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  • Adam Della Maggiora

Innovating Privacy to help the US Military Improve whole Health


Introduction

The U.S. military faces an ongoing crisis in keeping soldiers and veterans healthy (body, mind, AND spirit). According to the United Service Organization (USO), military suicide rates are four times higher than the deaths which occurred during military operations. Our warriors face mental and emotional health challenges that diminish fitness and readiness and reduce their quality of life afterward. To serve them better, our leaders need to know more about what makes a soldier happy, healthy, and strong.


The Life Aid Research Institute is a non-profit organization that has been running programs to improve the lives of soldiers, veterans, and first responders since 2008. The Institute's whole health approach combines the whole person into in-person programs and has transformed the lives of thousands of participants. With the success they found in their programs, they were asked how they could leverage technology to bring their program to the larger active duty and veteran communities.


Life Aid Discovers How to Serve the Broader Military

In 2021, Life Aid partnered with Avallano to develop LifeScore, an app to improve whole health while protecting the privacy of the soldiers that used it. Life Aid understood that the risk of a commander, employer, or family member finding out about sensitive issues often kept soldiers from sharing what was happening and seeking treatment or support. To learn about how mental health and spirituality impact well-being, the topics needed to be approached carefully and privately.


Through the app, soldiers identify their strengths and weaknesses in six key resilience areas: diet, use of medications and substances, physical fitness, sleep, spirituality, and state of mind. By using the information that soldiers shared anonymously, the app creates personalized recommendations on paths to improve specific aspects of where they scored low.


Thanks to the Avallano platform and its patent-pending blockchain-based privacy controls, commanders received comprehensive anonymous whole health data that helped them deploy targeted resources. They now had a reliable method to assess the needs and readiness of their troops without violating the trust of each service member. More importantly, each service member could not self-identify concerns and get treatment for maladies they previously would not have revealed.


Innovative Privacy is the Quickest Path to Self Care

Through app pilots with veterans and active duty military, participants shared sensitive information honestly that they would have previously not exposed to command or management:


  • 42% of participants opted to answer questions about their core beliefs & values

  • 48% opted-in on questions about activities that build spirit

  • 62% shared information about their self-image

  • 88% chose to answer questions about psyche-impacting service history, such as whether they had used deadly force in combat.


As one pilot participant put it, "Knowing that I can be honest with myself about what I’m struggling with, and not worry about what my peers or commander think of me, is a big part of why I think the app will help me."


We learned that you could not over-educate the soldier on how the application protects their identifying information. The more we educated soldiers, the more they shared, which meant the more they could discover and seek relevant treatments they previously were unaware of.


We also saw that plain-english questions about people’s lived experiences were more effective than questions that asked them to analyze themselves. When the Life Aid Research Institute asked questions like “how many hours did you sleep last night,” or "did you spend time with family this week," the rate of response was higher than when we asked questions about how they perceived their relationships with family members or what they thought of themselves.


Similarly, when asking a mix of questions, respondents remained engaged rather than abandoning the app partway through the questioning. This indicates that asking questions about symptoms or behaviors that impact or are impacted by someone’s state of mind or spiritual health may give researchers more insights than directly asking about the state of mind. A soldier is less inclined to think of themselves as depressed even if they have not spent any time pursuing activities that build morale and spirit. Still, they are likely to accurately self-report their time spent pursuing those activities.


Participation was highest when respondents saw "real-time" rewards for participation. The LifeScore app leveraged a whole health score which acted like a "credit score” for their life. The participant was rewarded immediately with updated scoring, personalized recommendations, and badges. The score became a big social component in our trials: soldiers compared notes and tried to one-up each other by showing they were on a “healthier” path. Watching soldiers compete with each other to develop strategies for sleep quality, improved state of mind, and total fitness indicated that a ‘network effect’ driven by safe sharing and “ethical gamification” improves adoption and sustained engagement.


Applying LifeScore Findings to Clinical Trials

We discovered how to provide engaging interactions that help communities of users self-identify interest in a clinical trial. We learned that educational assets like provider briefings and video content from familiar faces (physicians, advocates, influencers) increase participant comfort with the privacy protections and focus on self.


Asking easy-to-understand questions about behaviors and lived experiences were more effective for helping patients assemble a profile that matches them to the right trials and therapies. This is a vast improvement over today’s “tokenized registry” approach used for clinical trial recruitment.


Given some of the vulnerable communities in the LifeScore Pilot, we observed how these methods might help reduce stigma and mistrust from underserved communities (minorities, native peoples, LGBTQ+, and even veterans). We will continue to conduct studies to further understand how to apply these learnings to address Diversity, Equity, and Inclusion.


By bringing Avallano’s cloud and experience in creating consumer-grade applications, we were able to help the Life Aid Research Institute further their mission to improve the health and lives of our military. If we apply these learnings to clinical trial recruitment, Avallano and its partners ultimately reduce the cost and time to recruit participants.


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