text: Gro Health is a world-leading behavioural change platform that is used to self-manage physical and mental health and wellbeing.
  The app and its contents has been co-developed with behavioural change experts (led by award-winning researcher Charlotte Summers), clinicians and healthcare professionals to ensure it meets the needs of service users.
  The app uses behavioural change techniques (such as goal setting, re-appraisal, human counselling and peer support) to encourage and reinforce particular behaviours. You can read more about the architecture and behavioural change techniques used within Gro Health, as it is built upon a proprietary peer-reviewed digital behavioural change framework.
  Evidence of the app's use and benefits
  Gro Health provides multi-platform access to remotely monitored (where delivered by clinical teams) structured education, behavioural change support and coaching.
  Users are able to log their health and food over time and connect with popular wearables and health services. Users can engage in a library of on-demand behaviour change programmes providing Cognitive Behavioral Therapy (CBT), Acceptance Commitment Therapy (ACT), Mindfulness Based Therapy (MBT), nuttrition plans and support, on-demand activities, sleep aids, mindfulness techniques and exercises, 360° immersive experiences and human 1-to-1 and group coaching for counselling and guidance.
  The app delivers therapeutic care in areas including nutrition and weight management, mental health, hypertension, sleep, and cardiovascular disease.
  Gro Health has published, peer-reviewed evidence demonstrating improvements in the symptoms of stress, anxiety and depression after 12 weeks of use. The nutrition stream of the program enables you to choose from a variety of evidence-based nutrition programmes demonstrated to support weight loss and improvements in glycemic control.
  Gro Health is a personalised health tool. This means it personalised the information, guidance and support you receive based on your health and preferences.
  Most people find Gro Health a useful tool to provide mental and physical health and wellbeing education, behavioural change support and coaching to support self-selected health goals.
  Gro Health is used to provide personalised treatment pathways for adults diagnosed with:
  - Pre-diabetes / diabetes prevention
  - Type 2 diabetes
  Gro Health is also used to support weight loss as a family wellbeing intervention to support improvements in mental and physical health.
  Contraindications (who should not use the app)
  Please speak to a healthcare professional before starting any change to your lifestyle. Please do not use the app if you have any of the following, unless at the referral/request of your healthcare professional:
  - Pregnancy or breastfeeding
  - History of eating disorders
  - Severe mental illness or cognitive impairment
  - Carnitine deficiency (primary), carnitine palmitoyltransferase (CPT) I or II deficiency, Carnitine translocase deficiency, beta-oxidation defects, medium-chain acyl dehydrogenase deficiency (MCAD), long-chain acyl dehydrogenase deficiency (LCAD), short-chain acyl dehydrogenase deficiency (SCAD), long-chain 3-hydroxyacyl-CoA deficiency, medium-chain 3-hydroxyacyl-CoA deficiency, pyruvate carboxylase deficiency
  Evidence base for the app
  The platform has been developed with people, patients, healthcare professionals and professional bodies from around the world and there are 5 research studies taking place on Gro Health currently. Read more about our research.
  Clinical and technical safety
  We are committed to clinical and technical excellence. Effective application of clinical risk management, clinical risk and safety is managed by the DDM's Clinical Safety Officer, an appropriate, practicing physician skilled and experienced to provide safety and governance. All clinical guidance and references within the platform are aligned to National Health and Medical Research Council (NHMRC) and/or nationally accepted guidelines. Citations for all claims are available on request.
  The service has been evaluated, approved and validated by the Clinical Team, led by the Clinical Safety Officer.
  - The Clinical Safety Officer for this intervention is Dr Peter Foley.
  - The Caldicott Guardian is Michaela de la Fosse.
  - The Data Protection Officer is Amar Singh.
  All can be contacted here.
  Communications and peer support
  All peer-to-peer communications (community, 1-to-1 coaching, comments) are moderated to ensure a safe, inclusive, 24/7 peer-to-peer community. A team of human operators are moderators of the forum. There are also algorithms/filters to prevent spam and/or offensive content. All communications within the platform are logged at event level and audited weekly. Some posts may be removed or hidden to ensure continuity of the service.
  Risk and hazard management process
  DDM is committed to clinical and technical safety. As ISO27001, ISO9000 and ISO20000 accredited providers, DDM has embedded management and clinical risk systems in place to ensure the technical security, clinical safety and quality of its systems and the data within it.
  All data collected, processed and stored is done so utilising AES-256 encryption in-transit and at-rest in the country of participant signup. The transfer of data is via network only Transfer Layer Security (TLS) 1.2 only. This includes the transmission of data from DDM services to its hosts (Microsoft Azure). Remote access to infrastructure holding data is monitored on a daily basis.
  DDM has a clinical risk measurement, evaluation and management process overseen by the Clinical Safety Officer. The risk/hazard assessment process follows DDM’s standard Clinical Risk Management System approach. Risks may also be identified in other ways during the development and use of the Gro Health such as discovery during design of a solution by supplier or NHS Organisation; participant engagement; feedback; in-app message; testing of amended functionality; ad-hoc testing of live service functionality; reporting of an incident or problem within the live service; and identification by a member of staff within the supplier or NHS Organisation. A full Hazard Log is maintained and updated by the Clinical Safety Team.
  For each identified hazard, the following information will be defined and recorded as: hazard number; name and description; potential clinical impact, possible causes and existing controls – these are identified existing controls or measures that are currently in place and will remain in place post-implementation that provide mitigation again the hazard, i.e. will be used as part of the initial Hazard Risk Assessment. Each Hazard is reviewed by the Clinical Safety Team and appropriate stakeholders to estimate and evaluate clinical risk and controls, and record the outcome. For each identified hazard, estimation is made of the clinical risk. The estimation process follows that established by the safety processes defined in SCCI 0129. All and any apps and/or products belonging to third parties that are included within a release must be assessed thoroughly.
  DDM continually monitors its services. The contents of the app are reviewed every month by the Clinical Safety Team, or as peer-reviewed evidence emerges. In-app telemetry and feedback sent to our support team (in-app or on the web) helps us to identify and address inequities and inequalities in engagement and/or health outcomes.
  Risks associated with the app
  Safety of apps is an emerging issue. DDM has conducted several studies and continues to research the benefits and risks related to app use.
  Unless you have been referred to the app by a qualified healthcare professional, do not use the app if you are diagnosed with any of the conditions listed under Contraindications.
  Please consult your doctor before using this app. The app is not intended to replace the relationship with your doctor/physician. Follow the advice of your doctor.
  Risks associated with the use of the app for participants with type 2 diabetes taking medications are hypoglycemia and tiredness. People with hypertension (high blood pressure) taking hypertensive medications may experience dizziness. Do not use the app if you are at risk of problems resulting from changes to your diet or activity. Risks identified by participants with polycystic ovarian syndrome are pregnancy. Risks identified for participants with long COVID are tiredness and fatigue; please go at your own pace and consult your doctor if you feel unusually tired.
  If you become pregnant while using the app, there may be implications on the way the app could help you. Please consult your healthcare professional.
  Blue light from phones and tablets can cause eye strain and speed up blindness. It's also not advised to stare at your phone in the dark. Try not to use your phone before bed. The blue light emitted by your phone can affect the production of the hormone which controls your sleep-wake cycle, or circadian rhythm. This can disrupt your sleep. Find more information in the Sleep area of the Gro Health app.
  Be aware that by using a mobile phone and holding it consistently in your hand, and when moving the thumb rapidly over the keypad can put a great deal of strain on tendons in the arm and cause repetitive strain injury (RSI).