Understanding Patient Behaviour Towards Digital Therapeutics

Are we, as patients ready to pay for an app which is intended for Therapeutic Purpose & Helping us manage our lifestyle better?

What a Patient Thinks

Ideation of this whole article took a shape while having a discussion with my father who is a Type 2 Diabetes patient. I was actually insisting him to install an app to better manage his lifestyle specifically the dietary recommendation (Since he is a banker by profession and also manages family business, day to day life is a complete mess) given by his doctor. Initially he was in agreement but when he asked me if there is any cost associated, I nodded yes. His decision changed immediately. According to him, he knows what to eat, what not to eat and on top of it, he is taking his medication (which he often forgets) so there is no need of a digital intervention. I tried to explain to him multiple times thereafter but all in vain. According to him, it’s just a waste of money.

Patient Compliance Behaviour: Medication vs Lifestyle Recommendation

This is the story of most Chronic Disease patients for whom managing their lifestyle is a crucial need. But it’s really sad to see the poor grades when it comes to be compliant of various lifestyle aspects. According to a study conducted among Indian diabetes patients, only 24.1% were aware and have been following self-blood glucose monitoring appropriately. Similarly, only 37% of the patients are adhered to the dietary prescription made by their physicians and only 35% follow up the physical exercise recommendations.

Why is it important to talk about “Patient’s Compliance Behaviour” before getting into the “Patient’s Commercial Behaviour”? The reason is that patients need a push specifically in case of chronic diseases because it’s all about care, whether it’s done by the patient himself or by a caregiver. In case of medication, the weightage is higher since it’s coming from doctors (with serious words) while in case of lifestyle, it comes as a recommendation rather than a prescription which defines the seriousness.

So, if a patient is serious enough about his disease condition and strictly follows the testing, medication and lifestyle modification, he/she doesn’t need any intervention, traditional or digital to manage his/her lifestyle but the statistics don’t reflect the same. Hence, it becomes important for patients who are not serious or moderately serious to keep engaged and motivated to adhere with the doctor’s recommendation via a push. Digital gives that push.

Now comes the commercial behaviour. There are hundreds of apps available in the market to manage your disease conditions. Some are freely available; some are coming complementary with the devices/treatment and for some, you have to lighten your pockets. Definitely the skewness is higher towards the free ones. Most of us preferred the free apps and uninstall any paid app when it asks for a payment after the trial period. But free apps have their own limitation and for better services/attributes or features, you have to pay. Same goes with the apps which are offering lifestyle management solutions for patients.

A Preliminary Investigation

To get a deeper understanding of patient’s behaviour, I conducted a small survey among diabetes patients. The survey designed on SurveyMonkey consists of 10 questions (5 open ended, 5 close ended) and shared on a few social media & chatting platforms such as Facebook, WhatsApp etc. The key questions are:

1. Patient’s Name
2. Age
3. Is he a diabetic patient?
4. If yes, is he using any online application to manage his Lifestyle?
5. Name of the app he is currently using
6. Is it a paid app?
7. Approximate cost of the app.
8. Will he pay for an app which promises to better manage lifestyle (in case the answer of Q6 is no)?
9. If yes, what is the approximate cost he will pay?
10. If no, why?

There were 43 responses received in total out of which 32 were diabetics. The outcome of the survey are as follows:

• ~80% of the total respondents are within the age group of 30 to 60 years
• Out of total diabetes patients, only 36% are using one or another app to manage their lifestyle
• Majority of the patients are using MySugar (45%) followed by Apollo Sugar (27%), GOQii (18%) and Wellthy (9%).
• Only 2 out of the total patients with diabetes who are using an app have paid some amount
• The approximate cost which they have paid is ~INR 2500
• 77% of the patients who are using an app (and answered no for Q6) are not ready to pay even if it provides a better solution, while only 23% are ready to pay.
• The approximate cost which most of the patients feel comfortable to pay is INR 100-200 per month.
• Free availability, YouTube videos, Advice by friends and family, waste of money etc. are some of the major reasons why people don’t want to pay for an app.

So, if we look closely, patients are quite ignorant when it comes to pay for an app. Reason, they consider it as a waste of money. This outlook needs to be changed. This perception needs to be changed. And it can only be changed when it comes as a prescription and not just a simple recommendation.

Conclusion

If a patient can spend ~INR 9,000 (from an analysis conducted by Lady Hardinge Medical College) annually for his diabetes treatment, he can definitely spend few hundred bucks to manage his lifestyle for better outcomes. But the patient also needs support from other industry stakeholders such as Pharma, Devices and payers so that the cost can be shared and patient will have to bear minimum cost burden.