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Frith J, Robinson L, Gibbon JR, Allen J. The effect of lower limb strengthening exercise on orthostatic blood pressure and the skeletal muscle pump in older people with orthostatic hypotension. Clin Physiol Funct Imaging 2024; 44:205-210. [PMID: 37975574 DOI: 10.1111/cpf.12866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/24/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Activation of muscles during standing is recommended to activate the skeletal muscle pump, increasing venous return and increasing blood pressure (BP) in people with orthostatic hypotension (OH). AIM The aim of this study is to determine if increasing the strength of the lower limb muscles can improve the effectiveness of the venous pump and postural BP in older people with OH. METHODS Ten older people with OH underwent an 8-week lower limb strengthening intervention. Repeated measurements of orthostatic BP, calf venous ejection fraction (EF) and muscle strength took place before, during and after intervention. RESULTS The intervention increased calf muscle strength by 21% (interquartile range: 18-28), p = 0.018, from a median baseline of 38 (34-45) kg. Participants had normal levels of venous EF 64% (51-75) at baseline, with little to no venous reflux. The median ejection volume at baseline was 44 (36-58) mL per calf. Despite increasing muscle strength, venous EF did not increase (percentage change -10% (-16 to 24), p = 0.8) and systolic BP drop did not improve (percentage change 0% (-17 to 16), p = 1.0). Similarly, visual analysis of individual case-series trends revealed increasing muscle strength with no clinically meaningful change in EF or orthostatic BP. CONCLUSIONS Muscle strengthening exercise does not increase the effectiveness of the skeletal muscle pump and is not an efficacious intervention for OH. As there is little to no venous pooling in the calf during standing in older people with OH, below knee compression is unlikely to be clinically effective.
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Affiliation(s)
- James Frith
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Falls and Syncope Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lisa Robinson
- Rehabilitation Department, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Jake Ryan Gibbon
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John Allen
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Medical Physics, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Demirel S, Roke Y, Hoogendoorn AW, Hoefakker J, Hoeberichts K, van Harten PN. Assessing the Effectiveness of STAPP@Work, a Self-Management Mobile App, in Reducing Work Stress and Preventing Burnout: Single-Case Experimental Design Study. J Med Internet Res 2024; 26:e48883. [PMID: 38275128 PMCID: PMC10940977 DOI: 10.2196/48883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 12/06/2023] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Work-related stress and burnout remain common problems among employees, leading to impaired health and higher absenteeism. The use of mobile health apps to promote well-being has grown substantially; however, the impact of such apps on reducing stress and preventing burnout is limited. OBJECTIVE This study aims to assess the effectiveness of STAPP@Work, a mobile-based stress management intervention, on perceived stress, coping self-efficacy, and the level of burnout among mental health employees. METHODS The study used a single-case experimental design to examine the use of STAPP@Work among mental health employees without a known diagnosis of burnout (N=63). Participants used the app for 1 week per month repeatedly for a period of 6 months. Using a reversal design, the participants used the app 6 times to assess replicated immediate (1 week after use) and lasting (3 weeks after use) effects. The Perceived Stress Scale, the Coping Self-Efficacy Scale, and the Burnout Assessment Tool were used to measure the outcomes. Linear mixed models were used to analyze the data. RESULTS After 6 months of app use for 1 week per month, the participants showed a statistically significant decrease in perceived stress (b=-0.38, 95% CI -0.67 to -0.09; P=.01; Cohen d=0.50) and burnout symptoms (b=-0.31, 95% CI -0.51 to -0.12; P=.002; Cohen d=0.63) as well as a statistically significant improvement in problem-focused coping self-efficacy (b=0.42, 95% CI 0-0.85; P=.049; Cohen d=0.42). Long-term use of the app provided consistent reductions in burnout symptoms over time, including in the level of exhaustion and emotional impairment. CONCLUSIONS The use of an app-based stress management intervention has been shown to reduce burnout symptoms and enhance coping self-efficacy among mental health workers. Prevention of burnout and minimization of work-related stress are of utmost importance to protect employee health and reduce absenteeism.
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Affiliation(s)
- Sevda Demirel
- Expertise Center for Autism Spectrum Disorder, GGz Centraal, Almere, Netherlands
| | - Yvette Roke
- Expertise Center for Autism Spectrum Disorder, GGz Centraal, Almere, Netherlands
| | - Adriaan W Hoogendoorn
- Department of Psychiatry, Amsterdam Universitair Medische Centra, Amsterdam, Netherlands
- Mental Health Program, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | | | - Kirsten Hoeberichts
- Expertise Center for Autism Spectrum Disorder, GGz Centraal, Almere, Netherlands
| | - Peter N van Harten
- Department of Psychiatry, GGz Centraal, Amersfoort, Netherlands
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
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Dangare M, Yadav V. Gaming on an Immersive Virtual Reality Platform to Ameliorate the Level of Anxiety in Patients Undergoing Congenital Heart Disease. Cureus 2023; 15:e50694. [PMID: 38234943 PMCID: PMC10792342 DOI: 10.7759/cureus.50694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/17/2023] [Indexed: 01/19/2024] Open
Abstract
The double outlet right ventricle (DORV) is an unusual cardiovascular abnormality that is present at birth. The pulmonary artery and the aorta, the cardiovascular system's two major arteries, link to the right ventricle in the DORV. The coronary artery links to the right ventricular, while in an ideal heart, the aorta connects to the left ventricle. DORV is an issue as the right ventricle delivers blood that is low in oxygen, subsequently distributed all around the human being. DORV is always connected with a further cardiac ailment known as a ventricular septal defect (VSD). Behavioral issues are quite prevalent in children. Emotional-obsessive-compulsive disorder, sadness, stress, social fear, and developmental problems are among them. Virtual reality (VR) is a stimulating experience that uses position tracking and three-dimensional (3D) near-eye presentation to give the participant a realistic view of a virtual environment. VR applications involve enjoyment (especially video games). A nine-year-old female complained of a tingling sensation over her right palm. She also had right-side weakness and convulsions, which were restricted to the dominant side. After investigation and evaluation of the condition, it is a known case of congenital heart defects and was planned for surgical correction. The study aims to provide information on an instance of DORV, transposition of great arteries, VSD, and pulmonary stenosis with resolved brain abscess by giving VR video games to reduce anxiety in patients undergoing an operation.
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Affiliation(s)
- Mansee Dangare
- Cardiovascular and Respiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vaishnavi Yadav
- Cardiovascular and Respiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Hornstra R, Onghena P, van den Hoofdakker BJ, van der Veen-Mulders L, Luman M, Staff AI, van der Oord S. Components of Behavioral Parent Training for Children With Attention-Deficit/Hyperactivity Disorder: A Series of Replicated Single-Case Experiments. Behav Modif 2023; 47:1042-1070. [PMID: 37056055 PMCID: PMC10403966 DOI: 10.1177/01454455231162003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Behavioral parent training (BPT) is an evidence-based treatment for children with attention-deficit/hyperactivity disorder (ADHD). Stimulus control techniques (antecedent-based techniques, e.g., clear rules, instructions) and contingency management techniques (consequent-based techniques, e.g., praise, ignore) are the most common ones that are being taught to parents in BPT. However, research into the additive effects of these techniques is scarce. In this replicated single-case experimental ABC phase design, including six children on stable medication for ADHD (8-11 years) and their parents, the added efficacy of consequent-based techniques on top of antecedent-based techniques was evaluated. After a baseline period (phase A), we randomized the commencement time of two sessions parent training in antecedent-based techniques and two sessions parent training in consequent-based techniques for each child. Children's behaviors were assessed by daily parent ratings of selected problem behaviors and an overall behavior rating. Although visual inspection showed that behavior improved for most children in both phases, randomization tests did not demonstrate the added efficacy of the consequent-based techniques on top of the antecedent-based techniques. Limitations of the study and recommendations for future single-case experiments in this population are discussed.
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Affiliation(s)
- Rianne Hornstra
- University of Groningen, University Medical Center Groningen, The Netherlands
- Accare Child Study Center, Groningen, The Netherlands
- University of Groningen, The Netherlands
| | | | - Barbara J. van den Hoofdakker
- University of Groningen, University Medical Center Groningen, The Netherlands
- Accare Child Study Center, Groningen, The Netherlands
- University of Groningen, The Netherlands
| | - Lianne van der Veen-Mulders
- University of Groningen, University Medical Center Groningen, The Netherlands
- Accare Child Study Center, Groningen, The Netherlands
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Manolov R, Onghena P. Defining and assessing immediacy in single-case experimental designs. J Exp Anal Behav 2022; 118:462-492. [PMID: 36106573 PMCID: PMC9825864 DOI: 10.1002/jeab.799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/24/2022] [Accepted: 08/28/2022] [Indexed: 01/11/2023]
Abstract
Immediacy is one of six data aspects (alongside level, trend, variability, overlap, and consistency) that has to be accounted for when visually analyzing single-case data. Given that it is one of the aspects that has received considerably less attention than other data aspects, the current text offers a review of the proposed conceptual definitions of immediacy (i.e., what it refers to) and also of the suggested operational definitions (i.e., how exactly is it assessed and/or quantified). Provided that a variety of conceptual and operational definitions is identified, we propose following a sensitivity analysis using a randomization test for assessing immediate effects in single-case experimental designs, by identifying when changes were most clear. In such a sensitivity analysis, the immediate effects are tested for multiple possible intervention points and for different possible operational definitions. Robust immediate effects can be detected if the results for the different operational definitions converge.
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Affiliation(s)
- Rumen Manolov
- Department of Social Psychology and Quantitative Psychology, Faculty of PsychologyUniversity of Barcelona
| | - Patrick Onghena
- Faculty of Psychology and Educational Sciences, Methodology of Educational Sciences Research GroupKU Leuven – University of LeuvenLeuvenBelgium
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Epstein LH, Dallery J. The Family of Single-Case Experimental Designs. HARVARD DATA SCIENCE REVIEW 2022; 4:10.1162/99608f92.ff9300a8. [PMID: 36926648 PMCID: PMC10016625 DOI: 10.1162/99608f92.ff9300a8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Single-case experimental designs (SCEDs) represent a family of research designs that use experimental methods to study the effects of treatments on outcomes. The fundamental unit of analysis is the single case-which can be an individual, clinic, or community-ideally with replications of effects within and/or between cases. These designs are flexible and cost-effective and can be used for treatment development, translational research, personalized interventions, and the study of rare diseases and disorders. This article provides a broad overview of the family of single-case experimental designs with corresponding examples, including reversal designs, multiple baseline designs, combined multiple baseline/reversal designs, and integration of single-case designs to identify optimal treatments for individuals into larger randomized controlled trials (RCTs). Personalized N-of-1 trials can be considered a subcategory of SCEDs that overlaps with reversal designs. Relevant issues for each type of design-including comparisons of treatments, design issues such as randomization and blinding, standards for designs, and statistical approaches to complement visual inspection of single-case experimental designs-are also discussed.
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Affiliation(s)
- Leonard H Epstein
- Jacobs School of Medicine and Biomedical Sciences, Division of Behavioral Medicine, Department of Pediatrics, University at Buffalo, Buffalo, New York, United States of America
| | - Jesse Dallery
- Department of Psychology, University of Florida, Gainesville, Florida, United States of America
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Mattes RD, Rowe SB, Ohlhorst SD, Brown AW, Hoffman DJ, Liska DJ, Feskens EJM, Dhillon J, Tucker KL, Epstein LH, Neufeld LM, Kelley M, Fukagawa NK, Sunde RA, Zeisel SH, Basile AJ, Borth LE, Jackson E. Valuing the Diversity of Research Methods to Advance Nutrition Science. Adv Nutr 2022; 13:1324-1393. [PMID: 35802522 PMCID: PMC9340992 DOI: 10.1093/advances/nmac043] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/08/2022] [Indexed: 12/13/2022] Open
Abstract
The ASN Board of Directors appointed the Nutrition Research Task Force to develop a report on scientific methods used in nutrition science to advance discovery, interpretation, and application of knowledge in the field. The genesis of this report was growing concern about the tone of discourse among nutrition professionals and the implications of acrimony on the productive study and translation of nutrition science. Too often, honest differences of opinion are cast as conflicts instead of areas of needed collaboration. Recognition of the value (and limitations) of contributions from well-executed nutrition science derived from the various approaches used in the discipline, as well as appreciation of how their layering will yield the strongest evidence base, will provide a basis for greater productivity and impact. Greater collaborative efforts within the field of nutrition science will require an understanding that each method or approach has a place and function that should be valued and used together to create the nutrition evidence base. Precision nutrition was identified as an important emerging nutrition topic by the preponderance of task force members, and this theme was adopted for the report because it lent itself to integration of many approaches in nutrition science. Although the primary audience for this report is nutrition researchers and other nutrition professionals, a secondary aim is to develop a document useful for the various audiences that translate nutrition research, including journalists, clinicians, and policymakers. The intent is to promote accurate, transparent, verifiable evidence-based communication about nutrition science. This will facilitate reasoned interpretation and application of emerging findings and, thereby, improve understanding and trust in nutrition science and appropriate characterization, development, and adoption of recommendations.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Leonard H Epstein
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | | | - Michael Kelley
- Michael Kelley Nutrition Science Consulting, Wauwatosa, WI, USA
| | - Naomi K Fukagawa
- USDA Beltsville Human Nutrition Research Center, Beltsville, MD, USA
| | | | - Steven H Zeisel
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Tur C, Campos D, Suso-Ribera C, Kazlauskas E, Castilla D, Zaragoza I, García-Palacios A, Quero S. An Internet-delivered Cognitive-Behavioral Therapy (iCBT) for Prolonged Grief Disorder (PGD) in adults: A multiple-baseline single-case experimental design study. Internet Interv 2022; 29:100558. [PMID: 35865996 PMCID: PMC9294524 DOI: 10.1016/j.invent.2022.100558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
The death of a loved one has physical, psychological, and social consequences. Between 9.8 and 21.5 % of people who lose a loved one develop Prolonged Grief Disorder (PGD). Internet- and computer-based interventions (i.e., Internet-delivered Cognitive-Behavioral Therapy, iCBT) are cost-effective and scalable alternatives that make it possible to reach more people with PGD. The main goal of the present investigation was to examine the effect and feasibility (usability and satisfaction) of an iCBT (GROw program) for adults with PGD. A secondary objective was to detect adherence to the app (Emotional Monitor) used to measure daily grief symptoms. The study had a single-case multiple-baseline AB design with six participants. The GROw program is organized sequentially in eight modules, and it is based on the dual-process model of coping with bereavement. Evaluations included a pre-to-post treatment assessment of depression, grief symptoms, and typical grief beliefs, along with daily measures of symptom frequency and intensity on the Emotional Monitor App. Treatment opinions and adherence to the App were also collected. Efficacy data were calculated using a Nonoverlap of All Pairs (NAP) analysis and Reliable Change Index (RCI). The mean age of the sample was 29.5 years (SD = 8.19). Two participants dropped out of the study. Adherence to the App varied across patients (4.8 % -77.8 %). Most participants (75 %) showed a clinically significant change (recovered) in depression, and 50 % obtained a clinically significant improvement (recovered) in symptoms of loss and typical beliefs in complicated grief. The participants reported high usability and satisfaction with the treatment content and format. In sum, the GROw program was very well accepted and generally feasible, and it has strong potential for treating PGD. The results support scaling up the treatment by using more complex designs with larger samples (i.e., randomized controlled trials comparing GROw with active conditions).
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Affiliation(s)
- Cintia Tur
- Departmento de Psicología Básica, Clínica y Psicobiología. Universitat Jaume I, Castellón de la Plana, Spain
| | - Daniel Campos
- Departmento de Psicología y Sociología, Universidad de Zaragoza, Zaragoza, Spain,Instituto de Investigación Sanitaria Aragón (IISAragon), Zaragoza, Spain
| | - Carlos Suso-Ribera
- Departmento de Psicología Básica, Clínica y Psicobiología. Universitat Jaume I, Castellón de la Plana, Spain,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Evaldas Kazlauskas
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Lithuania
| | - Diana Castilla
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain,Universitat de València, València, Spain
| | - Irene Zaragoza
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Azucena García-Palacios
- Departmento de Psicología Básica, Clínica y Psicobiología. Universitat Jaume I, Castellón de la Plana, Spain,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Soledad Quero
- Departmento de Psicología Básica, Clínica y Psicobiología. Universitat Jaume I, Castellón de la Plana, Spain,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain,Corresponding author at: Universitat Jaume I, Av. Vicente Sos Baynat s/n, 12006, Castellón, Spain.
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Quetsch LB, Herschell AD, Kolko D, Liebsack BK, Carroll RA. Testing a community developed training protocol for an evidence-based treatment. EVALUATION AND PROGRAM PLANNING 2022; 92:102055. [PMID: 35227960 DOI: 10.1016/j.evalprogplan.2022.102055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/20/2022] [Accepted: 02/11/2022] [Indexed: 06/14/2023]
Abstract
The implementation of evidence-based treatments (EBTs) in community behavioral health settings is a recommended practice, yet training experienced by community-based clinicians may require novel and creative training methods. The current study focused on creating a training protocol for Alternative for Families: a Cognitive-Behavioral Therapy from both evidence-based foundations and community-based agency feedback to promote better EBT integration into agencies. Twenty-four clinicians from three agencies were trained using a community-informed training protocol. Outcomes for clinician-reports of organizational functioning, self-reports of skill and knowledge, and observational single-subject data of clinician skills were assessed. Minimal improvements were found for clinician skills across self-report and observations. More research on tailoring trainings to meet needs of community agencies and clinicians should be explored to determine best practice in wide-scale implementation efforts.
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Affiliation(s)
- Lauren B Quetsch
- University of Arkansas, Department of Psychological Science, USA
| | - Amy D Herschell
- Community Care Behavioral Health Organization, UPMC Insurance Services Division, USA; University of Pittsburgh School of Medicine, UPMC Western Psychiatric Hospital, USA.
| | - David Kolko
- University of Pittsburgh School of Medicine, UPMC Western Psychiatric Hospital, USA
| | | | - Regina A Carroll
- University of Nebraska Medical Center, Munroe-Meyer Institute, USA
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Abstract
Background: Ayres Sensory Integration (ASI) is widely employed by occupational therapists working with clients who experience challenges in sensory integration, including those with autism spectrum disorder (ASD). However, there is a dearth of research examining the feasibility of ASI outside of Western nations. This study documented the barriers associated with ASI in Saudi Arabia and assessed whether the intervention could improve process and participation skills. Methods: Single-Subject experimental design was used. The participant was a 4-year-old girl with ASD from Saudi Arabia. Data were gathered on sensory processing, motor skills, and participation in activities of daily living. The study used semi-structured interviews and assessments (Sensory Integration and Praxis Tests, the Sensory Processing Measure-Preschool, and the Peabody Developmental Motor Scale-2) to develop goals, identify outcome measures, and plan an ASI intervention. Results: Despite the limited availability of resources (e.g., toys, treatment spaces) and Arabic measures, improvements were observed on motor and sensory tasks and in occupational performance. Conclusion: ASI that adheres to the ASI fidelity tool can be of value for Saudi Arabian children with ASD. Additionally, the study provides a stepping-stone to further research for occupational therapists in Saudi Arabia working with children with ASD.
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Affiliation(s)
- Shahad Alkhalifah
- King Faisal Hospital & Research Centre, Centre for Autism Research, Riyadh, 11211, Saudi Arabia
| | - Susan Allen
- Department of Psychology and Clinical Language Science, University of Reading, Reading, RG6 6UR, UK
| | - Hesham Aldhalaan
- King Faisal Hospital & Research Centre, Centre for Autism Research, Riyadh, 11211, Saudi Arabia
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Mariakakis A, Karkar R, Patel SN, Kientz JA, Fogarty J, Munson SA. Using Health Concept Surveying to Elicit Usable Evidence: Case Studies of a Novel Evaluation Methodology. JMIR Hum Factors 2022; 9:e30474. [PMID: 34982038 PMCID: PMC8764610 DOI: 10.2196/30474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/15/2021] [Accepted: 10/09/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Developers, designers, and researchers use rapid prototyping methods to project the adoption and acceptability of their health intervention technology (HIT) before the technology becomes mature enough to be deployed. Although these methods are useful for gathering feedback that advances the development of HITs, they rarely provide usable evidence that can contribute to our broader understanding of HITs. OBJECTIVE In this research, we aim to develop and demonstrate a variation of vignette testing that supports developers and designers in evaluating early-stage HIT designs while generating usable evidence for the broader research community. METHODS We proposed a method called health concept surveying for untangling the causal relationships that people develop around conceptual HITs. In health concept surveying, investigators gather reactions to design concepts through a scenario-based survey instrument. As the investigator manipulates characteristics related to their HIT, the survey instrument also measures proximal cognitive factors according to a health behavior change model to project how HIT design decisions may affect the adoption and acceptability of an HIT. Responses to the survey instrument were analyzed using path analysis to untangle the causal effects of these factors on the outcome variables. RESULTS We demonstrated health concept surveying in 3 case studies of sensor-based health-screening apps. Our first study (N=54) showed that a wait time incentive could influence more people to go see a dermatologist after a positive test for skin cancer. Our second study (N=54), evaluating a similar application design, showed that although visual explanations of algorithmic decisions could increase participant trust in negative test results, the trust would not have been enough to affect people's decision-making. Our third study (N=263) showed that people might prioritize test specificity or sensitivity depending on the nature of the medical condition. CONCLUSIONS Beyond the findings from our 3 case studies, our research uses the framing of the Health Belief Model to elicit and understand the intrinsic and extrinsic factors that may affect the adoption and acceptability of an HIT without having to build a working prototype. We have made our survey instrument publicly available so that others can leverage it for their own investigations.
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Affiliation(s)
- Alex Mariakakis
- Department of Computer Science, University of Toronto, Toronto, ON, Canada
| | - Ravi Karkar
- School of Computer Science & Engineering, University of Washington, Seattle, WA, United States
| | - Shwetak N Patel
- School of Computer Science & Engineering, University of Washington, Seattle, WA, United States
| | - Julie A Kientz
- Department of Human Centered Design & Engineering, University of Washington, Seattle, WA, United States
| | - James Fogarty
- School of Computer Science & Engineering, University of Washington, Seattle, WA, United States
| | - Sean A Munson
- Department of Human Centered Design & Engineering, University of Washington, Seattle, WA, United States
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12
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Epstein LH, Bickel WK, Czajkowski SM, Paluch RA, Moeyaert M, Davidson KW. Single case designs for early phase behavioral translational research in health psychology. Health Psychol 2021; 40:858-874. [PMID: 34370494 PMCID: PMC8738131 DOI: 10.1037/hea0001055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The biomedical research community has long recognized that much of the basic research being conducted, whether in the biological, behavioral or social sciences, is not readily translated into clinical and public health applications. This translational gap is due in part to challenges inherent in moving research findings from basic or discovery research to applied research that addresses clinical or public health problems. In the behavioral and social sciences, research designs typically used in the early phases of translational research are small, underpowered "pilot" studies that may lack sufficient statistical power to test the research question of interest. While this approach is discouraged, these studies are often employed to estimate effect sizes before embarking on a larger trial with adequate statistical power to test the research hypothesis. The goal of this paper is to provide an alternative approach to early phase studies using single case designs (SCDs). METHOD Review basic principles of SCDs; provide a series of hypothetical SCD replication experiments to illustrate (1) how data from SCDs can be analyzed to test the effects of an intervention on behavioral and biological outcomes and (2) how sample sizes can be derived for larger randomized controlled trials (RCTs) based on clinically meaningful effects from SCDs; and review feedback between SCDs and RCTs. RESULTS The paper illustrates the use of SCD reversal and multiple baseline designs for early phase translational research. CONCLUSION SCDs provide a flexible and efficient platform for the use of experimental methods in early phase translational research. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Lewis CC, Hannon PA, Klasnja P, Baldwin LM, Hawkes R, Blackmer J, Johnson A. Optimizing Implementation in Cancer Control (OPTICC): protocol for an implementation science center. Implement Sci Commun 2021; 2:44. [PMID: 33892822 PMCID: PMC8062945 DOI: 10.1186/s43058-021-00117-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/28/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Evidence-based interventions (EBIs) could reduce cervical cancer deaths by 90%, colorectal cancer deaths by 70%, and lung cancer deaths by 95% if widely and effectively implemented in the USA. Yet, EBI implementation, when it occurs, is often suboptimal. This manuscript outlines the protocol for Optimizing Implementation in Cancer Control (OPTICC), a new implementation science center funded as part of the National Cancer Institute Implementation Science Consortium. OPTICC is designed to address three aims. Aim 1 is to develop a research program that supports developing, testing, and refining of innovative, efficient methods for optimizing EBI implementation in cancer control. Aim 2 is to support a diverse implementation laboratory of clinical and community partners to conduct rapid, implementation studies anywhere along the cancer care continuum for a wide range of cancers. Aim 3 is to build implementation science capacity in cancer control by training new investigators, engaging established investigators in cancer-focused implementation science, and contributing to the Implementation Science Consortium in Cancer. METHODS Three cores serve as OPTICC's foundation. The Administrative Core plans coordinates and evaluates the Center's activities and leads its capacity-building efforts. The Implementation Laboratory Core (I-Lab) coordinates a network of diverse clinical and community sites, wherein studies are conducted to optimize EBI implementation, implement cancer control EBIs, and shape the Center's agenda. The Research Program Core conducts innovative implementation studies, measurement and methods studies, and pilot studies that advance the Center's theme. A three-stage approach to optimizing EBI implementation is taken-(I) identify and prioritize determinants, (II) match strategies, and (III) optimize strategies-that is informed by a transdisciplinary team of experts leveraging multiphase optimization strategies and criteria, user-centered design, and agile science. DISCUSSION OPTICC will develop, test, and refine efficient and economical methods for optimizing EBI implementation by building implementation science capacity in cancer researchers through applications with our I-Lab partners. Once refined, OPTICC will disseminate its methods as toolkits accompanied by massive open online courses, and an interactive website, the latter of which seeks to simultaneously accumulate knowledge across OPTICC studies.
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Affiliation(s)
- Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.
| | - Peggy A Hannon
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Predrag Klasnja
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA
- School of Information, University of Michigan, Ann Arbor, Michigan, USA
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Rene Hawkes
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA
| | - Janell Blackmer
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Ashley Johnson
- Department of Family Medicine, University of Washington, Seattle, WA, USA
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Normand MP, Dallery J, Slanzi CM. Leveraging applied behavior analysis research and practice in the service of public health. J Appl Behav Anal 2021; 54:457-483. [PMID: 33817803 DOI: 10.1002/jaba.832] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/12/2021] [Accepted: 03/13/2021] [Indexed: 01/01/2023]
Abstract
Human behavior plays a central role in all domains of public health. Applied behavior analysis (ABA) research and practice can contribute to public health solutions that directly address human behavior. In this paper, we describe the field of public health, identify points of interaction between public health and ABA, summarize what ABA research has already contributed, and provide several recommendations for how ABA research and practice could continue to promote public health outcomes. A clearer focus on behavior and widespread adoption of research designs and interventions informed by the ABA literature could lead to better public health outcomes. Reciprocally, better integration of public health goals and strategies into ABA research, harnessing of technology, and more collaboration would help diversify and disseminate our applied science and could yield more effective and scalable interventions to prevent and treat public health problems.
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Hekler E, Tiro JA, Hunter CM, Nebeker C. Precision Health: The Role of the Social and Behavioral Sciences in Advancing the Vision. Ann Behav Med 2020; 54:805-826. [PMID: 32338719 PMCID: PMC7646154 DOI: 10.1093/abm/kaaa018] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In 2015, Collins and Varmus articulated a vision for precision medicine emphasizing molecular characterization of illness to identify actionable biomarkers to support individualized treatment. Researchers have argued for a broader conceptualization, precision health. Precision health is an ambitious conceptualization of health, which includes dynamic linkages between research and practice as well as medicine, population health, and public health. The goal is a unified approach to match a full range of promotion, prevention, diagnostic, and treatment interventions to fundamental and actionable determinants of health; to not just address symptoms, but to directly target genetic, biological, environmental, and social and behavioral determinants of health. PURPOSE The purpose of this paper is to elucidate the role of social and behavioral sciences within precision health. MAIN BODY Recent technologies, research frameworks, and methods are enabling new approaches to measure, intervene, and conduct social and behavioral science research. These approaches support three opportunities in precision health that the social and behavioral sciences could colead including: (a) developing interventions that continuously "tune" to each person's evolving needs; (b) enhancing and accelerating links between research and practice; and (c) studying mechanisms of change in real-world contexts. There are three challenges for precision health: (a) methods of knowledge organization and curation; (b) ethical conduct of research; and (c) equitable implementation of precision health. CONCLUSIONS Precision health requires active coleadership from social and behavioral scientists. Prior work and evidence firmly demonstrate why the social and behavioral sciences should colead with regard to three opportunity and three challenge areas.
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Affiliation(s)
- Eric Hekler
- Department of Family Medicine and Public Health, School of Medicine, UC San Diego, La Jolla, CA, USA
- Center for Wireless and Population Health Systems, Qualcomm Institute, UC San Diego, La Jolla, CA, USA
- Design Lab, UC San Diego, La Jolla, CA, USA
| | - Jasmin A Tiro
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Christine M Hunter
- Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD, USA
| | - Camille Nebeker
- Department of Family Medicine and Public Health, School of Medicine, UC San Diego, La Jolla, CA, USA
- Center for Wireless and Population Health Systems, Qualcomm Institute, UC San Diego, La Jolla, CA, USA
- Design Lab, UC San Diego, La Jolla, CA, USA
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16
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Soto PL. Single‐case experimental designs for behavioral neuroscience. J Exp Anal Behav 2020; 114:447-467. [DOI: 10.1002/jeab.633] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/29/2020] [Accepted: 10/04/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Paul L. Soto
- Department of Psychology Louisiana State University
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17
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Ondersma SJ, Walters ST. Clinician's Guide to Evaluating and Developing eHealth Interventions for Mental Health. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2020; 2:26-33. [PMID: 36101886 PMCID: PMC9175830 DOI: 10.1176/appi.prcp.2020.20190036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 02/11/2020] [Accepted: 02/26/2020] [Indexed: 11/30/2022] Open
Abstract
Objective This review aimed to examine key information regarding technology‐delivered interventions for patients with mental health and/or substance use disorders and to provide support for efforts by psychiatrists and other mental health professionals in recommending applications or helping to develop new technology‐delivered interventions. Methods The authors reviewed existing information about the appraisal, development, and evaluation of technology‐delivered interventions (eHealth interventions). Results High‐level guidance is available for clinicians who want to evaluate eHealth applications for their patients. Clinicians should be familiar with existing models of eHealth intervention development and with traditional as well as unique elements in the evaluation of efficacy for these approaches. However, existing intervention development models have not been empirically validated, and only one includes empirical optimization as an inherent part of its process. Conclusions Because of the proliferation of eHealth interventions, mental health professionals should bring to this area the same level of content knowledge, understanding of development and evaluation processes, and rigorous skepticism as they do for pharmacotherapy and therapist‐delivered behavioral interventions. eHealth interventions are rapidly transforming mental health treatment. Clinicians should apply the same rigor to evaluating eHealth interventions that they apply to pharmacological treatments or other behavioral therapies. High‐level guidance and recommendations regarding ideal eHealth intervention development are available to aid in such evaluation, but empirical evidence in support of these guidelines is lacking.
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Affiliation(s)
- Steven J. Ondersma
- Merrill Palmer Skillman InstituteDepartment of Psychiatry and Behavioral NeurosciencesWayne State UniversityDetroit
| | - Scott T. Walters
- Department of Health Behavior and Health SystemsSchool of Public HealthUniversity of North Texas Health Science CenterFort Worth
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Vilardaga R, Rizo J, Ries RK, Kientz JA, Ziedonis DM, Hernandez K, McClernon FJ. Formative, multimethod case studies of learn to quit, an acceptance and commitment therapy smoking cessation app designed for people with serious mental illness. Transl Behav Med 2020; 9:1076-1086. [PMID: 30445507 DOI: 10.1093/tbm/iby097] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Despite public health efforts, individuals with serious mental illness (SMI) still have very high rates of tobacco smoking. Innovative approaches to reach this population are needed. These series of case studies aimed to descriptively evaluate the usability, user experience (UX), and user engagement (UE) of Learn to Quit (LTQ), an acceptance and commitment therapy smoking cessation app designed for people with SMI, and to compare it with an app designed for the general population, NCI (National Cancer Institute) QuitGuide (QG). Both apps were combined with nicotine replacement therapy and technical coaching. Inspired by the ORBIT model, we implemented two case studies with crossover AB interventions, two B-phase training designs, and three bi-phasic AB single-case designs with Start-Point and Order randomization (A = QG, B = LTQ). Study outcomes were measured using the System Usability Scale, UX interviews, and background analytics. LTQ's usability levels were above the standard cutoff and on average higher than QG. UX outcomes suggested the relative benefits of LTQ's visual design, gamification and simple design structure. LTQ's overall UE was high; the app was opened for an average of 14 min per day (vs. QG: 7 min). However, users showed low levels of UE with each of the app's tracking feature. Measures of psychiatric functioning suggested the safety of LTQ in people with SMI. LTQ appears to be a usable and engaging smoking cessation app in people with SMI. An optimized version of LTQ should be tested in a Phase II study.
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Affiliation(s)
- Roger Vilardaga
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Javier Rizo
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Richard K Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Julie A Kientz
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Douglas M Ziedonis
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Kayla Hernandez
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Francis J McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
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Becraft JL, Borrero JC, Sun S, McKenzie AA. A primer for using multilevel models to meta‐analyze single case design data with AB phases. J Appl Behav Anal 2020; 53:1799-1821. [DOI: 10.1002/jaba.698] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/23/2019] [Accepted: 12/29/2019] [Indexed: 11/05/2022]
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20
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Calder SD, Claessen M, Ebbels S, Leitão S. Explicit Grammar Intervention in Young School-Aged Children With Developmental Language Disorder: An Efficacy Study Using Single-Case Experimental Design. Lang Speech Hear Serv Sch 2020; 51:298-316. [PMID: 32255750 DOI: 10.1044/2019_lshss-19-00060] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose This study evaluated the efficacy of an explicit, combined metalinguistic training and grammar facilitation intervention aimed at improving regular past tense marking for nine children aged 5;10-6;8 (years;months) with developmental language disorder. Method This study used an ABA across-participant multiple-baseline single-case experimental design. Participants were seen one-on-one twice a week for 20- to 30-min sessions for 10 weeks and received explicit grammar intervention combining metalinguistic training using the SHAPE CODING system with grammar facilitation techniques (a systematic cueing hierarchy). In each session, 50 trials to produce the target form were completed, resulting in a total of 1,000 trials over 20 individual therapy sessions. Repeated measures of morphosyntax were collected using probes, including trained past tense verbs, untrained past tense verbs, third-person singular verbs as an extension probe, and possessive 's as a control probe. Probing contexts included expressive morphosyntax and grammaticality judgment. Outcome measures also included pre-poststandard measures of expressive and receptive grammar. Results Analyses of repeated measures demonstrated significant improvement in past tense production on trained verbs (eight of nine children) and untrained verbs (seven of nine children), indicating efficacy of the treatment. These gains were maintained for 5 weeks. The majority of children made significant improvement on standardized measures of expressive grammar (eight of nine children). Only five of nine children improved on grammaticality judgment or receptive measures. Conclusion Results continue to support the efficacy of explicit grammar interventions to improve past tense marking in early school-aged children. Future research should aim to evaluate the efficacy of similar interventions with group comparison studies and determine whether explicit grammar interventions can improve other aspects of grammatical difficulty for early school-aged children with developmental language disorder. Supplemental Material https://doi.org/10.23641/asha.11958771.
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Affiliation(s)
- Samuel D Calder
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia
| | - Mary Claessen
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia
| | - Susan Ebbels
- Moor House Research and Training Institute, Moor House School & College, Oxted, United Kingdom.,Language and Cognition, University College London, United Kingdom
| | - Suze Leitão
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia
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Bossenbroek R, Wols A, Weerdmeester J, Lichtwarck-Aschoff A, Granic I, van Rooij MMJW. Efficacy of a Virtual Reality Biofeedback Game (DEEP) to Reduce Anxiety and Disruptive Classroom Behavior: Single-Case Study. JMIR Ment Health 2020; 7:e16066. [PMID: 32207697 PMCID: PMC7139423 DOI: 10.2196/16066] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/21/2019] [Accepted: 12/16/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Many adolescents in special education are affected by anxiety in addition to their behavioral problems. Anxiety leads to substantial long-term problems and may underlie disruptive behaviors in the classroom as a result of the individual's inability to tolerate anxiety-provoking situations. Thus, interventions in special needs schools that help adolescents cope with anxiety and, in turn, diminish disruptive classroom behaviors are needed. OBJECTIVE This study aimed to evaluate the effect of a virtual reality biofeedback game, DEEP, on daily levels of state-anxiety and disruptive classroom behavior in a clinical sample. In addition, the study also aimed to examine the duration of the calm or relaxed state after playing DEEP. METHODS A total of 8 adolescents attending a special secondary school for students with behavioral and psychiatric problems participated in a single-case experimental ABAB study. Over a 4-week period, participants completed 6 DEEP sessions. In addition, momentary assessments (ie, 3 times a day) of self-reported state-anxiety and teacher-reported classroom behavior were collected throughout all A and B phases. RESULTS From analyzing the individual profiles, it was found that 6 participants showed reductions in anxiety, and 5 participants showed reductions in disruptive classroom behaviors after the introduction of DEEP. On a group level, results showed a small but significant reduction of anxiety (d=-0.29) and a small, nonsignificant reduction of disruptive classroom behavior (d=-0.16) on days when participants played DEEP. Moreover, it was found that the calm or relaxed state of participants after playing DEEP lasted for about 2 hours on average. CONCLUSIONS This study demonstrates the potential of the game, DEEP, as an intervention for anxiety and disruptive classroom behavior in a special school setting. Future research is needed to fully optimize and personalize DEEP as an intervention for the heterogeneous special school population.
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Affiliation(s)
- Rineke Bossenbroek
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Aniek Wols
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | | | | | - Isabela Granic
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
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Budney AJ, Marsch LA, Aklin WM, Borodovsky JT, Brunette MF, Campbell AT, Dallery J, Kotz D, Knapp AA, Lord SE, Nunes EV, Scherer EA, Stanger C, Torrey WC. Workshop on the Development and Evaluation of Digital Therapeutics for Health Behavior Change: Science, Methods, and Projects. JMIR Ment Health 2020; 7:e16751. [PMID: 32130155 PMCID: PMC7066510 DOI: 10.2196/16751] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/11/2019] [Accepted: 12/15/2019] [Indexed: 12/22/2022] Open
Abstract
The health care field has integrated advances into digital technology at an accelerating pace to improve health behavior, health care delivery, and cost-effectiveness of care. The realm of behavioral science has embraced this evolution of digital health, allowing for an exciting roadmap for advancing care by addressing the many challenges to the field via technological innovations. Digital therapeutics offer the potential to extend the reach of effective interventions at reduced cost and patient burden and to increase the potency of existing interventions. Intervention models have included the use of digital tools as supplements to standard care models, as tools that can replace a portion of treatment as usual, or as stand-alone tools accessed outside of care settings or direct to the consumer. To advance the potential public health impact of this promising line of research, multiple areas warrant further development and investigation. The Center for Technology and Behavioral Health (CTBH), a P30 Center of Excellence supported by the National Institute on Drug Abuse at the National Institutes of Health, is an interdisciplinary research center at Dartmouth College focused on the goal of harnessing existing and emerging technologies to effectively develop and deliver evidence-based interventions for substance use and co-occurring disorders. The CTBH launched a series of workshops to encourage and expand multidisciplinary collaborations among Dartmouth scientists and international CTBH affiliates engaged in research related to digital technology and behavioral health (eg, addiction science, behavioral health intervention, technology development, computer science and engineering, digital security, health economics, and implementation science). This paper summarizes a workshop conducted on the Development and Evaluation of Digital Therapeutics for Behavior Change, which addressed (1) principles of behavior change, (2) methods of identifying and testing the underlying mechanisms of behavior change, (3) conceptual frameworks for optimizing applications for mental health and addictive behavior, and (4) the diversity of experimental methods and designs that are essential to the successful development and testing of digital therapeutics. Examples were presented of ongoing CTBH projects focused on identifying and improving the measurement of health behavior change mechanisms and the development and evaluation of digital therapeutics. In summary, the workshop showcased the myriad research targets that will be instrumental in promoting and accelerating progress in the field of digital health and health behavior change and illustrated how the CTBH provides a model of multidisciplinary leadership and collaboration that can facilitate innovative, science-based efforts to address the health behavior challenges afflicting our communities.
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Affiliation(s)
- Alan J Budney
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Will M Aklin
- Clinical Research Grants Branch, National Institute on Drug Abuse, National Institutes of Health, Rockville, MD, United States
| | - Jacob T Borodovsky
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, United States
| | - Mary F Brunette
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Andrew T Campbell
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Jesse Dallery
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Psychology, University of Florida, Gainesville, FL, United States
| | - David Kotz
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Ashley A Knapp
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Sarah E Lord
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Edward V Nunes
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Emily A Scherer
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Catherine Stanger
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - William C Torrey
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
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Ferrara PMM, Beaumont CT, Strohacker K. Quality of Single-Case Designs Targeting Adults’ Exercise and Physical Activity. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2019. [DOI: 10.1249/tjx.0000000000000109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lebrun C, Gély‐Nargeot M, Rossignol A, Geny C, Bayard S. Efficacy of cognitive behavioral therapy for insomnia comorbid to Parkinson's disease: A focus on psychological and daytime functioning with a single‐case design with multiple baselines. J Clin Psychol 2019; 76:356-376. [DOI: 10.1002/jclp.22883] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | - Alexia Rossignol
- Neurology DepartmentParkinson's Disease Expert Centre, Gui de Chauliac HospitalMontpellier France
| | - Christian Geny
- Neurology DepartmentParkinson's Disease Expert Centre, Gui de Chauliac HospitalMontpellier France
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25
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Martner SG, Dallery J. Technology-based contingency management and e-cigarettes during the initial weeks of a smoking quit attempt. J Appl Behav Anal 2019; 52:928-943. [PMID: 31578724 DOI: 10.1002/jaba.641] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/16/2019] [Indexed: 12/18/2022]
Abstract
Contingency management (CM) interventions are among the most effective behavioral interventions for smoking. This study assessed the effects of CM and electronic cigarettes (ECs) on smoking reductions and abstinence for durations of 30-36 days. Twelve participants were exposed to Baseline, EC alone, and EC + CM conditions. An internet-based platform was used to monitor smoking via breath carbon monoxide (CO) and deliver CM for smoking abstinence (CO ≤4 ppm). A Bluetooth-enabled EC monitored daily EC puffs. Abstinence rates were equivalent between EC (34.4%) and EC + CM (30.4%) conditions. Both conditions promoted smoking reductions. We observed an inverse correlation between smoking and EC puffs (r = -.62, p < .05). Results suggest the use of electronic cigarettes can promote smoking reductions and abstinence, and CM did not improve these outcomes. Larger magnitude consequences or tailoring EC characteristics (e.g., flavor) may have improved outcomes. Technology-based methods to collect intensive, longitudinal measures of smoking and electronic cigarette use may be useful to characterize their environmental determinants.
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Obrusnikova I, Novak HM, Cavalier AR. The Effect of Systematic Prompting on the Acquisition of Five Muscle-Strengthening Exercises by Adults With Mild Intellectual Disabilities. Adapt Phys Activ Q 2019; 36:447-471. [PMID: 31521057 DOI: 10.1123/apaq.2018-0192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 11/18/2022] Open
Abstract
Adults with intellectual disability have significantly lower musculoskeletal fitness than their peers without a disability. Appropriate instructional strategies are needed to facilitate their acquisition and maintenance of musculoskeletal fitness. In this multiple-baseline across-participants single-subject study, the authors evaluated the effects of a multicomponent package that included a video-enhanced system of least-to-most prompts on the acquisition of 5 muscle-strengthening exercises in 3 women with mild intellectual disability, age 24-37 yr. Results show substantive gains in correct and independent performance of steps in the 5 exercises during the treatment condition. The improved performance was maintained 2 wk after the last treatment session and in a large YMCA gym. The study suggests that use of the video-enhanced system of least-to-most prompts can lead to improved acquisition and maintenance of muscle-strengthening exercises by adults with mild intellectual disability.
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Hekler EB, Klasnja P, Chevance G, Golaszewski NM, Lewis D, Sim I. Why we need a small data paradigm. BMC Med 2019; 17:133. [PMID: 31311528 PMCID: PMC6636023 DOI: 10.1186/s12916-019-1366-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 06/13/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There is great interest in and excitement about the concept of personalized or precision medicine and, in particular, advancing this vision via various 'big data' efforts. While these methods are necessary, they are insufficient to achieve the full personalized medicine promise. A rigorous, complementary 'small data' paradigm that can function both autonomously from and in collaboration with big data is also needed. By 'small data' we build on Estrin's formulation and refer to the rigorous use of data by and for a specific N-of-1 unit (i.e., a single person, clinic, hospital, healthcare system, community, city, etc.) to facilitate improved individual-level description, prediction and, ultimately, control for that specific unit. MAIN BODY The purpose of this piece is to articulate why a small data paradigm is needed and is valuable in itself, and to provide initial directions for future work that can advance study designs and data analytic techniques for a small data approach to precision health. Scientifically, the central value of a small data approach is that it can uniquely manage complex, dynamic, multi-causal, idiosyncratically manifesting phenomena, such as chronic diseases, in comparison to big data. Beyond this, a small data approach better aligns the goals of science and practice, which can result in more rapid agile learning with less data. There is also, feasibly, a unique pathway towards transportable knowledge from a small data approach, which is complementary to a big data approach. Future work should (1) further refine appropriate methods for a small data approach; (2) advance strategies for better integrating a small data approach into real-world practices; and (3) advance ways of actively integrating the strengths and limitations from both small and big data approaches into a unified scientific knowledge base that is linked via a robust science of causality. CONCLUSION Small data is valuable in its own right. That said, small and big data paradigms can and should be combined via a foundational science of causality. With these approaches combined, the vision of precision health can be achieved.
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Affiliation(s)
- Eric B Hekler
- Center for Wireless & Population Health Systems, Department of Family Medicine and Public Health, Design Lab and Qualcomm Institute Faculty Member, UC San Diego, 9500 Gilman Ave, San Diego, CA, 92093, USA.
| | - Predrag Klasnja
- School of Information, University of Michigan, Ann Arbor, MI, USA
| | - Guillaume Chevance
- Center for Wireless & Population Health Systems, Department of Family Medicine and Public Health, Design Lab and Qualcomm Institute Faculty Member, UC San Diego, 9500 Gilman Ave, San Diego, CA, 92093, USA
| | - Natalie M Golaszewski
- Center for Wireless & Population Health Systems, Department of Family Medicine and Public Health, Design Lab and Qualcomm Institute Faculty Member, UC San Diego, 9500 Gilman Ave, San Diego, CA, 92093, USA
| | | | - Ida Sim
- School of Medicine, UC San Francisco, San Francisco, CA, USA
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Naar S, Spring B. Commentary: Methods and Designs for T1 Translation in Pediatric Psychology. J Pediatr Psychol 2019; 44:418-424. [PMID: 30462239 DOI: 10.1093/jpepsy/jsy083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 09/24/2018] [Accepted: 09/24/2018] [Indexed: 12/24/2022] Open
Affiliation(s)
- Sylvie Naar
- Center for Translational Behavioral Research, Department of Behavioral Sciences and Social Medicine, Florida State University
| | - Bonnie Spring
- Center for Behavior and Health, Institute for Public Health and Medicine, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
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Wen X, Eiden RD, Justicia-Linde FE, Wang Y, Higgins ST, Thor N, Haghdel A, Peters AR, Epstein LH. A multicomponent behavioral intervention for smoking cessation during pregnancy: a nonconcurrent multiple-baseline design. Transl Behav Med 2019; 9:308-318. [PMID: 29648615 DOI: 10.1093/tbm/iby027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Given serious consequences of maternal smoking, we aimed to develop and test a multicomponent behavioral intervention to enhance smoking cessation during pregnancy. In this nonconcurrent, multiple-baseline intervention pilot study, 48 daily smoking pregnant women (mean 13.7 weeks of gestation) were recruited from Buffalo, NY, USA. Upon completion of the repeated baseline smoking monitoring (up to 3 weeks), 30 continuous smokers received a contingent financial incentive-based intervention with three additional components (education and counseling, monitoring and feedback, and family support). After the quit date, participants met with counselors (~1 hr/visit) daily for 2 weeks and twice a week for another 6 weeks. Twenty-one out of 30 participants quit smoking completely (verified by urine cotinine) after receiving the intervention, and the other nine nonquitters decreased smoking substantially. The estimated smoking cessation rate was 70.0% (21/30) at the second week of the intervention, and 63.3% (19/30) at the conclusion of the 8-week intervention assuming the dropouts as smoking. In interrupted time series analysis, the mean daily number of cigarettes smoked among quitters decreased by 6.52, 5.34, and 4.67 among early, delayed, and late intervention groups, respectively. Quitters' mean urine cotinine level maintained stably high before the intervention but decreased rapidly to the nonsmoking range once the intervention was initiated. Most participants (85.7%) reported meeting or exceeding expectations, and 100% would recommend the program to others. This pilot multicomponent intervention was feasible and acceptable to most participants, resulting in a high smoking cessation rate among pregnant smokers who were unlikely to quit spontaneously.
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Affiliation(s)
- Xiaozhong Wen
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Rina D Eiden
- Research Institute on Addictions, State University of New York at Buffalo, Buffalo, NY, USA
| | - Faye E Justicia-Linde
- Department of Obstetrics and Gynecology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Youfa Wang
- Fisher Institute of Health and Well-being, Department of Nutrition and Health Sciences, College of Health, Ball State University, Muncie, IN, USA
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, Departments of Psychiatry and Psychology, University of Vermont, Burlington, VT, USA
| | - Nicolas Thor
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Arsalan Haghdel
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Ariel R Peters
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Leonard H Epstein
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
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Kishida M, Molenaar PCM, Elavsky S. The impact of trait mindfulness on relational outcomes in novice yoga practitioners participating in an academic yoga course. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2019; 67:250-262. [PMID: 29952718 DOI: 10.1080/07448481.2018.1469505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/10/2018] [Accepted: 04/23/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE This study examined the role of dispositional mindfulness in impacting the relational benefits of yoga in novice practitioners in an undergraduate academic yoga course. PARTICIPANTS 21 college students enrolled in a yoga course throughout a 15-week academic semester (January-April 2016). METHODS Participants attended lab assessments at the beginning and end of the semester and were asked to complete eight consecutive Internet-based daily surveys across six separate bursts, yielding 48 data points for each participant. RESULTS Multivariate time-series analyses revealed within-person subgroup differences such that in general, those in the high trait mindfulness group gleaned benefits from yoga practice with respect to relational outcomes. CONCLUSIONS This study demonstrated trait mindfulness impacts relational outcomes in novice yoga practitioners, suggesting those low in trait mindfulness may not garner immediate relational benefits from yoga and could benefit from additional strategies to bolster against any negative influences of initiating yoga practice.
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Affiliation(s)
- Moé Kishida
- a College of Nursing and Health Innovations , Arizona State University , Phoenix , AZ , USA
| | - Peter C M Molenaar
- b Human Development and Family Studies , The Pennsylvania State University , University Park , PA , USA
| | - Steriani Elavsky
- c Department of Human Movement Studies , University of Ostrava , Ostrava , Czech Republic
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Merlo G, Chiazzese G, Taibi D, Chifari A. Development and Validation of a Functional Behavioural Assessment Ontology to Support Behavioural Health Interventions. JMIR Med Inform 2018; 6:e37. [PMID: 29853438 PMCID: PMC6002668 DOI: 10.2196/medinform.7799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/05/2017] [Accepted: 03/14/2018] [Indexed: 11/22/2022] Open
Abstract
Background In the cognitive-behavioral approach, Functional Behavioural Assessment is one of the most effective methods to identify the variables that determine a problem behavior. In this context, the use of modern technologies can encourage the collection and sharing of behavioral patterns, effective intervention strategies, and statistical evidence about antecedents and consequences of clusters of problem behaviors, encouraging the designing of function-based interventions. Objective The paper describes the development and validation process used to design a specific Functional Behavioural Assessment Ontology (FBA-Ontology). The FBA-Ontology is a semantic representation of the variables that intervene in a behavioral observation process, facilitating the systematic collection of behavioral data, the consequential planning of treatment strategies and, indirectly, the scientific advancement in this field of study. Methods The ontology has been developed deducing concepts and relationships of the ontology from a gold standard and then performing a machine-based validation and a human-based assessment to validate the Functional Behavioural Assessment Ontology. These validation and verification processes were aimed to verify how much the ontology is conceptually well founded and semantically and syntactically correct. Results The Pellet reasoner checked the logical consistency and the integrity of classes and properties defined in the ontology, not detecting any violation of constraints in the ontology definition. To assess whether the ontology definition is coherent with the knowledge domain, human evaluation of the ontology was performed asking 84 people to fill in a questionnaire composed by 13 questions assessing concepts, relations between concepts, and concepts’ attributes. The response rate for the survey was 29/84 (34.52%). The domain experts confirmed that the concepts, the attributes, and the relationships between concepts defined in the FBA-Ontology are valid and well represent the Functional Behavioural Assessment process. Conclusions The new ontology developed could be a useful tool to design new evidence-based systems in the Behavioral Interventions practices, encouraging the link with other Linked Open Data datasets and repositories to provide users with new models of eHealth focused on the management of problem behaviors. Therefore, new research is needed to develop and implement innovative strategies to improve the poor reproducibility and translatability of basic research findings in the field of behavioral assessment.
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Affiliation(s)
- Gianluca Merlo
- Istituto per le Tecnologie Didattiche, Consiglio Nazionale delle Ricerche, Palermo, Italy
| | - Giuseppe Chiazzese
- Istituto per le Tecnologie Didattiche, Consiglio Nazionale delle Ricerche, Palermo, Italy
| | - Davide Taibi
- Istituto per le Tecnologie Didattiche, Consiglio Nazionale delle Ricerche, Palermo, Italy
| | - Antonella Chifari
- Istituto per le Tecnologie Didattiche, Consiglio Nazionale delle Ricerche, Palermo, Italy
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Verhagen SJW, Hasmi L, Drukker M, van Os J, Delespaul PAEG. Use of the experience sampling method in the context of clinical trials. EVIDENCE-BASED MENTAL HEALTH 2018; 19:86-9. [PMID: 27443678 PMCID: PMC5040762 DOI: 10.1136/ebmental-2016-102418] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 07/01/2016] [Indexed: 11/18/2022]
Abstract
Objective The experience sampling method (ESM) is a structured diary technique to appraise subjective experiences in daily life. It is applied in psychiatric patients, as well as in patients with somatic illness. Despite the potential of ESM assessment, the improved logistics and its increased administration in research, its use in clinical trials remains limited. This paper introduces ESM for clinical trials in psychiatry and beyond. Methods ESM is an ecologically valid method that yields a comprehensive view of an individual's daily life. It allows the assessment of various constructs (eg, quality of life, psychopathology) and psychological mechanisms (eg, stress-sensitivity, coping). These constructs are difficult to assess using cross-sectional questionnaires. ESM can be applied in treatment monitoring, as an ecological momentary intervention, in clinical trials, or in single case clinical trials. Technological advances (eg, smartphone applications) make its implementation easier. Results Advantages of ESM are highlighted and disadvantages are discussed. Furthermore, the ecological nature of ESM data and its consequences are explored, including the potential pitfalls of ambiguously formulated research questions and the specificities of ESM in statistical analyses. The last section focuses on ESM in relation to clinical trials and discusses its future use in optimising clinical decision-making. Conclusions ESM can be a valuable asset in clinical trial research and should be used more often to study the benefits of treatment in psychiatry and somatic health.
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Affiliation(s)
- Simone J W Verhagen
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Laila Hasmi
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Marjan Drukker
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - J van Os
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Philippe A E G Delespaul
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
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Hekler EB, Klasnja P, Riley WT, Buman MP, Huberty J, Rivera DE, Martin CA. Agile science: creating useful products for behavior change in the real world. Transl Behav Med 2017; 6:317-28. [PMID: 27357001 PMCID: PMC4927453 DOI: 10.1007/s13142-016-0395-7] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Evidence-based practice is important for behavioral interventions but there is debate on how best to support real-world behavior change. The purpose of this paper is to define products and a preliminary process for efficiently and adaptively creating and curating a knowledge base for behavior change for real-world implementation. We look to evidence-based practice suggestions and draw parallels to software development. We argue to target three products: (1) the smallest, meaningful, self-contained, and repurposable behavior change modules of an intervention; (2) “computational models” that define the interaction between modules, individuals, and context; and (3) “personalization” algorithms, which are decision rules for intervention adaptation. The “agile science” process includes a generation phase whereby contender operational definitions and constructs of the three products are created and assessed for feasibility and an evaluation phase, whereby effect size estimates/casual inferences are created. The process emphasizes early-and-often sharing. If correct, agile science could enable a more robust knowledge base for behavior change.
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Affiliation(s)
- Eric B Hekler
- School of Nutrition and Health Promotion, Arizona State University, 500 N. 3rd Street, Phoenix, AZ, 85003, USA.
| | | | | | - Matthew P Buman
- School of Nutrition and Health Promotion, Arizona State University, 500 N. 3rd Street, Phoenix, AZ, 85003, USA
| | - Jennifer Huberty
- School of Nutrition and Health Promotion, Arizona State University, 500 N. 3rd Street, Phoenix, AZ, 85003, USA
| | - Daniel E Rivera
- School of Nutrition and Health Promotion, Arizona State University, 500 N. 3rd Street, Phoenix, AZ, 85003, USA
| | - Cesar A Martin
- School of Nutrition and Health Promotion, Arizona State University, 500 N. 3rd Street, Phoenix, AZ, 85003, USA
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Rosenberg DE, Kadokura E, Morris ME, Renz A, Vilardaga RM. Application of N-of-1 Experiments to Test the Efficacy of Inactivity Alert Features in Fitness Trackers to Increase Breaks from Sitting in Older Adults. Methods Inf Med 2017; 56:16-02-0043. [PMID: 28816343 PMCID: PMC5997558 DOI: 10.3414/me16-02-0043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 07/24/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Frequent breaks from sitting could improve health. Many commercially available fitness trackers deliver vibration alerts that could be used to cue sitting breaks. As a potentially pragmatic approach to promote frequent breaks from sitting, we tested the efficacy of inactivity alerts among obese older adults, a highly sedentary population. METHODS We conducted 10 sequential N-of-1 (single-case) experimental ABA trials. Participants (mean age = 68, mean BMI = 35) were monitored for a baseline phase ("A1") followed by an intervention phase ("B"). The intervention was then removed and participants were monitored to test an experimental effect (reversal "A2" phase). Total time in the study was limited to 25 days. During the intervention phase ("B"), participants used fitness trackers to stand up or move every time they received an alert (every 15 or 20 minutes of inactivity). Participants wore activPAL devices to measure breaks from sitting each day. Randomization tests were used to determine whether the number of breaks was significantly higher during the "B" phase than the two "A" phases. RESULTS Breaks were higher by 7.2 breaks per day during the "B" phase compared to the mean of the "A" phases. Seven out of 10 participants had more sitting breaks during the intervention phase which subsequently decreased during the reversal "A2" phase (combined p-value < .05). CONCLUSION Inactivity alert features within commercially available devices are efficacious for promoting modest improvements in breaks from sitting among older adults with obesity and could be a simple health-promoting strategy in this population.
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Affiliation(s)
- Dori E Rosenberg
- Dori E. Rosenberg, PhD, MPH, Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA, E-mail:
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Klasnja P, Hekler EB, Korinek EV, Harlow J, Mishra SR. Toward Usable Evidence: Optimizing Knowledge Accumulation in HCI Research on Health Behavior Change. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2017; 2017:3071-3082. [PMID: 30272059 DOI: 10.1145/3025453.3026013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Over the last ten years, HCI researchers have introduced a range of novel ways to support health behavior change, from glanceable displays to sophisticated game dynamics. Yet, this research has not had as much impact as its originality warrants. A key reason for this is that common forms of evaluation used in HCI make it difficult to effectively accumulate-and use-knowledge across research projects. This paper proposes a strategy for HCI research on behavior change that retains the field's focus on novel technical contributions while enabling accumulation of evidence that can increase impact of individual research projects both in HCI and the broader behavior-change science. The core of this strategy is an emphasis on the discovery of causal effects of individual components of behavior-change technologies and the precise ways in which those effects vary with individual differences, design choices, and contexts in which those technologies are used.
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Perna FM, Dwyer LA, Tesauro G, Taber JM, Norton WE, Hartman AM, Geller AC. Research on Skin Cancer-Related Behaviors and Outcomes in the NIH Grant Portfolio, 2000-2014: Skin Cancer Intervention Across the Cancer Control Continuum (SCI-3C). JAMA Dermatol 2017; 153:398-405. [PMID: 28329179 PMCID: PMC5817496 DOI: 10.1001/jamadermatol.2016.6216] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 12/26/2016] [Indexed: 11/14/2022]
Abstract
Importance The Surgeon General's Call to Action to Prevent Skin Cancer broadly identified research gaps, but specific objectives are needed to further behavioral intervention research. Objective To review National Institute of Health (NIH) grants targeting skin cancer-related behaviors and relevant outcomes. Design, Setting, and Participants A portfolio analysis of the title, abstract, specific aims, and research plans of identified grant applications from 2000 to 2014 targeting skin cancer-related behaviors or testing behavioral intervention effects on cancer-relevant outcomes along the cancer continuum. Main Outcomes and Measures Funding trends were compared along the cancer control continuum, with respect to investigator demographics and use of theory, technology, policy, and changes to environmental surroundings (built environment). Results A total of 112 submitted applications met inclusion criteria; of these, 40 (35.7%) were funded, and 31 of the 40 were interventions. Comparing the 40 funded grants with the 72 unfunded grants, the overall success rates did not differ significantly between male (33.3%) and female (37.3%) investigators, nor did the frequency of R01 awards (36.7% and 28.1%, respectively). Among intervention awards, most (24 of 31) addressed prevention. Fewer awards targeted detection alone or in conjunction with prevention (3) or cancer survivorship (4), and no grant addressed emotional sequelae or adherence behavior related to diagnosis or treatment. Fewer than half of funded grants aimed for clinically related targets (eg, sunburn reduction). Use of theory and technology occurred in more than 75% of grants. However, the full capability of proposed technology was infrequently used, and rarely did constructs of the proposed behavior change theory clearly and comprehensively drive the intervention approach. Policy or environmental manipulation was present in all dissemination grants but was rarely used elsewhere, and 19.4% included policy implementation and 25.8% proposed changes in built environment. Conclusions and Relevance Grant success rate in skin cancer-related behavioral science compares favorably to the overall NIH grant success rate (approximately 18%), and the success rate of male and female investigators was not statistically different. However, gaps exist in behavioral research addressing all points of the skin cancer control continuum, measuring interventions that hit clinically related targets, and leveraging technology, theory, and environmental manipulation to optimize intervention approach.
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Affiliation(s)
| | | | | | | | | | | | - Alan C. Geller
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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Using Ecological Momentary Assessment to Track Goal Progress Toward the Adoption of a Low Glycemic Index Diet Among Adults With Type 2 Diabetes. TOP CLIN NUTR 2016. [DOI: 10.1097/tin.0000000000000083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Liao P, Klasnja P, Tewari A, Murphy SA. Sample size calculations for micro-randomized trials in mHealth. Stat Med 2015; 35:1944-71. [PMID: 26707831 DOI: 10.1002/sim.6847] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 09/20/2015] [Accepted: 11/24/2015] [Indexed: 11/06/2022]
Abstract
The use and development of mobile interventions are experiencing rapid growth. In "just-in-time" mobile interventions, treatments are provided via a mobile device, and they are intended to help an individual make healthy decisions 'in the moment,' and thus have a proximal, near future impact. Currently, the development of mobile interventions is proceeding at a much faster pace than that of associated data science methods. A first step toward developing data-based methods is to provide an experimental design for testing the proximal effects of these just-in-time treatments. In this paper, we propose a 'micro-randomized' trial design for this purpose. In a micro-randomized trial, treatments are sequentially randomized throughout the conduct of the study, with the result that each participant may be randomized at the 100s or 1000s of occasions at which a treatment might be provided. Further, we develop a test statistic for assessing the proximal effect of a treatment as well as an associated sample size calculator. We conduct simulation evaluations of the sample size calculator in various settings. Rules of thumb that might be used in designing a micro-randomized trial are discussed. This work is motivated by our collaboration on the HeartSteps mobile application designed to increase physical activity. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Peng Liao
- Department of Statistics, University of Michigan, MI, 48109, Ann Arbor, U.S.A
| | - Predrag Klasnja
- School of Information, University of Michigan, MI, 48109, Ann Arbor, U.S.A
| | - Ambuj Tewari
- Department of Statistics, University of Michigan, MI, 48109, Ann Arbor, U.S.A
| | - Susan A Murphy
- Department of Statistics, University of Michigan, MI, 48109, Ann Arbor, U.S.A
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Klasnja P, Hekler EB, Shiffman S, Boruvka A, Almirall D, Tewari A, Murphy SA. Microrandomized trials: An experimental design for developing just-in-time adaptive interventions. Health Psychol 2015; 34S:1220-8. [PMID: 26651463 PMCID: PMC4732571 DOI: 10.1037/hea0000305] [Citation(s) in RCA: 279] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This article presents an experimental design, the microrandomized trial, developed to support optimization of just-in-time adaptive interventions (JITAIs). JITAIs are mHealth technologies that aim to deliver the right intervention components at the right times and locations to optimally support individuals' health behaviors. Microrandomized trials offer a way to optimize such interventions by enabling modeling of causal effects and time-varying effect moderation for individual intervention components within a JITAI. METHOD The article describes the microrandomized trial design, enumerates research questions that this experimental design can help answer, and provides an overview of the data analyses that can be used to assess the causal effects of studied intervention components and investigate time-varying moderation of those effects. RESULTS Microrandomized trials enable causal modeling of proximal effects of the randomized intervention components and assessment of time-varying moderation of those effects. CONCLUSION Microrandomized trials can help researchers understand whether their interventions are having intended effects, when and for whom they are effective, and what factors moderate the interventions' effects, enabling creation of more effective JITAIs.
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Czajkowski SM, Powell LH, Adler N, Naar-King S, Reynolds KD, Hunter CM, Laraia B, Olster DH, Perna FM, Peterson JC, Epel E, Boyington JE, Charlson ME. From ideas to efficacy: The ORBIT model for developing behavioral treatments for chronic diseases. Health Psychol 2015; 34:971-82. [PMID: 25642841 PMCID: PMC4522392 DOI: 10.1037/hea0000161] [Citation(s) in RCA: 572] [Impact Index Per Article: 63.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Given the critical role of behavior in preventing and treating chronic diseases, it is important to accelerate the development of behavioral treatments that can improve chronic disease prevention and outcomes. Findings from basic behavioral and social sciences research hold great promise for addressing behaviorally based clinical health problems, yet there is currently no established pathway for translating fundamental behavioral science discoveries into health-related treatments ready for Phase III efficacy testing. This article provides a systematic framework for developing behavioral treatments for preventing and treating chronic diseases. METHOD The Obesity-Related Behavioral Intervention Trials (ORBIT) model for behavioral treatment development features a flexible and progressive process, prespecified clinically significant milestones for forward movement, and return to earlier stages for refinement and optimization. RESULTS This article presents the background and rationale for the ORBIT model, a summary of key questions for each phase, a selection of study designs and methodologies well-suited to answering these questions, and prespecified milestones for forward or backward movement across phases. CONCLUSIONS The ORBIT model provides a progressive, clinically relevant approach to increasing the number of evidence-based behavioral treatments available to prevent and treat chronic diseases. (PsycINFO Database Record
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Affiliation(s)
- Susan M Czajkowski
- Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health
| | - Lynda H Powell
- Department of Preventive Medicine, Rush University Medical Center
| | - Nancy Adler
- Department of Psychiatry, Center for Health and Community, University of California, San Francisco
| | | | - Kim D Reynolds
- School of Community and Global Health, Claremont Graduate University
| | - Christine M Hunter
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health
| | - Barbara Laraia
- Division of Community Health and Human Development, School of Public Health, University of California, Berkeley
| | - Deborah H Olster
- Office of Behavioral and Social Sciences Research, Office of the Director, National Institutes of Health
| | - Frank M Perna
- Behavioral Research Program, National Cancer Institute, National Institutes of Health
| | | | - Elissa Epel
- Department of Psychiatry, Center for Health and Community, University of California, San Francisco
| | - Josephine E Boyington
- Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health
| | - Mary E Charlson
- Center for Integrative Medicine, Weill Cornell Medical College
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O'Brien N, Philpott-Morgan S, Dixon D. Using impairment and cognitions to predict walking in osteoarthritis: A series of n-of-1 studies with an individually tailored, data-driven intervention. Br J Health Psychol 2015; 21:52-70. [PMID: 26227024 DOI: 10.1111/bjhp.12153] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 06/26/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVES First, this study compares the ability of an integrated model of activity and activity limitations, the International Classification of Functioning, Disability and Health (ICF), and the Theory of Planned Behaviour (TPB) to predict walking within individuals with osteoarthritis. Second, the effectiveness of a walking intervention in these individuals is determined. DESIGN A series of n-of-1 studies with an AB intervention design was used. METHODS Diary methods were used to study four community-dwelling individuals with lower-limb osteoarthritis. Data on impairment symptoms (pain, pain on movement, and joint stiffness), cognitions (intention, self-efficacy, and perceived controllability), and walking (step count) were collected twice daily for 12 weeks. At 6 weeks, an individually tailored, data-driven walking intervention using action planning or a control cognition manipulation was delivered. Simulation modelling analysis examined cross-correlations and differences in baseline and intervention phase means. Post-hoc mediation analyses examined theoretical relationships and multiple regression analyses compared theoretical models. RESULTS Cognitions, intention in particular, were better and more consistent within individual predictors of walking than impairment. The walking intervention did not increase walking in any of the three participants receiving it. The integrated model and the TPB, which recognize a predictive role for cognitions, were significant predictors of walking variance in all participants, whilst the biomedical ICF model was only predictive for one participant. CONCLUSION Despite the lack of evidence for an individually tailored walking intervention, predictive data suggest that interventions for people with osteoarthritis that address cognitions are likely to be more effective than those that address impairment only. Further within-individual investigation, including testing mediational relationships, is warranted. STATEMENT OF CONTRIBUTION What is already known on this subject? N-of-1 methods have been used to study within-individual predictors of walking in healthy and chronic pain populations An integrated biomedical and behavioural model of activity and activity limitations recognizes the roles of impairment and psychology (cognitions) Interventions modifying cognitions can increase physical activity in people with mobility limitations What does this study add? N-of-1 methods are suitable to study within-individual predictors of walking and interventions in osteoarthritis An integrated and a psychological model are better predictors of walking in osteoarthritis than a biomedical model There was no support for an individually tailored, data-driven walking intervention.
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Affiliation(s)
- Nicola O'Brien
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Siôn Philpott-Morgan
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Diane Dixon
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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Dallery J, Jarvis B, Marsch L, Xie H. Mechanisms of change associated with technology-based interventions for substance use. Drug Alcohol Depend 2015; 150:14-23. [PMID: 25813268 PMCID: PMC4386723 DOI: 10.1016/j.drugalcdep.2015.02.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 02/23/2015] [Accepted: 02/28/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Technology-based interventions (TBIs) for substance use disorders have been increasing steadily. The mechanisms by which TBIs produce change in substance use outcomes have not been reviewed. This article is the first review of the conceptual and empirical underpinnings of the mechanisms associated with TBIs for substance use disorders. METHODS We review the literature on potential mechanisms associated with TBIs targeting tobacco, alcohol, and poly-substance use. We did not identify TBIs targeting other drug classes and that assessed mechanisms. RESULTS Research suggests that TBIs impact outcomes via similar potential mechanisms as in non-TBIs (e.g., in-person treatment), with the exception of substance use outcomes being associated with changes in the quality of coping skills. The most frequent potential mechanisms detected were self-efficacy for tobacco abstinence and perceived peer drinking for alcohol abstinence. CONCLUSIONS Research on mechanisms associated with TBIs is still in a nascent stage. We provide several recommendations for future work, including broadening the range of mechanisms assessed and increasing the frequency of assessment to detect temporal relations between mechanisms and outcomes. We also discuss unique challenges and opportunities afforded by technology that can advance theory, method, and clinical practice.
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Affiliation(s)
- Jesse Dallery
- Department of Psychology, University of Florida, United States.
| | | | - Lisa Marsch
- Center for Technology and Health, Dartmouth Psychiatric Research Center, Department of Psychiatry, Hanover, New Hampshire
| | - Haiyi Xie
- Center for Technology and Health, Dartmouth Psychiatric Research Center, Department of Psychiatry, Hanover, New Hampshire
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Kurti AN, Dallery J. INTEGRATING TECHNOLOGICAL ADVANCEMENTS IN BEHAVIORAL INTERVENTIONS TO PROMOTE HEALTH: UNPRECEDENTED OPORTUNITIES FOR BEHAVIOR ANALYSTS. REVISTA MEXICANA DE ANALISIS DE LA CONDUCTA = MEXICAN JOURNAL OF BEHAVIOR ANALYSIS 2014; 40:106-126. [PMID: 25774070 PMCID: PMC4358800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The use of mobile devices is growing worldwide in both industrialized and developing nations. Alongside the worldwide penetration of web-enabled devices, the leading causes of morbidity and mortality are increasingly modifiable lifestyle factors (e.g., improving one's diet and exercising more). Behavior analysts have the opportunity to promote health by combining effective behavioral methods with technological advancements. The objectives of this paper are (1) to highlight the public health gains that may be achieved by integrating technology with a behavior analytic approach to developing interventions, and (2) to review some of the currently, under-examined issues related to merging technology and behavior analysis (enhancing sustainability, obtaining frequent measures of behavior, conducting component analyses, evaluating cost-effectiveness, incorporating behavior analysis in the creation of consumer-based applications, and reducing health disparities). Thorough consideration of these issues may inspire the development, implementation, and dissemination of innovative, efficacious interventions that substantially improve global public health.
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Riley WT, Rivera DE. Methodologies for optimizing behavioral interventions: introduction to special section. Transl Behav Med 2014; 4:234-7. [PMID: 25264463 PMCID: PMC4167896 DOI: 10.1007/s13142-014-0281-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- William T. Riley
- />National Institutes of Health, 9609 Medical Center Dr., MSC 9761, Rockville, MD 20850 USA
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Dallery J, Kurti A, Erb P. A New Frontier: Integrating Behavioral and Digital Technology to Promote Health Behavior. THE BEHAVIOR ANALYST 2014; 38:19-49. [PMID: 27347477 DOI: 10.1007/s40614-014-0017-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Modifiable behavioral risk factors such as cigarette smoking, physical inactivity, and obesity contribute to over 40 % of premature deaths in the USA. Advances in digital and information technology are creating unprecedented opportunities for behavior analysts to assess and modify these risk factors. Technological advances include mobile devices, wearable sensors, biomarker detectors, and real-time access to therapeutic support via information technology. Integrating these advances with behavioral technology in the form of conceptually systematic principles and procedures could usher in a new generation of effective and scalable behavioral interventions targeting health behavior. In this selective review of the literature, we discuss how technological tools can assess and modify a range of antecedents and consequences of healthy and unhealthy behavior. We also describe practical, methodological, and conceptual advantages for behavior analysts that stem from the use of technology to assess and treat health behavior.
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Affiliation(s)
- Jesse Dallery
- Department of Psychology, University of Florida, P. O. Box 112250, Gainesville, FL 32611 USA
| | - Allison Kurti
- Department of Psychology, University of Florida, P. O. Box 112250, Gainesville, FL 32611 USA
| | - Philip Erb
- Department of Psychology, University of Florida, P. O. Box 112250, Gainesville, FL 32611 USA
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