Guidance

Recommendations

Recommendations

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.

Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity) and safeguarding.

1.1 Developing digital and mobile health interventions

These recommendations support adopting healthy behaviours in the health and lifestyle areas covered in this guideline (eating more healthily, becoming more active, stopping smoking, reducing alcohol intake, practising safer sex).

1.1.3

When designing digital and mobile health interventions, use evidence-based behaviour change techniques that help people start and maintain changes. These include: goals and planning, feedback and monitoring, and social support (see NICE's guideline on behaviour change: individual approaches).

1.1.4

Consider designing interventions that allow the user to tailor goals to their own needs.

1.1.5

Do not develop interventions or components that allow people to set unhealthy or dangerous goals, for example goals that would lead to the person being underweight.

1.1.6

Design interventions so they have the flexibility to be:

  • scaled up

  • customised for local needs and use.

1.1.7

Make information available about:

  • how users can check and set preferences for how their personal information and data may be used

  • when the intervention is likely to use mobile data, and how much mobile data it is likely to use

  • any additional costs

  • terms and conditions.

1.1.8

When developing digital and mobile health interventions, involve a wide range of stakeholders, including potential users, as early as possible and throughout development to:

  • Develop and review the content, structure, interface and flow of the intervention.

  • Identify the best digital platforms for the target population.

  • Identify and address any aspects of the intervention that may unintentionally increase inequity and digital exclusion.

  • Discuss and ensure that users understand who the intervention is for, which behaviour it is trying to change, its aims, any possible harms, the time needed to establish behaviour change and how frequently users are likely to interact with the intervention.

1.1.9

Use feedback from testing and after releasing the intervention to continually improve the intervention.

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on developing digital and mobile health interventions.

Full details of the evidence and the committee's discussion are in evidence review A: smoking behaviour, evidence review B: alcohol, evidence review C: diet, physical activity and sedentary behaviour and evidence review D: sexual health behaviour.

1.2 Commissioning digital and mobile health interventions

These recommendations support adopting healthy behaviours in the health and lifestyle areas covered in this guideline (eating more healthily, becoming more active, stopping smoking, reducing alcohol intake, practising safer sex).

1.2.2

If commissioning digital and mobile health interventions, do this as a supplement to existing services, not as a replacement.

1.2.3

Assess whether specific digital and mobile health interventions could meet some of the needs of the local population by using a needs assessment, including the need to address digital exclusion.

1.2.4

Check expert sources (such as the NHS apps library) for any existing evidence-based digital and mobile health interventions that can meet local needs. Do this before commissioning the development of a new one.

1.2.6

If a new digital and mobile health intervention is needed, assess whether a local-level multidisciplinary collaboration, or partnerships with other health and care organisations, would be appropriate to share development costs.

1.2.7

When commissioning digital and mobile health interventions, take into account equality of access as part of an equality impact assessment. For example:

  • anything that might limit usability of the intervention (such as literacy, sensory impairments and language barriers)

  • potential related costs for users (such as cost of apps and data usage)

  • availability of the necessary hardware and operating system

  • access to the internet, phone signal and data networks (for example in rural communities, closed institutions and detention settings)

  • protected characteristics and levels of deprivation.

1.2.8

Be aware that interventions without adverts are preferable, but interventions with adverts may help reduce costs for users.

1.2.9

Do not commission digital and mobile health interventions that are funded or developed by the tobacco industry.

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on commissioning digital and mobile health interventions.

Full details of the evidence and the committee's discussion are in evidence review A: smoking behaviour, evidence review B: alcohol, evidence review C: diet, physical activity and sedentary behaviour and evidence review D: sexual health behaviour.

1.3 Using digital and mobile health interventions

These recommendations support adopting healthy behaviours in the health and lifestyle areas covered in this guideline (eating more healthily, becoming more active, stopping smoking, reducing alcohol intake, practising safer sex). These are to support healthcare professionals.

1.3.2

When discussing the use of a digital or mobile health intervention with the person, take into account:

  • their preferences and behaviour change goals, and interventions that allow tailoring towards these

  • their capability, opportunity and motivation for change

  • their digital, health and reading literacy

  • the digital platforms available

  • the aim of the intervention

  • how frequently and intensely they are willing to use interventions

  • that some interventions may not have evidence of effectiveness

  • how it would fit into their current care pathway.

1.3.3

Advise people who may use a digital and mobile health intervention to:

  • use one from an expert source if available (such as the NHS apps library) because it is likely to have been assessed for safety, effectiveness and data security

  • check and set preferences for how their personal information and data may be used

  • be aware of any possible extra costs

  • check they are willing and able to pay any associated costs

  • be aware that the intervention may use mobile data after it is downloaded

  • seek advice from a healthcare professional if they have health concerns while using the intervention

  • read the terms and conditions.

1.3.4

When advising on the use of a digital and mobile health intervention, take into account whether the content is appropriate for the user and any possible adverse effects. For example, whether the intervention could:

  • lead to people self-managing with digital interventions when their behaviour could be more effectively modified with existing health or social care services that involve clinical expertise, face-to-face interaction or treatment

  • prevent vulnerable people from accessing face-to-face services and interventions

  • have components that could encourage the person to adopt unhealthy behaviours, such as excessive exercise or disordered eating

  • have a negative impact on some people's mental health, possibly from using social media components

  • increase anxiety about health and lead people to consult healthcare professionals more often.

For a short explanation of why the committee made these recommendations and how they might affect practice, see rationale and impact section on using digital and mobile health interventions.

Full details of the evidence and the committee's discussion are in evidence review A: smoking behaviour, evidence review B: alcohol, evidence review C: diet, physical activity and sedentary behaviour and evidence review D: sexual health behaviour.

1.4 Diet and physical activity

1.4.1

Consider digital and mobile health interventions as an option for people who would benefit from improving their diet or increasing their physical activity levels as an adjunct to existing services. Be aware that their effectiveness is variable.

1.4.2

Advise people to use digital and mobile health interventions that include self-monitoring, such as recording by activity trackers, or food or physical activity diaries. This can help the person to review their own progress towards their diet or physical activity goals.

1.4.3

If you are aware that the person is at risk of developing or resuming an eating disorder or another unhealthy behaviour such as excessive exercise, consider interventions that do not include self-monitoring.

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on diet and physical activity.

Full details of the evidence and the committee's discussion are in evidence review C: diet, physical activity and sedentary behaviour.

1.5 Smoking

1.5.2

Advise the person who wants to stop smoking using a digital or mobile health intervention that text message-based interventions with tailored messages may be more effective than other digital and mobile health interventions.

1.5.3

Do not offer digital and mobile health interventions that are known to be funded or developed by the tobacco industry.

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on smoking.

Full details of the evidence and the committee's discussion are in evidence review A: smoking behaviour.

1.6 Alcohol use

1.6.2

Advise the person that some interventions may include particular components that suit them better and reduce their alcohol intake more than other components. For example, a component that compares the person's intake with that of their peers (a personalised normative feedback approach).

1.6.3

Advise the person that interventions they interact with multiple times may be better than a one-off intervention, but a one-off intervention is better than no intervention at all.

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on alcohol use.

Full details of the evidence and the committee's discussion are in evidence review B: alcohol.

1.7 Unsafe sexual behaviour

1.7.1

Consider online brief interventions as an option to help reduce unsafe sexual behaviour as an adjunct to existing services. Be aware that their effectiveness is variable.

1.7.2

If advising people to use online brief interventions, consider ones that include videos with set choice points, scripted scenarios or dramatisation.

1.7.3

When advising on the use of online brief interventions, tell the person that some may have sexually explicit content.

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on unsafe sexual behaviour.

Full details of the evidence and the committee's discussion are in evidence review D: sexual health behaviour.

Terms used in this guideline

This section defines terms that have been used in a particular way for this guideline. For other definitions see the NICE glossary or, for public health and social care terms, the Think Local, Act Personal Care and Support Jargon Buster.

Choice points

In an interactive scripted scenario, choice points give the person using the intervention options on what the character should do next at key moments. This models how the person would react in a similar situation in real life, and the consequences of their actions. The intervention can give feedback on how choosing differently may help them change their behaviour.

Characteristics

A characteristic is an attribute that applies to the whole intervention. For example, how often it will be performed, or if it is specific for a group with a certain condition.

Components

A component is one part of an intervention. For example, a diary that people can use to track their eating habits. Interventions can be made up of many components.

Digital and mobile health interventions

Digital health interventions are delivered through: hardware and electronic devices, such as smartwatches; software, such as computer programs or apps; and websites. Mobile health interventions can be delivered through phones, for example by texts, apps or interactive voice response calls. These technologies can deliver interventions independently from healthcare professionals, or healthcare professionals can use them to deliver interventions remotely. This guideline covers digital and mobile health interventions delivered by the technology itself and not by healthcare professionals using technology to deliver interventions.

Digital exclusion

Digital exclusion describes circumstances in which people are unable or do not want to use digital services. This may be because of a lack of digital skills, confidence, motivation or internet access, or the services may not be accessible. See the NHS information on digital exclusion.

Digital platforms

Examples include apps, computer programs, websites, smartwatches, interactive voice response systems, or texts.

Disordered eating

Disordered eating describes a range of irregular eating behaviours. These can include symptoms that reflect many but not all of the symptoms of eating disorders, such as anorexia nervosa, bulimia nervosa and binge eating disorder. Examples of disordered eating include fasting or chronic restrained eating, skipping meals, binge eating, self-induced vomiting, restrictive dieting, and laxative or diuretic misuse.

(For further information on eating disorders refer to the NHS information on eating disorders.)

Excessive exercise

Exercising more than is recommended if it is detrimental to the person's mental, social or physical wellbeing.

Scaled up

Technology needs to be designed so it has the ability to cope with an increasing number of people or organisations using it across different parts of the country. The digital architecture must be able to support this. How the technology is supported and regulated is different when more people are using it. An intervention that supports few people in one region is a smaller scale intervention than one that supports more people across multiple regions.