1216

Skiba, D. (2012). The Health IT Pledge. Nursing Education Perspectives, 33(5), 346-348. doi:10.5480/1536-5026-33.5.346

Skiba, D. (2013). Digital taxonomy: Evaluating and creating. Nursing Education Perspectives, 34(6), 428-429. doi:10.5480/1536-5026-34.6.428

Smith, A. (2014, February 3). 6 new facts about Facebook. [PewResearch Internet Project]. Retrieved from www.pewresearch. org/fact-tank/2014/02/03/6-new-facts-about-facebook/

World Health Organization. (2011). mHealth: New horizons for health through mobile technologies (Global Observatory for eHealth Series, Volume 3). Retrieved from publications/goe_mhealth_web.pdf

Diane J. Skiba, Editor

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Source: Nursing Education Perspectives

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