Dose Response in Digital Health Interventions

person using smartphone
Photo by Adrienn on


Using digital health apps to monitor, track, and support behavior change is table-stakes for most app companies these days. I have a few criticisms about how this space is evolving, one is using apps gives you LOTS of data but rarely insights on what patterns mean and how you could change them to improve your success rate with whatever the behavior of focus is. My second criticism is too little of the science of behavior change is represented in how the user experience gets designed and executed. All too often, companies copy one sticky aspect like gamification but don’t evolve beyond that. Using streaks us also popular, but when people lose a day, it ends up being a demotivator and can even as a negative reinforcement for the very behavior you signed up to change. Some companies allow you to “pay” to reinstate your streak- is this the direction we should be going in?

A new paper from Megan McVay and colleagues published in Health Psychology examines the dose-response research as it relates to digital health interventions. In face-to-face interventions, health coaches registered dietitians, and other behavior change experts pace the lessons by breaking down target actions to support successful behavior change and address any issues people may have with making changes.

That can be initially harder to do in an app setting. Still, once someone exchanges information, like the number of steps, walked, sleep quality, heart rate, food intake, etc. it can be compelling to deliver insights in real-time so adjustments can be made. A lot of this can also be achieved with passive tracking, so it reduces the burden on the end-user. 

Think about any medication you take? If you took half or a quarter of a pill, do you think it would get you the desired outcome? Behavioral interventions are no different- eating a salad once a month is better than no salad but not likely to get you to a healthier nutritional profile that takes repeated exposures to leafy greens!

The authors call for a mapping of digital health interventions, so at the very least an app-based intervention can deliver maximally effective digital health interventions. They define dose as “how much intervention has been delivered and received.” The dose would also encompass the frequency, intensity, and duration of the intervention. 

The diagram below is a great illustration of the relationships between intervention and participant actions, how they both contribute to focusing on the target behavior, and what path must be reliably taken to achieve clinical outcomes. In the digital space, many more translation studies need to happen to translate mechanisms of action in a class setting with particiapants into an app setting. The upside of digital is continuous data collection can inform a theoretical dose of interventions against real-world doses. There is so much complexity yet to be mapped, and new models can emerge once more rigor of translating evidence-based interventions into apps is applied versus some of the scattershot we see in solutions. 


Screenshot 2019-10-23 10.00.45

Source: PMID:31580127DOI:10.1037/hea0000805

The scientific community and funders of tech solutions need to be sitting at tables with much greater frequency at all stages of product development so early products can demonstrate value earlier in their funding cycles, and health care consumers can get value for money sooner. The time is ripe to move beyond the hype.


Thanks for reading – Trina

(Opinions are my own)




Dose-Response research in digital helath interventions:  concepts, considerations, and challenges.

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