Historically, the consumer space in digital health has been one of the most challenging categories for investors, including Rock Health. Thousands of people have been surveyed in search of reliable data representing the entire U.S. adult population. The aim of the study was to answer to several key questions: what are the current market penetration rates for the major digital health categories, what are the primary demographic and attitudinal drivers of adoption, what is consumers’ attitude toward data privacy and who do consumers trust in terms of sharing health data? The report presents data from the most recent survey conducted this summer which included over 4000 respondents (original report).

The results may surprise you. We often hear clichéd opinions that people who are interested in digital health are young, educated, rich and, on the whole, healthy. Instead, the study has found that, on the contrary, it was the attitude toward health (sense of responsibility, self-discipline and being ready to pay out of their own pocket) which was the decisive factor. People who had health problems were more willing to make that choice. Adoption of digital medicine reflects the general adoption of new technology.

About 50% of Americans used only one digital medicine category, or none at all. But the need to engage consumers in healthcare is as strong as ever.

Survey overview

The survey of digital medicine consumers covered 6 major digital health technology technologies and attitudes toward data privacy and sharing within the healthcare system.

Overview

  • All questions and materials used in the survey have been devised by Rock Health.
  • The audience of the survey was internet-connected adult Americans.
  • The survey was less than 15 minutes long and the questions were divided into three main sections: demographics, attitudes, preferences and adoption trends.
  • Respondents answered 101 questions. The question formats ranged from multiple choice to open responses.

Demographics

  • Basic demographic questions (sex, age, income, education, employment, occupation etc.)
  • Health status (insurance coverage, self-reported state of health, number of prescription drugs, number of hospitalizations, number of chronic diseases, and number of doctor visits)
  • Technology adoption (e.g., smartphone user, active app user, social media user).

Digital health adoption

  • Adoption levels of online health information.
  • Adoption levels of online reviews of healthcare services.
  • Adoption levels and mediums of tracking health factors.
  • Adoption levels, recency of purchase, plans to purchase wearable devices.
  • Adoption levels plans to use, and satisfaction rates for genetic-based services.
  • Adoption levels, plans to use, and satisfaction rates for telemedicine services.

Attitudes and preferences

  • Agreement with data privacy and sharing scenarios (i.e., sharing health data in specific use cases).
  • Willingness to share health data with industry stakeholders for a range of health data types.
  • Level of trust.

Adoption

The primary objective of the survey was to test the current penetration of six core digital health categories that operate within B2C market contexts.

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Source: Rock Health survey data (n = 4017).

There are a number of digital health companies working to redefine the way consumers interact with the healthcare system. These companies are attempting to establish direct to consumer business models and fall into six overarching categories: online health information (e.g., WebMD), online health reviews (e.g., ZocDoc), mobile health tracking (e.g., MyFitnessPal), wearables (e.g., Fitbit), consumer-driven genetic services (e.g., 23andMe), and telemedicine (e.g., Doctor on Demand). These categories represent key parts of the consumer lifecycle in healthcare, from understanding their own conditions and finding a physician, to proactively tracking their health.

80% of Americans have used at least one of the digital health categories studied in this survey. 48% have used zero or exactly one of the technologies listed. Only 2% of respondents have used five or six of the technologies. Searching online for health information is the most well-adopted digital health category.

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The survey looked at historical searching for specific health categories, including: diagnosis (based on symptoms), treatment options (based on a diagnosis), prescription drug information, and supplement information. Overall, 71% have previously searched online for these types of information.

However, when asked to force rank the trustworthiness of health information sources, consumers ranked health websites, mobile health apps, and social media/online communities behind physicians and friends/family. Health information websites still need to do significant work to improve their general trustworthiness, beginning with adding minimal personalization and context for consumers.

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The survey also assessed whether consumers had ever sought reviews across four separate categories (physicians, hospitals, nursing homes, and caregivers). Across all categories, approximately 50% of respondents sought online reviews, more than half of which (in aggregate) used the reviews to make selection decisions.

Those who had selected based upon reviews were asked to indicate which of seven characteristics (quality of care, customer comments, location, what insurance they accept, appointment availability, ease of scheduling, and price) had been most helpful in terms of making a decision. The answers indicate that consumers are heavily leaning on the information they have been previously trained to seek in reviews: quality (think of the Amazon star rating) and customer comments (think of Amazon customer reviews). Price was a non-factor, likely due to unavailability of information.

With the exception of physical activity, more consumers are currently tracking key health factors on paper or in their heads than with mobile applications.

17% of Americans who participated in the survey are currently tracking a key health factor in a mobile application, but a significant number of respondents still tracks key health factors without using technology. However, it is obvious that the factors which currently dominate in paper tracking (weight and blood pressure) are the most likely to shift towards mobile-based tracking.

Physical activity was the sole health factor that more people tracked in a mobile app than on paper or in their heads. It is likely that motion sensors embedded in the vast majority of smartphones have played a major role in that. Despite the lack of interest in heart rate tracking, it is reasonable to expect the proliferation of fitness trackers to push the percent tracking on mobile to grow quickly.

Nearly two-thirds of Americans are purchasing smart devices for themselves, with most citing the factors of being active or losing weight. The demographics of wearable owners have begun to shift: Recent purchasers are more likely to be unhealthy, including high rates of hospitalization, countering the popular narrative of only healthy individuals purchasing wearables.

While consumer-driven adoption of genetic services is relatively low, satisfaction is high and many consumers are considering using these services in the future.

Usage of telemedicine is highest amongst the 35-54 age bracket. All respondents report high satisfaction.

Telemedicine (across email, text, and video channels) was the only individual digital health category that showed significant differences in adoption based upon age. Younger and older individuals tend to adopt at lower rates than middle-aged individuals. This suggests that those who have had limited interaction with the healthcare system (the young) and generally lower technology penetration (the old) are less inclined to explore this new method of receiving healthcare services.

Telephone is the preferred medium for telemedicine across both urgent and non-urgent use cases, although video ranks higher amongst those who have previously used it.

When asked to force rank the various potential mediums for a telemedicine encounter, consumers overwhelmingly prefer phone (a non-digital medium) in both cases. Preference for phone-based telemedicine, particularly in non-urgent use cases, appears to be an artifact of video being a nascent technology.

Wearables and telemedicine are set to be the fastest growing digital health markets in the near-term, with many also considering tracking health on their phone.

When non-adopters were asked whether they planned to adopt digital health technologies, consumers responded most favorably to telemedicine (100% adoption growth) and wearables (40%). This suggests that these two categories are likely to grow the fastest over the coming year.

Drivers

While 52% of consumers strongly agree that they are responsible for their own health, only 7% would say the same about their willingness to pay out-of-pocket for healthcare.

While consumers generally feel responsible for their health and many are actively taking care of their health, less than 10% strongly agree with the concept of paying for health care expenses out-of-pocket, creating significant challenges for B2C businesses in digital health.

Three attitudinal questions around how consumers perceive their relationship to healthcare were used to composite a “consumer index score.” 45% of respondents strongly agreed with at least two out of the three attitudinal questions and were considered to score “high” on the composite consumer index. All other respondents (55%) were classified as “low” on the index.

Demographic variables including gender, age, income, and education were not found to have a statistically significant effect on adoption of digital health, except in a few specific cases. High income was a predictor of mobile health tracking adoption, and age/gender were both predictors of telemedicine adoption.

Adoption rates were reviewed at the intersection of self-reported health status and consumer index. The largest segment of the population (healthy and low consumer index, 34%) are the slowest adopters of digital health, while the smallest segment (unhealthy and high consumer index, 14%) are the fastest adopters.

Privacy and data

While consumers vehemently agree that they should be in control of health data access, the majority are willing to share data for personal and public health.

Consumers’ attitudes towards privacy demonstrate that there are no material concerns with sharing data under specific use cases, including for improved care (80%), medical research (59%), and discounts on premium insurance (52%). Almost 40% of consumers indicated they would even be open to sharing their health data for money. However, they overwhelmingly (90%) agree or strongly agree that they should be in control of who has access to their health data.

This suggests that what is important to consumers is control and governance over their own data. These attitudes reflect Apple’s health data strategy, which places control in the hands of consumers — they are responsible for provisioning access to specific data elements to specific apps. Attitudes towards data sharing were found to be highly correlative with adoption of digital health technology.

Physicians remain at the center of data in the context of healthcare, with consumers more willing to share their information with them than anyone else.

Methodology

Survey demographics

  • Qualifying population: Individuals with personal internet access, either at home, work or via their mobile phones with the incidence rate of 90%. Additional screening was based on demographic requirements.
  • Demographic breakdown: n = 4017. Respondents were a nationally representative population based on U.S. Census percentages for sex, age, and region.
  • Survey timing: The full launch of the survey began on July 7, 2015 and ended on August 28, 2015.

Data quality

  • Respondent quality: third-party data sources including the U.S. Postal Service and telephone directories were used to select respondents. Additionally, digital fingerprinting technologies were used to ensure there are no duplicate respondents.
  • Response quality: for questions surrounding mobile health tracking, wearable devices, genetic services, and telemedicine, free response qualifying questions were used to validate whether a respondent had truly adopted the technology. All free responses were reviewed and coded by Rock Health —respondents with invalid answers were not included in overall adoption metrics.

Survey design and analysis

  • Survey design: Rock Health conceived and wrote all questions and materials used in the survey. To ensure best practice survey techniques were used, Rock Health employed Toluna’s internal questionnaire review team.
  • Survey analysis: Findings from the data were based on internal analyses conducted in R.

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