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Cox DJ, Jennings AM. The Promises and Possibilities of Artificial Intelligence in the Delivery of Behavior Analytic Services. Behav Anal Pract 2024; 17:123-136. [PMID: 38405282 PMCID: PMC10890993 DOI: 10.1007/s40617-023-00864-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 02/27/2024] Open
Abstract
Artificial intelligence (AI) has begun to affect nearly every aspect of our daily lives and nearly every industry and profession. Many readers of this journal likely work in one or more areas of behavioral health. For readers who work in behavioral health and who are interested in AI, the purpose of this article is to highlight the pervasiveness of AI research being conducted around many facets of behavioral health service delivery. To do this, we first provide a brief overview of some of the areas within AI and the types of problems each area of AI attempts to solve. We then outline the prototypical client journey in behavioral healthcare beginning with diagnosis/assessment and ending with intervention withdrawal or ongoing monitoring. Next, for each stage in the client journey, we highlight several areas that parallel existing behavior analytic practice where researchers have begun to use AI, often to improve the efficiency of service delivery or to learn new things that improve the effectiveness of behavioral health services. Finally, for those whose appetite has been whet for getting involved with AI, we close by describing three roles they might consider trying out and that parallel the three main domains of behavior analysis. These three roles are an AI tool designer (akin to EAB), AI tool implementer (akin to ABA), or AI tool supporter (akin to practice).
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Affiliation(s)
- David J. Cox
- Department of Applied Behavior Analysis, Endicott College, Beverly, MA USA
| | - Adrienne M. Jennings
- Department of Behavioral Science, Daemen University, 4380 Main Street, Amherst, NY USA
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Stecher C, Cloonan S, Linnemayr S, Huberty J. Combining Behavioral Economics-Based Incentives With the Anchoring Strategy: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e39930. [PMID: 37115610 PMCID: PMC10182474 DOI: 10.2196/39930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 02/20/2023] [Accepted: 03/16/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Chronic (ie, long-term) elevated stress is associated with a number of mental and physical health conditions. Mindfulness meditation mobile apps are a promising tool for stress self-management that can overcome several barriers associated with in-person interventions; however, to date, poor app-based intervention adherence has limited the efficacy of these mobile health tools. Anchoring, or pairing, a new behavior with an existing routine has been shown to effectively establish habits that are maintained over time, but this strategy typically only works for those with high initial motivation and has yet to be tested for maintaining meditation with a mobile app. OBJECTIVE This study will test novel combinations of behavioral economics-based incentives with the anchoring strategy for establishing and maintaining adherence to an effective dose of meditation with a mobile app. METHODS This 16-week study will use a 5-arm, parallel, partially blinded (participants only), randomized controlled design. We will implement a fractional factorial study design that varies the use of self-monitoring messages and financial incentives to support participants' use of their personalized anchoring strategy for maintaining adherence to a ≥10 minute-per-day meditation prescription during an 8-week intervention period, followed by an 8-week postintervention observation period. Specifically, we will vary the use of self-monitoring messages of either the target behavior (ie, meditation tracking) or the outcome associated with the target behavior (ie, mood symptom tracking). We will also vary the use of financial incentives conditional on either meditation at any time of day or meditation performed at approximately the same time of day as participants' personalized anchors. RESULTS Continuous meditation app use data will be used to measure weekly meditation adherence over the 16-week study period as a binary variable equal to 1 if participants complete ≥10 minutes of meditation for ≥4 days per week and 0 otherwise. We will measure weekly anchoring plan adherence as a binary variable equal to 1 if participants complete ≥10 minutes of meditation within +1 or -1 hour of the timing of their chosen anchor on ≥4 days per week and 0 otherwise. In addition to these primary measures of meditation and anchoring plan adherence, we will also assess the secondary measures of stress, anxiety, posttraumatic stress disorder, sleep disturbance, and meditation app habit strength at baseline, week 8, and week 16. CONCLUSIONS This study will fill an important gap in the mobile health literature by testing novel intervention approaches for establishing and maintaining adherence to app-based mindfulness meditation. If successful, this study will identify an accessible and scalable stress self-management intervention that can help combat stress in the United States. TRIAL REGISTRATION ClinicalTrials.gov NCT05217602; https://clinicaltrials.gov/ct2/show/NCT05217602. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/39930.
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Affiliation(s)
- Chad Stecher
- Arizona State University, Phoenix, AZ, United States
| | - Sara Cloonan
- Arizona State University, Phoenix, AZ, United States
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Soltero EG, Lopez C, Musaad SM, O'Connor TM, Thompson D. Fit24, a digital health intervention to reduce type 2 diabetes risk among Hispanic youth: Protocol for a feasibility pilot study. Contemp Clin Trials 2023; 127:107117. [PMID: 36775009 PMCID: PMC10065958 DOI: 10.1016/j.cct.2023.107117] [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: 11/02/2022] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Poor physical activity (PA) and sleep behaviors in Hispanic adolescents contributes to increased risk for type 2 diabetes. Commonly owned digital devices and services like smartphones and text-messaging are highly used among adolescents and are promising intervention tools for reaching this age group. Personal activity trackers assess activity and sleep, making them ideal tools for addressing these behaviors. We propose to examine the feasibility of a 12-week intervention that uses theoretically grounded text messages and a Fitbit device to improve PA and sleep among Hispanic adolescents with obesity, as compared to a wait-list control group with a Fitbit device only. METHODS Participants (N = 48; 14-16 years) will be randomized (1:1) to the intervention or wait-list control group. Youth in the intervention will receive a Fitbit Charge 5 and daily text messages. Youth in the wait-list control group will receive a Fitbit Charge 5 and information on PA and sleep guidelines. RESULTS Feasibility will be examined by collecting process evaluation data on the following criteria: (1) recruit 48 Hispanic adolescents 14-16 years; (2) retain 85% of participants for post-assessments; (3) Fitbit wear ≥4 days/week and respond to 80% of text messages when prompted; (4) ≤10% technical issues; and (5) obtain 80% satisfaction from participants. DISCUSSION This study will advance our knowledge on the feasibility of digital prevention strategies to promote PA and sleep behaviors to reduce T2D risk among Hispanic youth. If feasible, this approach has the potential to be a scalable, cost-effective diabetes prevention strategy among high-risk youth. TRIAL REGISTRATION NCT04953442, registered on July 8, 2021.
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Affiliation(s)
- Erica G Soltero
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates St., Houston, TX 77030, USA; Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | - Callie Lopez
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates St., Houston, TX 77030, USA; Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Salma M Musaad
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates St., Houston, TX 77030, USA; Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Teresia M O'Connor
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates St., Houston, TX 77030, USA; Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates St., Houston, TX 77030, USA; Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
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Szigethy E, Wolfson D, Sinclair-McBride K, Williams K, Jhe G, Lee EH, Bialostozky M, Wallace M, Bhatnagar S, Demaso DR, Yealy DM, Hollenbach K. Efficacy of a digital mental health intervention embedded in routine care compared with treatment as usual in adolescents and young adults with moderate depressive symptoms: protocol for randomised controlled trial. BMJ Open 2023; 13:e067141. [PMID: 37001917 PMCID: PMC10069502 DOI: 10.1136/bmjopen-2022-067141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
INTRODUCTION There are unmet mental health needs of depressed adolescents and young adults (AYAs) across the USA. Behavioural technology adequately integrated into clinical care delivery has potential to improve care access and efficiency. This multisite randomised controlled trial evaluates how a coach-enhanced digital cognitive behavioural intervention (dCBI) enhances usual care for depressed AYAs in paediatric practices with minority enriched samples. METHODS AND ANALYSIS Participants (n=750) ages 16-22 who meet threshold criteria for depressive severity (Patient Health Questionnaire-9; PHQ-9 score 10-24) will be recruited through paediatric practices across three academic institutions (Boston, Pittsburgh and San Diego). Participants will be randomised to 12 weeks of dCBI+treatment as usual (TAU) (n=450) or TAU alone (n=300) in outpatient paediatric practices. Assessments will be completed at baseline, 6 weeks and 12 weeks with the primary outcome being improvement in clinician-rated and self-reported depressive severity (Children's Depression Rating Scale-Revised and PHQ-9) and secondary outcomes being self-reported suicidal ideation (item 9 on PHQ-9), anxiety severity (Generalised Anxiety Disorder), general quality of life (Satisfaction with Life Scale) and general functioning (Children's Global Assessment Scale). The study design is an intent-to-treat mixed effects regression with group, and covariates nested within the sites. ETHICS AND DISSEMINATION All participants or their parent/guardian (under 18 years or unemancipated) will give informed consent to a study team member. All data are expected to be collected over 18 months. The Institutional Review Board (IRB) is a board at each institution in the United States that reviews and monitors research involving human subjects. IRB approval from the University of Pittsburgh was obtained on 30 November 2021 (STUDY21080150), from the University of California San Diego's Human Research Protection Program IRB on 14 July 2022 (802047), and from the Boston Children's Hospital IRB on 25 October 2022 (P00040987). Full study results are planned to be published within 2 years of initial study recruitment (October 2024). Dissemination of findings will occur in peer-reviewed journals, professional conferences and through reports to participating entities and stakeholders. TRIAL REGISTRATION NUMBER NCT05159713; ClinicalTrials.gov.
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Affiliation(s)
- Eva Szigethy
- Department of Psychiatry and Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David Wolfson
- Department of Pediatrics, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | | | - Kelly Williams
- University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Grace Jhe
- Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Erica H Lee
- Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | | | - Sonika Bhatnagar
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - D R Demaso
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Donald M Yealy
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Schaffer M, McLoone JK, Wakefield CE, Brierley ME, Girgis A, McCarthy MC, Thornton-Benko E, Chan RJ, Johnston KA, Cohn RJ, Signorelli C. eHealth tools for childhood cancer survivorship care: A qualitative analysis of survivors', parents', and general practitioners' views. PEC INNOVATION 2022; 1:100010. [PMID: 37364028 PMCID: PMC10194118 DOI: 10.1016/j.pecinn.2021.100010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/11/2021] [Accepted: 11/23/2021] [Indexed: 06/28/2023]
Abstract
Objective We assessed the acceptability of, and perceived benefits/barriers to, using Electronic health (eHealth) technology for childhood cancer survivorship care. Methods We interviewed survivors, their parents, and their nominated GP. We described a hypothetical eHealth tool to manage survivorship care and asked their likely use of, and perceived benefits/concerns for, the use of the tool. Results 31 survivors (mean age = 27.0), 29 parents (survivors' mean age = 12.6), and 51 GPs (mean years practising = 28.2) participated. Most survivors/parents (85%) and GPs (75%) indicated that they would be willing to use an eHealth tool. Survivors/parents reported that an eHealth tool would increase their confidence in their ability, and their GP's ability, to manage their survivorship care. GPs agreed that an eHealth tool would provide easier access to survivors' medical information and increase their capacity to provide support during survivorship. Some GPs (7%) and survivors (43%) reported being hesitant to use eHealth tools due to privacy/security concerns. Conclusion Overall, eHealth tools appear acceptable and may help to improve the management of late effects for childhood cancer survivors and assist their GPs to coordinate their care. Innovation Concerns raised by key stakeholders should be addressed in the design of eHealth technologies to optimise their uptake and effectiveness.
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Affiliation(s)
- Maria Schaffer
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Jordana K. McLoone
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Claire E. Wakefield
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Mary-Ellen Brierley
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Afaf Girgis
- South West Sydney Clinical Campuses, UNSW Medicine & Health, UNSW Sydney, Australia
| | - Maria C. McCarthy
- Murdoch Children's Research Institute, Parkville, Victoria 3052, Australia
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria 3052, Australia
| | - Elysia Thornton-Benko
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
- Bondi Road Doctors, Bondi Junction, NSW, Australia
| | - Raymond J. Chan
- Cancer and Palliative Care Outcomes Centre and School of Nursing, Queensland University of Technology (QUT), Kelvin Grove, Queensland 4059, Australia
- Division of Cancer Services, Princess Alexandra Hospital, Woolloongabba, Queensland 4102, Australia
| | - Karen A. Johnston
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Richard J. Cohn
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Christina Signorelli
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
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Szigethy EM, Silfee V, Marroquin MA, Pavlick AN, Wallace ML, Williams KR, Hoberman AM. A Digital Cognitive-Behavioral Intervention for Depression and Anxiety Among Adolescents and Young Adults. Psychiatr Serv 2022; 74:437-440. [PMID: 36164775 DOI: 10.1176/appi.ps.202200045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Adolescents and young adults frequently experience anxiety and depression. The authors evaluated engagement in and effects of a coach-enhanced digital cognitive-behavioral intervention (dCBI; RxWell) targeting emotional distress in this age group. The dCBI app was prescribed to 506 adolescents and young adults at 35 pediatric practices; 278 enrolled in the app, of whom 58% engaged and 63% messaged their coach. Patients completed monthly General Anxiety Disorder-7 and eight-item Patient Health Questionnaire assessments, and a subset completed qualitative interviews. The dCBI app was associated with a significant reduction in anxiety and depression at 1 and 3 months. A dCBI is feasible as part of routine pediatric care and associated with reduced emotional distress.
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Affiliation(s)
- Eva M Szigethy
- Departments of Psychiatry (Szigethy, Marroquin, Pavlick, Wallace) and Pediatrics (Szigethy, Hoberman), University of Pittsburgh, Pittsburgh; UPMC Insurance Services Division (Silfee) and UPMC Center for High Value Health Care (Williams), Pittsburgh
| | - Valerie Silfee
- Departments of Psychiatry (Szigethy, Marroquin, Pavlick, Wallace) and Pediatrics (Szigethy, Hoberman), University of Pittsburgh, Pittsburgh; UPMC Insurance Services Division (Silfee) and UPMC Center for High Value Health Care (Williams), Pittsburgh
| | - Maria A Marroquin
- Departments of Psychiatry (Szigethy, Marroquin, Pavlick, Wallace) and Pediatrics (Szigethy, Hoberman), University of Pittsburgh, Pittsburgh; UPMC Insurance Services Division (Silfee) and UPMC Center for High Value Health Care (Williams), Pittsburgh
| | - Alexa N Pavlick
- Departments of Psychiatry (Szigethy, Marroquin, Pavlick, Wallace) and Pediatrics (Szigethy, Hoberman), University of Pittsburgh, Pittsburgh; UPMC Insurance Services Division (Silfee) and UPMC Center for High Value Health Care (Williams), Pittsburgh
| | - Meredith L Wallace
- Departments of Psychiatry (Szigethy, Marroquin, Pavlick, Wallace) and Pediatrics (Szigethy, Hoberman), University of Pittsburgh, Pittsburgh; UPMC Insurance Services Division (Silfee) and UPMC Center for High Value Health Care (Williams), Pittsburgh
| | - Kelly R Williams
- Departments of Psychiatry (Szigethy, Marroquin, Pavlick, Wallace) and Pediatrics (Szigethy, Hoberman), University of Pittsburgh, Pittsburgh; UPMC Insurance Services Division (Silfee) and UPMC Center for High Value Health Care (Williams), Pittsburgh
| | - Alejandro M Hoberman
- Departments of Psychiatry (Szigethy, Marroquin, Pavlick, Wallace) and Pediatrics (Szigethy, Hoberman), University of Pittsburgh, Pittsburgh; UPMC Insurance Services Division (Silfee) and UPMC Center for High Value Health Care (Williams), Pittsburgh
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Nastasi JA, Curry EM, Martinez RE, Arigo D, Raiff BR. Stepping Up: An Evaluation of Social Comparison of Physical Activity During Fitbit Challenges. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2022; 7:265-276. [PMID: 35224181 PMCID: PMC8857400 DOI: 10.1007/s41347-022-00241-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 12/17/2021] [Accepted: 02/02/2022] [Indexed: 11/17/2022]
Abstract
The current set of within-subject, single-case design studies examined how exposure to social comparison information may impact physical activity in sedentary individuals. In Study 1, participants (N = 6) were exposed to two Fitbit challenges, one with a physically active confederate and another with a sedentary confederate. Each challenge phase lasted 7 days, during which participants were able to compare their daily steps to the assigned confederate on a ranked leaderboard, received notifications if their cumulative steps were surpassed by the confederate, and a notification indicating if they won at the conclusion of each challenge (i.e., active confederate in challenge one then sedentary confederate in challenge two, or vice versa). Study 2 replicated the procedures used in Study 1 but controlled for the distance between confederate and participant daily steps (N = 4). In Study 3, participants (N = 4) were exposed to the same confederate twice to evaluate potential order effects. Results showed that physical activity increased for most participants, but the direction and magnitude of effects differed across participants, challenge type, and order of confederate exposure. The factors producing differential responding to the Fitbit challenges, and the implications for future research on the effects of competition and social comparison on behavior, are discussed.
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Erath TG, DiGennaro Reed FD. Technology-based contingency management for walking to prevent prolonged periods of workday sitting. J Appl Behav Anal 2022; 55:746-762. [PMID: 35388466 DOI: 10.1002/jaba.917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 11/05/2022]
Abstract
Sedentary behavior is an emerging public health issue. Frequent, brief bouts of walking are recommended by experts to reduce the health risks correlated with physical inactivity and prolonged sedentary periods. The purpose of the current study was to extend the literature by evaluating a remote, technology-based contingency management (CM) intervention that reinforced frequent, brief bouts of walking to decrease prolonged periods of sitting during the workday. A packaged intervention consisting of a contingency contract, monetary incentives, goal setting, textual prompts, and performance feedback was implemented with individuals with sedentary job responsibilities working from home during the COVID-19 pandemic. The intervention increased the number of physically active intervals to mastery for 4 participants, thereby disrupting prolonged periods of sedentary time. For 2 participants, the intervention did not meaningfully increase the number of physically active intervals. Results suggest that a remote, digital CM intervention can decrease sedentary behavior in home office environments.
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Affiliation(s)
- Tyler G Erath
- Department of Applied Behavioral Science, University of Kansas
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Hurmuz MZ, Jansen-Kosterink SM, Beinema T, Fischer K, op den Akker H, Hermens HJ. Evaluation of a virtual coaching system eHealth intervention: A mixed methods observational cohort study in the Netherlands. Internet Interv 2022; 27:100501. [PMID: 35198411 PMCID: PMC8844700 DOI: 10.1016/j.invent.2022.100501] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 01/24/2022] [Accepted: 02/02/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND With the rise in human life expectancy, the prevalence of chronic disease has increased significantly. Adopting a healthy lifestyle can decrease the risk of chronic disease. Virtual coaching systems can help older adults adopt a healthy lifestyle.AimThe primary objective of this study was to assess the use, user experience and potential health effects of a conversational agent-based eHealth platform (Council of Coaches) implemented in a real-world setting among older adults. METHODS An observational cohort study was conducted with older adults aged 55 years or older in the Netherlands. Participants were enrolled for 5-9 weeks during which they had access to Council of Coaches. They completed three questionnaires: pre-test, post-test, and at follow-up. After five weeks, an interview was conducted, and participants chose whether they wanted to use the eHealth intervention for another four weeks during the facultative phase. RESULTS The study population consisted of 51 older adults (70.6% female) with a mean age of 65.3 years (SD = 7.4). Of these, 94.1% started interacting with Council of Coaches, and most participants interacted once per week. During the facultative phase, 21 participants were still interacting with Council of Coaches. Minimal clinical important differences in quality of life were found among the study population after interacting with Council of Coaches. CONCLUSION Our results demonstrate that eHealth interventions with virtual coaching can be used among older adults. This may increase quality of life for older adults, and decrease their healthcare needs. Future research into such eHealth interventions should take into account the inclusion of sufficient personalised content and the use of a mixed methods study for assessing the eHealth intervention.
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Affiliation(s)
- Marian Z.M. Hurmuz
- Roessingh Research and Development, eHealth department, Roessinghsbleekweg 33b, 7522, AH, Enschede, the Netherlands
- University of Twente, Biomedical Signal and Systems group, Drienerlolaan 5, 7522, NB, Enschede, the Netherlands
- Corresponding author at: Roessingh Research and Development, Roessinghsbleekweg 33b, 7522, AH, Enschede, the Netherlands.
| | - Stephanie M. Jansen-Kosterink
- Roessingh Research and Development, eHealth department, Roessinghsbleekweg 33b, 7522, AH, Enschede, the Netherlands
- University of Twente, Biomedical Signal and Systems group, Drienerlolaan 5, 7522, NB, Enschede, the Netherlands
| | - Tessa Beinema
- Roessingh Research and Development, eHealth department, Roessinghsbleekweg 33b, 7522, AH, Enschede, the Netherlands
- University of Twente, Biomedical Signal and Systems group, Drienerlolaan 5, 7522, NB, Enschede, the Netherlands
| | - Katrien Fischer
- VU University Amsterdam, Faculty of Human Movement Sciences, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands
| | - Harm op den Akker
- Roessingh Research and Development, eHealth department, Roessinghsbleekweg 33b, 7522, AH, Enschede, the Netherlands
- University of Twente, Biomedical Signal and Systems group, Drienerlolaan 5, 7522, NB, Enschede, the Netherlands
| | - Hermie J. Hermens
- Roessingh Research and Development, eHealth department, Roessinghsbleekweg 33b, 7522, AH, Enschede, the Netherlands
- University of Twente, Biomedical Signal and Systems group, Drienerlolaan 5, 7522, NB, Enschede, the Netherlands
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Choi E, Yoon EH, Park MH. Game-based digital therapeutics for children and adolescents: Their therapeutic effects on mental health problems, the sustainability of the therapeutic effects and the transfer of cognitive functions. Front Psychiatry 2022; 13:986687. [PMID: 36523871 PMCID: PMC9744939 DOI: 10.3389/fpsyt.2022.986687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/20/2022] [Indexed: 11/30/2022] Open
Abstract
Mental health problems in childhood and adolescence (e. g., attention deficits, problems in emotional understanding and subclinical levels of anxiety) are reported to develop further in adulthood and/or to increase the risk of developing mental health disorders in adulthood. Although it is important to provide treatment or prevention interventions for children and adolescents in order to reduce the risk of the further development of mental health problems, the pharmacological and behavioral treatments for this age group have limitations (e.g., limited access, unsustainable treatment effects and the lack of engagement in intervention). In order to overcome the limitations of conventional treatments, the use of digital technology, especially video games for this age group, is suggested. In order to be accepted as clinical interventions, objective evidence for the therapeutic effects of digital therapeutic that used video games to treat or prevent targeted mental health problems are required. Thus, this review aims to explore whether game-based digital therapeutics (DTx) for children and adolescents showed therapeutic effects on targeted mental health problems. As game-based DTx are suggested to show sustained therapeutic effects and the transfer of cognitive functions, it also reviews the maintenance of the therapeutic effects of DTx and the extent of the transfer of cognitive functions. Game-based DTx that are developed to treat or prevent mental health problems (e.g., attention deficit, depression) in children and adolescents are found to show therapeutic effects on targeted mental health problems despite the limitations (e.g., small sample size, limited investigation of the sustainability). This review would contribute to the understanding of whether there is objective evidence of the therapeutic effects of digital therapeutics using video games that deliver treatment or prevention interventions for mental health problems in children and adolescents.
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Affiliation(s)
- Eunhye Choi
- Department of Psychiatry, Eunpyeong St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea
| | - Eun-Ha Yoon
- Department of Psychiatry, Eunpyeong St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea
| | - Min-Hyeon Park
- Department of Psychiatry, Eunpyeong St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea
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Sucala M, Ezeanochie NP, Cole-Lewis H, Turgiss J. An iterative, interdisciplinary, collaborative framework for developing and evaluating digital behavior change interventions. Transl Behav Med 2021; 10:1538-1548. [PMID: 31328775 PMCID: PMC7796712 DOI: 10.1093/tbm/ibz109] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The rapid expansion of technology promises to transform the behavior science field by revolutionizing the ways in which individuals can monitor and improve their health behaviors. To fully live into this promise, the behavior science field must address distinct challenges, including: building interventions that are not only scientifically sound but also engaging; using evaluation methods to precisely assess intervention components for intervention optimization; and building personalized interventions that acknowledge and adapt to the dynamic ecosystem of individual and contextual variables that impact behavior change. The purpose of this paper is to provide a framework to address these challenges by leveraging behavior science, human-centered design, and data science expertise throughout the cycle of developing and evaluating digital behavior change interventions (DBCIs). To define this framework, we reviewed current models and practices for intervention development and evaluation, as well as technology industry models for product development. The framework promotes an iterative process, aiming to maximize outcomes by incorporating faster and more frequent testing cycles into the lifecycle of a DBCI. Within the framework provided, we describe each phase, from development to evaluation, to discuss the optimal practices, necessary stakeholders, and proposed evaluation methods. The proposed framework may inform practices in both academia and industry, as well as highlight the need to offer collaborative platforms to ensure successful partnerships that can lead to more effective DBCIs that reach broad and diverse populations.
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Affiliation(s)
- Madalina Sucala
- Johnson and Johnson Health and Wellness Solutions Inc., New Brunswick, NJ, USA
| | | | - Heather Cole-Lewis
- Johnson and Johnson Health and Wellness Solutions Inc., New Brunswick, NJ, USA
| | - Jennifer Turgiss
- Johnson and Johnson Health and Wellness Solutions Inc., New Brunswick, NJ, USA
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Lavefjord A, Sundström FT, Buhrman M, McCracken LM. Assessment methods in single case design studies of psychological treatments for chronic pain: A scoping review. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Kim H, Lee C, Lee S, Chung KM. Effect of Group Contingency Type on Walking: Comparisons of Effectiveness and Cost Efficiency. Front Psychol 2021; 12:655663. [PMID: 34122239 PMCID: PMC8195251 DOI: 10.3389/fpsyg.2021.655663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/21/2021] [Indexed: 11/13/2022] Open
Abstract
Group contingency (GC) is an effective and cost-efficient strategy that can be successfully applied to technology-based interventions. This study examined the relative effectiveness and cost efficiency of three types of technology-based group contingencies on walking among adults. Seventy two students were divided into teams of three. Each team was randomly assigned to one of three GC conditions (independent, interdependent, or dependent) and underwent 66 days of technology-based group contingency intervention. Sixty five participants completed the intervention and 61 completed the follow-up assessment 2 months later. Step counts and self-reported walking activity increased after the intervention under all three conditions. The proportion of participants that met the target step counts was significantly higher under the dependent group contingency condition. However, 2 months later, intervention effects were not maintained under any condition. For cost efficiency, the increase in step count per point was significantly higher under the interdependent group contingency condition. Group cohesion and social validity (point satisfaction and point utility) were significantly higher under the dependent group contingency condition. Finally, the clinical implications and limitations of this study are discussed.
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Affiliation(s)
- Heewon Kim
- Department of Psychology, Yonsei University, Seoul, South Korea
| | - Changseok Lee
- Department of Psychology, Yonsei University, Seoul, South Korea
| | - Seoi Lee
- Department of Psychology, Yonsei University, Seoul, South Korea
| | - Kyong-Mee Chung
- Department of Psychology, Yonsei University, Seoul, South Korea
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Getty CA, Weaver T, Lynskey M, Kirby KC, Dallery J, Metrebian N. Patients' beliefs towards contingency management: Target behaviours, incentives and the remote application of these interventions. Drug Alcohol Rev 2021; 41:96-105. [PMID: 34034358 DOI: 10.1111/dar.13314] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/19/2021] [Accepted: 04/26/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Contingency management interventions are among the most efficacious psychosocial interventions in promoting abstinence from smoking, alcohol and substance use. The aim of this study was to assess the beliefs and objections towards contingency management among patients in UK-based drug and alcohol services to help understand barriers to uptake and support the development and implementation of these interventions. METHODS The Service User Survey of Incentives was developed and implemented among patients (N = 181) at three UK-based drug and alcohol treatment services. Descriptive analyses were conducted to ascertain positive and negative beliefs about contingency management, acceptability of different target behaviours, incentives and delivery mechanisms including delivering incentives remotely using technology devices such as mobile telephones. RESULTS Overall, 81% of participants were in favour of incentive programs, with more than 70% of respondents agreeing with the majority of positive belief statements. With the exception of two survey items, less than a third of participants agreed with negative belief statements. The proportion of participants indicating a neutral response was higher for negative statements (27%) indicating greater levels of ambiguity towards objections and concerns regarding contingency management. DISCUSSION AND CONCLUSIONS Positive beliefs towards contingency management interventions were found, including high levels of acceptability towards a range of target behaviours, incentives and the use of technology devices to remotely monitor behaviour and deliver incentives. These findings have implications for the development and implementation of remote contingency management interventions within the UK drug treatment services.
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Affiliation(s)
- Carol-Ann Getty
- National Addiction Centre, King's College London, London, UK
| | - Tim Weaver
- Department of Mental Health and Social Work, Middlesex University, London, UK
| | - Michael Lynskey
- National Addiction Centre, King's College London, London, UK
| | - Kimberly C Kirby
- TRI Center on Addictions, Public Health Management Corporation, Philadelphia, USA
| | - Jesse Dallery
- Department of Psychology, University of Florida, Gainesville, USA
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Jain JP, Offer C, Rowe C, Turner C, Dawson-Rose C, Hoffmann T, Santos GM. The Psychosocial Predictors and Day-Level Correlates of Substance Use Among Participants Recruited via an Online Crowdsourcing Platform in the United States: Daily Diary Study. JMIR Public Health Surveill 2021; 7:e23872. [PMID: 33904828 PMCID: PMC8114164 DOI: 10.2196/23872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/30/2020] [Accepted: 01/22/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Alcohol consumption and stimulant use are major public health problems and contribute to morbidity and mortality in the United States. To inform interventions for substance use, there is a need to identify the day-level correlates of substance use by collecting repeated measures data in one's natural environment. There is also a need to use crowdsourcing platforms like Amazon Mechanical Turk (MTurk) to efficiently engage larger populations of people who use alcohol and stimulants in research. OBJECTIVE We aimed to (1) utilize daily diaries to examine the temporal relationship between day-level cravings for alcohol and stimulant/substance use (ie, heavy drinking or any drug use) in a given day over 14 days and (2) assess whether depression, negative affect, and self-esteem measured at baseline predict substance use in a given day over 14 days among people who use alcohol and/or stimulants in the United States. METHODS Individuals aged ≥18 years in the United States, who reported alcohol or stimulant (ie, cocaine, crack cocaine, and methamphetamine) use in the past year, were recruited using MTurk between March 26 and April 13, 2018. Eligible participants completed a baseline survey and 14 daily surveys online. The baseline survey assessed sociodemographics and psychosocial (ie, depression, affect, self-esteem, and stress) factors. Daily surveys assessed substance use and cravings for alcohol and stimulants. Four multivariable random-intercept logistic regression models were built to examine psychosocial constructs separately along with other significant predictors from bivariate analyses while controlling for age and education. RESULTS Among a total of 272 participants, 220 were White, 201 were male, and 134 were men who have sex with men (MSM). The mean age was 36.1 years (SD 10.5). At baseline, 173 participants engaged in any current or past hazardous alcohol consumption, 31 reported using cocaine, 19 reported using methamphetamine, 8 reported using crack cocaine, and 104 reported any noninjection or injection drug use in the past 6 months. Factors independently associated with substance use were depression (adjusted odds ratio [aOR] 1.11, 95% CI 1.02-1.21; P=.01), negative affect (aOR 1.08, 95% CI 1.01-1.16; P=.01), lower levels of self-esteem (aOR 0.90, 95% CI 0.82-0.98; P=.02), and cravings for alcohol (aOR 1.02, 95% CI 1.01-1.03; P<.001) and stimulants (aOR 1.03, 95% CI 1.01-1.04; P=.01). MSM had higher odds of engaging in substance use in all models (model 1: aOR 4.90, 95% CI 1.28-18.70; P=.02; model 2: aOR 5.47, 95% CI 1.43-20.87; P=.01; model 3: aOR 5.99, 95% CI 1.55-23.13; P=.009; and model 4: aOR 4.94, 95% CI 1.29-18.84; P=.01). CONCLUSIONS Interventions for substance use should utilize evidenced-based approaches to reduce depression, negative affect, and cravings; increase self-esteem; and engage MSM. Interventions may also consider leveraging technology-based approaches to reduce substance use among populations who use crowdsourcing platforms.
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Affiliation(s)
| | - Claudine Offer
- San Francisco Department of Public Health, San Francisco, CA, United States
| | - Christopher Rowe
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Caitlin Turner
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Carol Dawson-Rose
- San Francisco Department of Public Health, San Francisco, CA, United States
| | - Thomas Hoffmann
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Glenn-Milo Santos
- San Francisco Department of Public Health, San Francisco, CA, United States
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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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Dallery J, Stinson L, Bolívar H, Modave F, Salloum RG, Viramontes TM, Rohilla P. mMotiv8
: A smartphone‐based contingency management intervention to promote smoking cessation. J Appl Behav Anal 2020; 54:38-53. [DOI: 10.1002/jaba.800] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/19/2020] [Accepted: 10/19/2020] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | - François Modave
- Department of Health Outcomes & Biomedical Informatics University of Florida
| | - Ramzi G. Salloum
- Department of Health Outcomes & Biomedical Informatics University of Florida
| | | | - Pulkit Rohilla
- Department of Health Outcomes & Biomedical Informatics University of Florida
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Digital Health Applications for Pharmacogenetic Clinical Trials. Genes (Basel) 2020; 11:genes11111261. [PMID: 33114567 PMCID: PMC7692850 DOI: 10.3390/genes11111261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/20/2020] [Accepted: 10/24/2020] [Indexed: 12/15/2022] Open
Abstract
Digital health (DH) is the use of digital technologies and data analytics to understand health-related behaviors and enhance personalized clinical care. DH is increasingly being used in clinical trials, and an important field that could potentially benefit from incorporating DH into trial design is pharmacogenetics. Prospective pharmacogenetic trials typically compare a standard care arm to a pharmacogenetic-guided therapeutic arm. These trials often require large sample sizes, are challenging to recruit into, lack patient diversity, and can have complicated workflows to deliver therapeutic interventions to both investigators and patients. Importantly, the use of DH technologies could mitigate these challenges and improve pharmacogenetic trial design and operation. Some DH use cases include (1) automatic electronic health record-based patient screening and recruitment; (2) interactive websites for participant engagement; (3) home- and tele-health visits for patient convenience (e.g., samples for lab tests, physical exams, medication administration); (4) healthcare apps to collect patient-reported outcomes, adverse events and concomitant medications, and to deliver therapeutic information to patients; and (5) wearable devices to collect vital signs, electrocardiograms, sleep quality, and other discrete clinical variables. Given that pharmacogenetic trials are inherently challenging to conduct, future pharmacogenetic utility studies should consider implementing DH technologies and trial methodologies into their design and operation.
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Sigurdsson V, Fagerstrøm A. An Introduction to the Special Section on "Health, Technology, & Behavior Science". Perspect Behav Sci 2020; 43:445-449. [PMID: 33029574 DOI: 10.1007/s40614-020-00267-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This special section of the Perspectives on Behavior Science focuses on health, technology, and behavior science. The aim is to provide reviews and empirical research that integrates the latest technological innovations and behavior science. The selected articles are categorized into contributions in which technology is used to study health-related behavior and articles on the use of technology to deliver health behavior interventions. The contributors in this special section demonstrate that behavior science can aid an understanding of why people do or do not engage in a healthy lifestyle and help identify what is needed to design a successful health behavior intervention through the use of technology.
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Maramis C, Moulos I, Ioakimidis I, Papapanagiotou V, Langlet B, Lekka I, Bergh C, Maglaveras N. A smartphone application for semi-controlled collection of objective eating behavior data from multiple subjects. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 194:105485. [PMID: 32464588 DOI: 10.1016/j.cmpb.2020.105485] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/04/2020] [Accepted: 03/29/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND & OBJECTIVE The study of eating behavior has made significant progress towards understanding the association of specific eating behavioral patterns with medical problems, such as obesity and eating disorders. Smartphones have shown promise in monitoring and modifying unhealthy eating behavior patterns, often with the help of sensors for behavior data recording. However, when it comes to semi-controlled deployment settings, smartphone apps that facilitate eating behavior data collection are missing. To fill this gap, the present work introduces ASApp, one of the first smartphone apps to support researchers in the collection of heterogeneous objective (sensor-acquired) and subjective (self-reported) eating behavior data in an integrated manner from large-scale, naturalistic human subject research (HSR) studies. METHODS This work presents the overarching and deployment-specific requirements that have driven the design of ASApp, followed by the heterogeneous eating behavior dataset that is collected and the employed data collection protocol. The collected dataset combines objective and subjective behavior information, namely (a) dietary self-assessment information, (b) the food weight timeseries throughout an entire meal (using a portable weight scale connected wirelessly), (c) a photograph of the meal, and (d) a series of quantitative eating behavior indicators, mainly calculated from the food weight timeseries. The designed data collection protocol is quick, straightforward, robust and capable of satisfying the requirement of semi-controlled HSR deployment. RESULTS The implemented functionalities of ASApp for research assistants and study participants are presented in detail along with the corresponding user interfaces. ASApp has been successfully deployed for data collection in an in-house testing study and the SPLENDID study, i.e., a real-life semi-controlled HSR study conducted in the cafeteria of a Swedish high-school in the context of an EC-funded research project. The two deployment studies are described and the promising results from the evaluation of the app with respect to attractiveness, usability, and technical soundness are discussed. Access details for ASApp are also provided. CONCLUSIONS This work presents the requirement elucidation, design, implementation and evaluation of a novel smartphone application that supports researchers in the integrated collection of a concise yet rich set of heterogeneous eating behavior data for semi-controlled HSR.
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Affiliation(s)
- Christos Maramis
- Department of Medicine, School of Life Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Ioannis Moulos
- Department of Medicine, School of Life Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Ioakimidis
- Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden
| | - Vasileios Papapanagiotou
- Department of Electrical & Computer Engineering, School of Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Billy Langlet
- Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden
| | - Irini Lekka
- Department of Medicine, School of Life Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Nicos Maglaveras
- Department of Medicine, School of Life Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Otterbring T, Gidlöf K, Rolschau K, Shams P. Cereal Deal: How the Physical Appearance of Others Affects Attention to Healthy Foods. Perspect Behav Sci 2020; 43:451-468. [PMID: 33029575 PMCID: PMC7490312 DOI: 10.1007/s40614-020-00242-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
This eye-tracking study investigated whether the physical appearance of another consumer can influence people's visual attention and choice behavior in a grocery shopping context. Participants (N = 96) took part in a lab-based experiment and watched a brief video recording featuring a female consumer standing in front of a supermarket shelf. The appearance and body type of the consumer was manipulated between conditions, such that she was perceived as 1) healthy and of normal weight, 2) unhealthy by means of overweight, or 3) unhealthy through visual signs associated with a potentially unhealthy lifestyle, but not by means of overweight. Next, participants were exposed to a supermarket shelf with cereals and were asked to choose one alternative they could consider buying. Prior exposure to a seemingly unhealthy (vs. healthy) consumer resulted in a relative increase in participants' visual attention towards products perceived to be healthy (vs. unhealthy), which prompted cereal choices deemed to be healthier. This effect was stronger for products that holistically, through their design features, managed to convey the impression that they are healthy rather than products with explicit cues linked to healthiness (i.e., the keyhole label). These results offer important implications regarding packaging design for marketers, brand owners, and policy makers. Moreover, the findings highlight the value of technological tools, such as eye-tracking methodology, for capturing consumers' entire decision-making processes instead of focusing solely on outcome-based metrics, such as choice data or purchase behavior.
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Affiliation(s)
- Tobias Otterbring
- Department of Management/MAPP, Aarhus University, Fuglesangs Allé 4, 8210 Aarhus V, Denmark
| | - Kerstin Gidlöf
- Department of Management/MAPP, Aarhus University, Fuglesangs Allé 4, 8210 Aarhus V, Denmark
| | - Kristian Rolschau
- Department of Management/MAPP, Aarhus University, Fuglesangs Allé 4, 8210 Aarhus V, Denmark
| | - Poja Shams
- Department of Business Administration & CTF, Service Research Center, Karlstad University, Universitetsgatan 2, 65188 Karlstad, Sweden
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Are you ready for the challenge? Social Media Health Challenges for Behaviour Change. Perspect Behav Sci 2020; 43:543-578. [PMID: 33029579 DOI: 10.1007/s40614-020-00261-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Challenges are one of the most common strategies used by Opinion Leaders on Social Media to engage users. They are often found in different areas; in the Health field, the use of challenges is growing, namely through initiatives aiming at eating behaviour change. Instagram is considered to be one of the most used Social Media applications to develop these initiatives, allowing Opinion Leaders to communicate and engage with their online followers. Despite this scenario, little is known regarding how Health Challenges are being used and what is their impact on behaviour change. Previous research has already shown how Opinion Leaders use Instagram to promote eating behaviour change. The purpose of this paper is to conceptualize, describe and discuss Social Media Health Challenges, aiming to analyse Instagram challenges on healthy eating. The study was organized in two phases: the first one is a literature review based on Prisma method that supported the conceptualisation of Social Media Challenges and the design for the second phase where Social Media Health Challenges of Opinion Leaders, such as Nutritionists, Health Lifestylers and Patient Opinion Leaders (POLS) were analysed. Results showed that most of the challenges are promoted by Patient Opinion Leaders and Health Lifestylers. Followers adhere to Social Media Health Challenges related to weight loss, engaging with Opinion Leaders. The psychological-cognitive components (such as habits, motivation, and self-control) were found in the analysed challenges, and Instagram is one of the used tools to promote these Initiatives. These results point to new paths regarding future research on other behaviour change online initiatives.
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Nguyen N, Nguyen C, Thrul J. Digital health for assessment and intervention targeting tobacco and cannabis co-use. CURRENT ADDICTION REPORTS 2020; 7:268-279. [PMID: 33643768 DOI: 10.1007/s40429-020-00317-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose of review This article aims to summarize current research on digital health for assessment and intervention targeting tobacco and cannabis co-use and to answer the following questions: Which digital tools have been used? Which populations have been targeted? And what are implications for future research? Recent findings Ecological Momentary Assessment (EMA) via text messages or interactive voice response calls has been used to capture co-use patterns within a time window or co-administration of both substances via blunts among young adults. Feasibility of multicomponent interventions targeting dual cessation of both substances among adult co-users with cannabis use disorder, delivered via smartphone apps, online, and computer modules has been demonstrated. Summary Digital tools, particularly those using EMAs and mobile sensors, should be expanded to assess co-use of emerging tobacco and cannabis products. Digital cessation interventions should be tailored to different groups of co-users and address specific mechanisms underlying different co-use patterns.
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Affiliation(s)
- Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
| | - Charlie Nguyen
- Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD
| | - Johannes Thrul
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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Esbensen BA, Kennedy N, Brodin N. Prevention and adherence in Rheumatic and Musculoskeletal disease. Best Pract Res Clin Rheumatol 2020; 34:101525. [PMID: 32417107 DOI: 10.1016/j.berh.2020.101525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Rheumatic and Musculoskeletal Diseases (RMDs) are chronic conditions that affect a substantial number of people. RMDs are significantly related to co-morbidity. Therefore, focusing on prevention in RMDs is of importance to promote and maintain health. Prevention includes primary-, secondary-, tertiary-, and clinical prevention. Primary prevention aims to prevent the onset of disease before the disease process begins, secondary prevention includes detecting and reducing disease and risk factors at the earliest possible point, and tertiary prevention aims to limit the influence of a recognized or verified disease and to address or reduce further development or worsening of the disease, including physical and psychosocial disability. Clinical prevention attempts to integrate prevention into the disease management to limit disease progression and prevent complications and relapse. This chapter will focus on the evidence for prevention and highlight how innovations and trends can contribute by using digital technologies as an example.
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Affiliation(s)
- Bente Appel Esbensen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Valdemar Hansens Vej 13-17, Entrance 5, DK-2600, Glostrup, Denmark.
| | - Norelee Kennedy
- Discipline of Physiotherapy, School of Allied Health, Faculty of Education & Health Sciences and Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland.
| | - Nina Brodin
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, 23100, S-141 83, Huddinge, Sweden.
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Marsch LA, Campbell A, Campbell C, Chen CH, Ertin E, Ghitza U, Lambert-Harris C, Hassanpour S, Holtyn AF, Hser YI, Jacobs P, Klausner JD, Lemley S, Kotz D, Meier A, McLeman B, McNeely J, Mishra V, Mooney L, Nunes E, Stafylis C, Stanger C, Saunders E, Subramaniam G, Young S. The application of digital health to the assessment and treatment of substance use disorders: The past, current, and future role of the National Drug Abuse Treatment Clinical Trials Network. J Subst Abuse Treat 2020; 112S:4-11. [PMID: 32220409 PMCID: PMC7134325 DOI: 10.1016/j.jsat.2020.02.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/30/2020] [Accepted: 02/08/2020] [Indexed: 01/17/2023]
Abstract
The application of digital technologies to better assess, understand, and treat substance use disorders (SUDs) is a particularly promising and vibrant area of scientific research. The National Drug Abuse Treatment Clinical Trials Network (CTN), launched in 1999 by the U.S. National Institute on Drug Abuse, has supported a growing line of research that leverages digital technologies to glean new insights into SUDs and provide science-based therapeutic tools to a diverse array of persons with SUDs. This manuscript provides an overview of the breadth and impact of research conducted in the realm of digital health within the CTN. This work has included the CTN's efforts to systematically embed digital screeners for SUDs into general medical settings to impact care models across the nation. This work has also included a pivotal multi-site clinical trial conducted on the CTN platform, whose data led to the very first "prescription digital therapeutic" authorized by the U.S. Food and Drug Administration (FDA) for the treatment of SUDs. Further CTN research includes the study of telehealth to increase capacity for science-based SUD treatment in rural and under-resourced communities. In addition, the CTN has supported an assessment of the feasibility of detecting cocaine-taking behavior via smartwatch sensing. And, the CTN has supported the conduct of clinical trials entirely online (including the recruitment of national and hard-to-reach/under-served participant samples online, with remote intervention delivery and data collection). Further, the CTN is supporting innovative work focused on the use of digital health technologies and data analytics to identify digital biomarkers and understand the clinical trajectories of individuals receiving medications for opioid use disorder (OUD). This manuscript concludes by outlining the many potential future opportunities to leverage the unique national CTN research network to scale-up the science on digital health to examine optimal strategies to increase the reach of science-based SUD service delivery models both within and outside of healthcare.
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Affiliation(s)
- Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Dr, Lebanon, NH 03766, USA; Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Dr, Lebanon, NH 03766, USA.
| | - Aimee Campbell
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Dr, Lebanon, NH 03766, USA; Department of Psychiatry, Columbia University, 1051 Riverside Dr, New York, NY 10032, USA
| | - Cynthia Campbell
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612, USA
| | - Ching-Hua Chen
- Computational Health Behavior and Decision Science Research, IBM Thomas J. Watson Research, 1101 Kitchawan Rd, Yorktown Heights, NY 10598, USA
| | - Emre Ertin
- The Ohio State University College of Engineering, 2070 Neil Ave, Columbus, OH 43210, USA
| | - Udi Ghitza
- The National Institute on Drug Abuse, 6001 Executive Blvd, Rockville, MD 20852, USA
| | - Chantal Lambert-Harris
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Dr, Lebanon, NH 03766, USA
| | - Saeed Hassanpour
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Dr, Lebanon, NH 03766, USA
| | - August F Holtyn
- Psychiatry and Behavioral Sciences, Johns Hopkins Medicine, 5255 Loughboro Road, N.W., Washington, DC 20016, USA
| | - Yih-Ing Hser
- Department of Psychiatry and Behavioral Sciences at the UCLA Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Ste. 200, Los Angeles, CA 90025, USA
| | - Petra Jacobs
- The National Institute on Drug Abuse, 6001 Executive Blvd, Rockville, MD 20852, USA
| | - Jeffrey D Klausner
- Epidemiology UCLA Fielding School of Public Health, Box 951772, Los Angeles, CA 90095-1772, USA
| | - Shea Lemley
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Dr, Lebanon, NH 03766, USA
| | - David Kotz
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Dr, Lebanon, NH 03766, USA
| | - Andrea Meier
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Dr, Lebanon, NH 03766, USA
| | - Bethany McLeman
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Dr, Lebanon, NH 03766, USA
| | - Jennifer McNeely
- Department of Population Health, Department of Medicine, NYU School of Medicine, 227 East 30th Street, Seventh Floor, New York, NY 10016, USA
| | - Varun Mishra
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Dr, Lebanon, NH 03766, USA
| | - Larissa Mooney
- Resnick Neuropsychiatric Hospital at UCLA, Ronald Reagan UCLA Medical Center, 150 Medical Plaza Driveway, Los Angeles, CA 90095, USA
| | - Edward Nunes
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Dr, Lebanon, NH 03766, USA; Department of Psychiatry, Columbia University, 1051 Riverside Dr, New York, NY 10032, USA
| | | | - Catherine Stanger
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Dr, Lebanon, NH 03766, USA
| | - Elizabeth Saunders
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Dr, Lebanon, NH 03766, USA
| | - Geetha Subramaniam
- The National Institute on Drug Abuse, 6001 Executive Blvd, Rockville, MD 20852, USA
| | - Sean Young
- University of California, Irvine, UC Institute for Prediction Technology, Donald Bren Hall: 6135, Irvine, CA 92697, USA
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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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Dallery J, Raiff BR, Grabinski MJ, Marsch LA. Technology-Based Contingency Management in the Treatment of Substance-Use Disorders. Perspect Behav Sci 2019; 42:445-464. [PMID: 31976444 PMCID: PMC6768925 DOI: 10.1007/s40614-019-00214-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Contingency management is one of the most efficacious interventions to promote drug abstinence. Contingency management has traditionally been delivered in person so that clinicians could confirm drug abstinence and provide access to additional therapeutic services. Now, new technologies not only permit remote confirmation of abstinence, but also remote delivery of incentives. We discuss several technology-based tools to assess substance use, and new ways to deliver contingency management to promote tobacco, alcohol, and cannabis abstinence. These new tools have the potential to dramatically increase access while maintaining high levels of treatment fidelity. Technology-based methods also allow arranging group contingencies that harness online communities, and they permit targeting multiple health-risk behaviors with a combination of sensor-based technologies. Overall, there are unprecedented opportunities to link technology with contingency management to promote drug abstinence.
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Affiliation(s)
- Jesse Dallery
- Department of Psychology, University of Florida, PO Box 112250, Gainesville, FL 32611 USA
| | | | | | - Lisa A. Marsch
- The Geisel School of Medicine, Dartmouth College, Hanover, NH USA
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Mahoney A, Li A, Curiel H, Plattner C, Poling A. Self‐ and cross‐citations in theJournal of Applied Behavior Analysisand theJournal of the Experimental Analysis of Behavior: 2004‐2018. J Appl Behav Anal 2019; 52:1130-1139. [DOI: 10.1002/jaba.585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 03/14/2019] [Indexed: 11/11/2022]
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Ganjali R, Taherzadeh Z, Ghorban Sabbagh M, Nazemiyan F, Mamdouhi F, Tabesh H, Badiee Aval S, Golmakani R, Mostafavi SM, Eslami S. Effect of an interactive voice response system on self-management in kidney transplant recipients: Protocol for a randomized controlled trial. Medicine (Baltimore) 2019; 98:e14291. [PMID: 30732143 PMCID: PMC6380874 DOI: 10.1097/md.0000000000014291] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Adherence to a complex and ongoing set of therapeutic recommendations significantly determines short and long-term outcomes after kidney transplantation (KT). Interactive voice response system (IVRS) is a novel phone-based platform which is potentially useful to deliver health behavior interventions. OBJECTIVE The aims of the study is to describe the development of a theory-driven and educational IVRS investigate the effect of an IVRS on the self-management outcomes in KT recipients as compared with the control group. METHODS This study has been designed as a randomized, 2 parallel groups controlled trial. The KT recipients' older than18 years of age with access to a cellphone will be included. A total of 120 patients will be randomly assigned to the control and intervention groups. The participants in the intervention group will receive completely automatic calls in 3 categories: educational, medication adherence, and reminders by the IVRS, whereas those in the control group will receive usual care. The follow up will be performed within 6 months. The primary outcome will be the medication adherence while patients' transplant knowledge, health-related quality of life, and rehospitalization rates will be considered as secondary outcomes. RESULTS Thus far, recruitment of participants has not been completed and results will be published in 2019. DISCUSSION The IVRS is potentially useful to help KT recipients improve the self-management outcomes. The hypothesis is using an IVRS intervention makes a significant difference between basel assessment of adherence to immunosuppressive medications scale, 12-item short form survey, second version, kidney transplant understanding tool baseline scores, and those obtained at the end of study. TRIAL REGISTRATION NUMBER This trial is registered with the Iran Trial Registrar under registration number IRCT20180124038492N1 and registration date 30 January 2018. https://irct.ir/trial/29215.
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Affiliation(s)
| | - Zhila Taherzadeh
- Neurogenic Inflammation Research Center
- Targeted Drug Delivery Research Center
| | - Mahin Ghorban Sabbagh
- Kidney Transplantation Complications Research Center
- Department of Nephrology, Faculty of Medicine
| | - Fatemeh Nazemiyan
- Kidney Transplantation Complications Research Center
- Department of Nephrology, Faculty of Medicine
| | - Fereshteh Mamdouhi
- Kidney Transplantation Complications Research Center
- Department of Nephrology, Faculty of Medicine
| | - Hamed Tabesh
- Department of Medical Informatics, Faculty of Medicine
| | | | - Reza Golmakani
- Department of Emergency Medicine, Doctor Shariati Hospital
| | | | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Medical Informatics, University of Amsterdam, Amsterdam, The Netherlands
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Kwasnicka D, Inauen J, Nieuwenboom W, Nurmi J, Schneider A, Short CE, Dekkers T, Williams AJ, Bierbauer W, Haukkala A, Picariello F, Naughton F. Challenges and solutions for N-of-1 design studies in health psychology. Health Psychol Rev 2019; 13:163-178. [PMID: 30626274 DOI: 10.1080/17437199.2018.1564627] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Theories of behaviour change and health behaviour change interventions are most often evaluated in between-person designs. However, behaviour change theories apply to individuals not groups and behavioural interventions ultimately aim to achieve within-person rather than between-group change. Within-person methodology, such as N-of-1 (also known as single case design), can circumvent this issue, though has multiple design-specific challenges. This paper provides a conceptual review of the challenges and potential solutions for undertaking N-of-1 studies in health psychology. Key challenges identified include participant adherence to within-person protocols, carry-over and slow onset effects, suitability of behaviour change techniques for evaluation in N-of-1 experimental studies, optimal allocation sequencing and blinding, calculating power/sample size, and choosing the most suitable analysis approach. Key solutions include involving users in study design, employing recent technologies for unobtrusive data collection and problem solving by design. Within-person designs share common methodological requirements with conventional between-person designs but require specific methodological considerations. N-of-1 evaluation designs are appropriate for many though not all types of interventions. A greater understanding of patterns of behaviours and factors influencing behaviour change at the within-person level is required to progress health psychology into a precision science. Video abstract: Supplementary Material 1.
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Affiliation(s)
- Dominika Kwasnicka
- a School of Psychology , Curtin University , Perth , Western Australia.,b SWPS University of Social Sciences and Humanities , Wroclaw , Poland
| | - Jennifer Inauen
- c Department of Environmental Social Sciences, Environmental and Health Psychology , Eawag - Swiss Federal Institute of Aquatic Science & Technology , Duebendorf , Switzerland
| | - Wim Nieuwenboom
- d University of Applied Sciences Northwestern Switzeland, School of Social Work , Institute for Social Work and Health , Olten , Switzerland
| | - Johanna Nurmi
- e Faculty of Social Sciences , University of Helsinki , Helsinki , Finland.,f Behavioural Science Group, Institute of Public Health , University of Cambridge , Cambridge , UK
| | - Annegret Schneider
- g Department of Clinical, Educational and Health Psychology , University College London , London , UK
| | - Camille E Short
- h The Freemasons Foundation Centre for Men's Health, School of Medicine , University of Adelaide , Adelaide , South Australia , Australia
| | - Tessa Dekkers
- i Faculty of Industrial Design Engineering , Delft University of Technology , Delft , The Netherlands
| | - A Jess Williams
- j Institute for Mental Health, School of Psychology , University of Birmingham , Birmingham , UK
| | - Walter Bierbauer
- k Department of Psychology, Applied Social and Health Psychology , University of Zurich , Zurich , Switzerland
| | - Ari Haukkala
- e Faculty of Social Sciences , University of Helsinki , Helsinki , Finland
| | - Federica Picariello
- l Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology, and Neuroscience , King's College London , London , UK
| | - Felix Naughton
- m School of Health Sciences , University of East Anglia , Norwich , UK
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O’Neill SJ, Smyth S, Smeaton A, O’Connor NE. Assistive technology: Understanding the needs and experiences of individuals with autism spectrum disorder and/or intellectual disability in Ireland and the UK. Assist Technol 2019; 32:251-259. [DOI: 10.1080/10400435.2018.1535526] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Sean J. O’Neill
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Sinéad Smyth
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Alan Smeaton
- Insight Centre for Data Analytics, Dublin City University, Dublin, Ireland
| | - Noel E. O’Connor
- Insight Centre for Data Analytics, Dublin City University, Dublin, Ireland
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Digital diabetes: Perspectives for diabetes prevention, management and research. DIABETES & METABOLISM 2018; 45:322-329. [PMID: 30243616 DOI: 10.1016/j.diabet.2018.08.012] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/22/2018] [Accepted: 08/27/2018] [Indexed: 12/20/2022]
Abstract
Digital medicine, digital research and artificial intelligence (AI) have the power to transform the field of diabetes with continuous and no-burden remote monitoring of patients' symptoms, physiological data, behaviours, and social and environmental contexts through the use of wearables, sensors and smartphone technologies. Moreover, data generated online and by digital technologies - which the authors suggest be grouped under the term 'digitosome' - constitute, through the quantity and variety of information they represent, a powerful potential for identifying new digital markers and patterns of risk that, ultimately, when combined with clinical data, can improve diabetes management and quality of life, and also prevent diabetes-related complications. Moving from a world in which patients are characterized by only a few recent measurements of fasting glucose levels and glycated haemoglobin to a world where patients, healthcare professionals and research scientists can consider various key parameters at thousands of time points simultaneously will profoundly change the way diabetes is prevented, managed and characterized in patients living with diabetes, as well as how it is scientifically researched. Indeed, the present review looks at how the digitization of diabetes can impact all fields of diabetes - its prevention, management, technology and research - and how it can complement, but not replace, what is usually done in traditional clinical settings. Such a profound shift is a genuine game changer that should be embraced by all, as it can provide solid research results transferable to patients, improve general health literacy, and provide tools to facilitate the everyday decision-making process by both healthcare professionals and patients living with diabetes.
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Wattanapisit A, Saengow U, Ng CJ, Thanamee S, Kaewruang N. Gaming behaviour with Pokémon GO and physical activity: A preliminary study with medical students in Thailand. PLoS One 2018; 13:e0199813. [PMID: 29958272 PMCID: PMC6025865 DOI: 10.1371/journal.pone.0199813] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 06/06/2018] [Indexed: 01/17/2023] Open
Abstract
Pokémon GO becomes the most rapidly downloaded mobile application in history. This study aimed to determine the physical activity of medical students, who played Pokémon GO, and the change in their use of Pokémon GO and physical activity over time. An observational study was conducted. Physical activity was measured by using self-administered questionnaires at baseline (phase 0), 1 month (phase 1) and 3 months (phase 2) post-Pokémon GO download. The changes in physical activity (phase 0 to 1 and phase 1 to 2) were analysed using Wilcoxon Signed Ranked test. The trend (3-point analysis) of physical activity from phase 0, 1 to 2 were analysed using Friedman’s test. The relationship between physical activity and time spent gaming was analysed by using Spearman’s rank correlation. Twenty-six participants (mean age 22.04±1.70 years) participated in the study. There was no statistically significant change in physical activity during the three-month period (p = 0.45). Only 11 participants (42.3%) were still playing Pokémon GO 3 months after download. The key reasons for playing game were ‘have fun’ and ‘pass time/boredom’. The most common commuting mode to play the game was walking; some drove a car or motorcycle while playing the game. There was no correlation between physical activity and time spent gaming. This study highlights how the lack of sustainability of the game and the motivation behind using Pokémon GO as a game rather than a physical activity app may have undermined the potential of using the game to improve physical activity. Further studies need to explore the reasons for the lack of sustainability and how to combine fun with behavioural change.
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Affiliation(s)
- Apichai Wattanapisit
- School of Medicine, Walailak University, Thasala, Nakhon Si Thammarat, Thailand
- Center of Excellence in Health System and Medical Research, Walailak University, Thasala, Nakhon Si Thammarat, Thailand
- * E-mail:
| | - Udomsak Saengow
- School of Medicine, Walailak University, Thasala, Nakhon Si Thammarat, Thailand
- Center of Excellence in Health System and Medical Research, Walailak University, Thasala, Nakhon Si Thammarat, Thailand
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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O'Reilly-Shah VN, Kitzman J, Jabaley CS, Lynde GC. Evidence for increased use of the Society of Pediatric Anesthesia Critical Events Checklist in resource-limited environments: A retrospective observational study of app data. Paediatr Anaesth 2018; 28:167-173. [PMID: 29285834 DOI: 10.1111/pan.13305] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Electronic decision support tools in anesthesiology practice have great value, including the potential for mobile applications to simplify delivery of best-practice guidelines. AIMS We sought to combine demographics with usage information to elucidate important patterns in the rate of use of the Society of Pediatric Anesthesia Critical Events Checklist, as measured by in-app accesses of the checklist via the freely available anesthesia calculator app anesthesiologist. METHODS We performed a retrospective analytic observational case-control study using analytics and survey data collected from the app. Users of the app were classified on the basis of whether or not they had accessed the checklist. This classification was used to perform logistic regression against a number of independent variables, including frequency of app use, country income level, professional role, rating of app importance, length of time in practice, group size, practice model, community served, and primary practice environment. RESULTS Individual app users practicing in low- and middle-income countries have a significantly higher rate of Society for Pediatric Anesthesia Critical Events Checklist utilization as compared with high-income countries. Rural practitioners had higher utilization of the checklist. Practice size did not affect the utilization of the checklist. The checklist was used for both provider learning and for just-in-time patient care. CONCLUSION mHealth apps are invaluable resource in everyday clinical practice. Mobile app analytics and in-app survey data reveal variable penetration and applicability of such technology worldwide. mHealth apps may be particularly impactful in limited-resource areas, such as lower-income environments and rural communities.
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Affiliation(s)
- Vikas N O'Reilly-Shah
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA.,Division of Pediatric Anesthesiology, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Jamie Kitzman
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA.,Division of Pediatric Anesthesiology, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Craig S Jabaley
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Grant C Lynde
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA
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Vilardaga R, Rizo J, Zeng E, Kientz JA, Ries R, Otis C, Hernandez K. User-Centered Design of Learn to Quit, a Smoking Cessation Smartphone App for People With Serious Mental Illness. JMIR Serious Games 2018; 6:e2. [PMID: 29339346 PMCID: PMC5790963 DOI: 10.2196/games.8881] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 11/10/2017] [Accepted: 11/25/2017] [Indexed: 01/14/2023] Open
Abstract
Background Smoking rates in the United States have been reduced in the past decades to 15% of the general population. However, up to 88% of people with psychiatric symptoms still smoke, leading to high rates of disease and mortality. Therefore, there is a great need to develop smoking cessation interventions that have adequate levels of usability and can reach this population. Objective The objective of this study was to report the rationale, ideation, design, user research, and final specifications of a novel smoking cessation app for people with serious mental illness (SMI) that will be tested in a feasibility trial. Methods We used a variety of user-centered design methods and materials to develop the tailored smoking cessation app. This included expert panel guidance, a set of design principles and theory-based smoking cessation content, development of personas and paper prototyping, usability testing of the app prototype, establishment of app’s core vision and design specification, and collaboration with a software development company. Results We developed Learn to Quit, a smoking cessation app designed and tailored to individuals with SMI that incorporates the following: (1) evidence-based smoking cessation content from Acceptance and Commitment Therapy and US Clinical Practice Guidelines for smoking cessation aimed at providing skills for quitting while addressing mental health symptoms, (2) a set of behavioral principles to increase retention and comprehension of smoking cessation content, (3) a gamification component to encourage and sustain app engagement during a 14-day period, (4) an app structure and layout designed to minimize usability errors in people with SMI, and (5) a set of stories and visuals that communicate smoking cessation concepts and skills in simple terms. Conclusions Despite its increasing importance, the design and development of mHealth technology is typically underreported, hampering scientific innovation. This report describes the systematic development of the first smoking cessation app tailored to people with SMI, a population with very high rates of nicotine addiction, and offers new design strategies to engage this population. mHealth developers in smoking cessation and related fields could benefit from a design strategy that capitalizes on the role visual engagement, storytelling, and the systematic application of behavior analytic principles to deliver evidence-based content.
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Affiliation(s)
- Roger Vilardaga
- Center for Addiction Science and Technology, Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States
| | - Javier Rizo
- Center for Addiction Science and Technology, Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States
| | - Emily Zeng
- Design Use Build, Department of Human Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Julie A Kientz
- Design Use Build, Department of Human Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Richard Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Chad Otis
- Chad Otis Illustration & Design, Seattle, WA, United States
| | - Kayla Hernandez
- Center for Addiction Science and Technology, Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States
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Larsen NM, Sigurdsson V, Breivik J. The Use of Observational Technology to Study In-Store Behavior: Consumer Choice, Video Surveillance, and Retail Analytics. THE BEHAVIOR ANALYST 2017; 40:343-371. [PMID: 31976978 PMCID: PMC6701250 DOI: 10.1007/s40614-017-0121-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The store is the main laboratory for in-store experimental analysis. This article provides an introduction to a research program aimed at improving research practices in this laboratory, particularly emphasizing the importance of behavioral data and the new opportunities that technology offers. This complex modern-day Skinner box has sets of well-studied stimuli-behavior interactions that constantly adapt to the latest economic environment and as such constantly stretch the boundaries of behavioral analytic theory. However, the retail setting is highly important to applied behavior analysis for such issues as health, debt, environmental conservation, animal welfare, self-control, and consumer protection in general. This article presents a research strategy that emphasizes key environmental touch points throughout the customer journey in grocery retailing. We highlight the latest development by examining a particular research case and discussing the need for behavioral economic understanding of the start of the grocery journey, that is, the consumer choice of in-store product carrying equipment (e.g., cart, basket, or nothing). The conceptual system consists of a molecular four-term contingency framework as well as a more molar approach with conversion-rate modeling, where actual choice behavior is detected through video surveillance. The data are analyzed using a Shopper Flow© Tracking System in which software is designed to provide automatic data on shopper behavior and to assist human observers in tracking individual shopping trips. We discuss behavioral classifications, methodology, and implications related to the data from consumer tracking efforts.
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Affiliation(s)
- Nils Magne Larsen
- School of Business, UiT–The Arctic University of Norway, N-9480 Harstad, Norway
| | | | - Jørgen Breivik
- School of Business, UiT–The Arctic University of Norway, N-9480 Harstad, Norway
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O'Reilly-Shah V, Easton G, Gillespie S. Assessing the global reach and value of a provider-facing healthcare app using large-scale analytics. BMJ Glob Health 2017; 2:e000299. [PMID: 29082007 PMCID: PMC5656127 DOI: 10.1136/bmjgh-2017-000299] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/17/2017] [Accepted: 06/13/2017] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The rapid global adoption of mobile health (mHealth) smartphone apps by healthcare providers presents challenges and opportunities in medicine. Challenges include ensuring the delivery of high-quality, up-to-date and optimised information. Opportunities include the ability to study global practice patterns, access to medical and surgical care and continuing medical education needs. METHODS We studied users of a free anaesthesia calculator app used worldwide. We combined traditional app analytics with in-app surveys to collect user demographics and feedback. RESULTS 31 173 subjects participated. Users were from 206 countries and represented a spectrum of healthcare provider roles. Low-income country users had greater rates of app use (p<0.001) and ascribed greater importance of the app to their practice (p<0.001). Physicians from low-income countries were more likely to adopt the app (p<0.001). The app was used primarily for paediatric patients. The app was used around the clock, peaking during times typical for first start cases. CONCLUSIONS This mHealth app is a valuable decision support tool for global healthcare providers, particularly those in more resource-limited settings and with less training. App adoption and use may provide a mechanism for measuring longitudinal changes in access to surgical care and engaging providers in resource-limited settings. In-app surveys and app analytics provide a window into healthcare provider behaviour at a breadth and level of detail previously impossible to achieve. Given the potentially immense value of crowdsourced information, healthcare providers should be encouraged to participate in these types of studies.
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Affiliation(s)
- Vikas O'Reilly-Shah
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Pediatric Anesthesiology, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - George Easton
- Department of Information Systems & Operations Management, Emory University Goizueta Business School, Atlanta, Georgia, USA
| | - Scott Gillespie
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
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Lentferink AJ, Oldenhuis HK, de Groot M, Polstra L, Velthuijsen H, van Gemert-Pijnen JE. Key Components in eHealth Interventions Combining Self-Tracking and Persuasive eCoaching to Promote a Healthier Lifestyle: A Scoping Review. J Med Internet Res 2017; 19:e277. [PMID: 28765103 PMCID: PMC5558041 DOI: 10.2196/jmir.7288] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/03/2017] [Accepted: 06/05/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The combination of self-tracking and persuasive eCoaching in automated interventions is a new and promising approach for healthy lifestyle management. OBJECTIVE The aim of this study was to identify key components of self-tracking and persuasive eCoaching in automated healthy lifestyle interventions that contribute to their effectiveness on health outcomes, usability, and adherence. A secondary aim was to identify the way in which these key components should be designed to contribute to improved health outcomes, usability, and adherence. METHODS The scoping review methodology proposed by Arskey and O'Malley was applied. Scopus, EMBASE, PsycINFO, and PubMed were searched for publications dated from January 1, 2013 to January 31, 2016 that included (1) self-tracking, (2) persuasive eCoaching, and (3) healthy lifestyle intervention. RESULTS The search resulted in 32 publications, 17 of which provided results regarding the effect on health outcomes, 27 of which provided results regarding usability, and 13 of which provided results regarding adherence. Among the 32 publications, 27 described an intervention. The most commonly applied persuasive eCoaching components in the described interventions were personalization (n=24), suggestion (n=19), goal-setting (n=17), simulation (n=17), and reminders (n=15). As for self-tracking components, most interventions utilized an accelerometer to measure steps (n=11). Furthermore, the medium through which the user could access the intervention was usually a mobile phone (n=10). The following key components and their specific design seem to influence both health outcomes and usability in a positive way: reduction by setting short-term goals to eventually reach long-term goals, personalization of goals, praise messages, reminders to input self-tracking data into the technology, use of validity-tested devices, integration of self-tracking and persuasive eCoaching, and provision of face-to-face instructions during implementation. In addition, health outcomes or usability were not negatively affected when more effort was requested from participants to input data into the technology. The data extracted from the included publications provided limited ability to identify key components for adherence. However, one key component was identified for both usability and adherence, namely the provision of personalized content. CONCLUSIONS This scoping review provides a first overview of the key components in automated healthy lifestyle interventions combining self-tracking and persuasive eCoaching that can be utilized during the development of such interventions. Future studies should focus on the identification of key components for effects on adherence, as adherence is a prerequisite for an intervention to be effective.
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Affiliation(s)
- Aniek J Lentferink
- Centre for eHealth & Wellbeing Research, Departement of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands.,Marian van Os Centre for Entrepreneurship, Hanze University of Applied Sciences, Groningen, Netherlands.,Quantified Self Institute, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Hilbrand Ke Oldenhuis
- Marian van Os Centre for Entrepreneurship, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Martijn de Groot
- Quantified Self Institute, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Louis Polstra
- Marian van Os Centre for Entrepreneurship, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Hugo Velthuijsen
- Marian van Os Centre for Entrepreneurship, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Julia Ewc van Gemert-Pijnen
- Centre for eHealth & Wellbeing Research, Departement of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands
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Dallery J, Raiff BR, Kim SJ, Marsch LA, Stitzer M, Grabinski MJ. Nationwide access to an internet-based contingency management intervention to promote smoking cessation: a randomized controlled trial. Addiction 2017; 112:875-883. [PMID: 27923264 PMCID: PMC5382065 DOI: 10.1111/add.13715] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/30/2016] [Accepted: 11/28/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Contingency management (CM) is one of the most effective behavioral interventions to promote drug abstinence, but availability of this treatment is limited. We evaluated the efficacy and acceptability of internet-based CM relative to an internet-based monitoring and goal-setting control group in a nationwide sample of cigarette smokers. DESIGN Randomized controlled trial with 3- and 6-month follow-ups. SETTING United States. PARTICIPANTS Smokers (n = 94) from 26 states were enrolled (mean age 36, 56% female). INTERVENTION AND COMPARATOR Participants were randomized to earn financial incentives (up to $480 over 7 weeks) based on video-verified abstinence using breath carbon monoxide (CO) output (n = 48; abstinent contingent group, AC), or based on submitting CO samples (n = 46, submission contingent, SC). Both groups also received the same CO-based goals. A $50 deposit was required in both groups that could be recouped from initial earnings. MEASURES The primary outcome was point prevalence at week 4. Secondary outcomes were point prevalence at the 3- and 6-month follow-ups, percentages of negative CO samples, adherence to the CO sampling protocol, and treatment acceptability ratings on a 0-100-mm visual analog scale. FINDINGS Abstinence rates differed at 4 weeks between the AC (39.6%) and SC (13.0%) groups [odds ratio (OR) = 4.4, 95% confidence interval (CI) = 1.6-12.3], but not at the 3- (29.2% AC and 19.6% SC, OR = 1.7, 95% CI = 0.6-4.4) or 6- (22.9% AC and 13.0% SC, OR = 2.0, 95% CI = 0.7-5.9) month follow-ups. During the two main treatment phases, there were significant differences in negative COs (53.9% AC and 24.8% SC, OR = 3.5, 95% CI = 3.1-4.0; 43.4% AC and 24.6% SC, OR = 2.3, 95% CI = 1.6-3.4). Adherence to the CO submission protocol was equivalent (78% AC and 85% SC, difference = 7.0%, 95% CI = -10.3 to 23.8 %, F < 1, P = 0.39). The lowest acceptability ratings were for the items assessing the deposit, whereas the highest ratings concerned the ease of the intervention, the graph of CO results, and earning money. CONCLUSIONS A contingency management/financial incentive program delivered via the internet improved short-term abstinence rates compared with an internet program without the incentives.
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Affiliation(s)
- Jesse Dallery
- University of Florida, Gainesville, FL, National Development and Research Institutes, New York, NY
| | | | | | | | - Maxine Stitzer
- The Johns Hopkins University School of Medicine, Baltimore, MD
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Finn HE, Watson RA. The Use of Health Coaching to Improve Health Outcomes: Implications for Applied Behavior Analysis. PSYCHOLOGICAL RECORD 2017. [DOI: 10.1007/s40732-017-0241-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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McDonald S, Quinn F, Vieira R, O’Brien N, White M, Johnston DW, Sniehotta FF. The state of the art and future opportunities for using longitudinal n-of-1 methods in health behaviour research: a systematic literature overview. Health Psychol Rev 2017; 11:307-323. [DOI: 10.1080/17437199.2017.1316672] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Suzanne McDonald
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Francis Quinn
- School of Applied Social Studies, The Robert Gordon University, Aberdeen, UK
| | - Rute Vieira
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola O’Brien
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Martin White
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Falko F. Sniehotta
- Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, UK
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Reed DD, Critchfield TS, Amlung M, Jarmolowicz DP. Choice and Chronic Health Conditions: Introduction to the Special Issue. PSYCHOLOGICAL RECORD 2017. [DOI: 10.1007/s40732-017-0232-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hird N, Ghosh S, Kitano H. Digital health revolution: perfect storm or perfect opportunity for pharmaceutical R&D? Drug Discov Today 2016; 21:900-11. [PMID: 26821131 DOI: 10.1016/j.drudis.2016.01.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/04/2016] [Accepted: 01/19/2016] [Indexed: 12/21/2022]
Abstract
The convergence of technology and medicine has pushed healthcare to the brink of a major disruption that pharma has, until recently, been slow to recognize. Tech players have pioneered the emerging field of digital wellness and health, and pharma is ideally placed to use its expertise in drug development and embrace these technologies to create digital applications that address major medical needs. This review describes digital innovation from a pharma R&D perspective, outlining principal drivers, digital components, opportunities and challenges as well as a sustainable new business model predicated on empowered patients and achieving therapeutic outcomes.
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Affiliation(s)
- Nick Hird
- Takeda Pharmaceutical Company Limited, Fujisawa 251-8555, Japan.
| | - Samik Ghosh
- The Systems Biology Institute, Tokyo 108-0071, Japan
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Nahum-Shani I, Hekler EB, Spruijt-Metz D. Building health behavior models to guide the development of just-in-time adaptive interventions: A pragmatic framework. Health Psychol 2015; 34S:1209-19. [PMID: 26651462 PMCID: PMC4732268 DOI: 10.1037/hea0000306] [Citation(s) in RCA: 259] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Advances in wireless devices and mobile technology offer many opportunities for delivering just-in-time adaptive interventions (JITAIs)-suites of interventions that adapt over time to an individual's changing status and circumstances with the goal to address the individual's need for support, whenever this need arises. A major challenge confronting behavioral scientists aiming to develop a JITAI concerns the selection and integration of existing empirical, theoretical and practical evidence into a scientific model that can inform the construction of a JITAI and help identify scientific gaps. The purpose of this paper is to establish a pragmatic framework that can be used to organize existing evidence into a useful model for JITAI construction. This framework involves clarifying the conceptual purpose of a JITAI, namely, the provision of just-in-time support via adaptation, as well as describing the components of a JITAI and articulating a list of concrete questions to guide the establishment of a useful model for JITAI construction. The proposed framework includes an organizing scheme for translating the relatively static scientific models underlying many health behavior interventions into a more dynamic model that better incorporates the element of time. This framework will help to guide the next generation of empirical work to support the creation of effective JITAIs.
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Affiliation(s)
| | - Eric B. Hekler
- School of Nutrition and Health Promotion, Arizona State University
| | - Donna Spruijt-Metz
- Center for Economic and Social Research, University of Southern California
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Short SE, Mollborn S. Social Determinants and Health Behaviors: Conceptual Frames and Empirical Advances. Curr Opin Psychol 2015; 5:78-84. [PMID: 26213711 PMCID: PMC4511598 DOI: 10.1016/j.copsyc.2015.05.002] [Citation(s) in RCA: 195] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Health behaviors shape health and well-being in individuals and populations. Drawing on recent research, we review applications of the widely applied "social determinants" approach to health behaviors. This approach shifts the lens from individual attribution and responsibility to societal organization and the myriad institutions, structures, inequalities, and ideologies undergirding health behaviors. Recent scholarship integrates a social determinants perspective with biosocial approaches to health behavior dynamics. Empirical advances model feedback among social, psychological and biological factors. Health behaviors are increasingly recognized as multidimensional and embedded in health lifestyles, varying over the life course and across place and reflecting dialectic between structure and agency that necessitates situating individuals in context. Advances in measuring and modeling health behaviors promise to enhance representations of this complexity.
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Affiliation(s)
- Susan E. Short
- Department of Sociology, Brown University, Box 1916, Providence, RI 02912, USA
| | - Stefanie Mollborn
- Institute of Behavioral Science and Department of Sociology, University of Colorado Boulder, UCB 483, Boulder, CO 80309-0483, USA
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Hurley JC, Hollingshead KE, Todd M, Jarrett CL, Tucker WJ, Angadi SS, Adams MA. The Walking Interventions Through Texting (WalkIT) Trial: Rationale, Design, and Protocol for a Factorial Randomized Controlled Trial of Adaptive Interventions for Overweight and Obese, Inactive Adults. JMIR Res Protoc 2015; 4:e108. [PMID: 26362511 PMCID: PMC4704955 DOI: 10.2196/resprot.4856] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/06/2015] [Accepted: 08/11/2015] [Indexed: 11/24/2022] Open
Abstract
Background Walking is a widely accepted and frequently targeted health promotion approach to increase physical activity (PA). Interventions to increase PA have produced only small improvements. Stronger and more potent behavioral intervention components are needed to increase time spent in PA, improve cardiometabolic risk markers, and optimize health. Objective Our aim is to present the rationale and methods from the WalkIT Trial, a 4-month factorial randomized controlled trial (RCT) in inactive, overweight/obese adults. The main purpose of the study was to evaluate whether intensive adaptive components result in greater improvements to adults’ PA compared to the static intervention components. Methods Participants enrolled in a 2x2 factorial RCT and were assigned to one of four semi-automated, text message–based walking interventions. Experimental components included adaptive versus static steps/day goals, and immediate versus delayed reinforcement. Principles of percentile shaping and behavioral economics were used to operationalize experimental components. A Fitbit Zip measured the main outcome: participants’ daily physical activity (steps and cadence) over the 4-month duration of the study. Secondary outcomes included self-reported PA, psychosocial outcomes, aerobic fitness, and cardiorespiratory risk factors assessed pre/post in a laboratory setting. Participants were recruited through email listservs and websites affiliated with the university campus, community businesses and local government, social groups, and social media advertising. Results This study has completed data collection as of December 2014, but data cleaning and preliminary analyses are still in progress. We expect to complete analysis of the main outcomes in late 2015 to early 2016. Conclusions The Walking Interventions through Texting (WalkIT) Trial will further the understanding of theory-based intervention components to increase the PA of men and women who are healthy, insufficiently active and are overweight or obese. WalkIT is one of the first studies focusing on the individual components of combined goal setting and reward structures in a factorial design to increase walking. The trial is expected to produce results useful to future research interventions and perhaps industry initiatives, primarily focused on mHealth, goal setting, and those looking to promote behavior change through performance-based incentives. Trial Registration ClinicalTrials.gov NCT02053259; https://clinicaltrials.gov/ct2/show/NCT02053259 (Archived by WebCite at http://www.webcitation.org/6b65xLvmg).
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Affiliation(s)
- Jane C Hurley
- Exercise Science and Health Promotion, School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, United States
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Dallery J, Meredith S, Jarvis B, Nuzzo PA. Internet-based group contingency management to promote smoking abstinence. Exp Clin Psychopharmacol 2015; 23:176-83. [PMID: 25821915 PMCID: PMC4461474 DOI: 10.1037/pha0000013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Internet-based group contingencies have been shown to promote brief periods of abstinence from cigarette smoking. Under a group contingency, small teams of smokers must collectively meet abstinence goals to receive monetary consequences. The present study investigated 2 arrangements, 1 in which all team members had to meet group treatment goals to receive monetary consequences (full group), and 1 in which team members had to meet some group goals and some individual goals to receive these consequences (mixed group). Mo̅tiv8 Systems, an Internet-based remote monitoring platform, was used to collect video-recorded breath carbon monoxide (CO) samples. All team members could communicate with each other via an online discussion forum. During baseline conditions, only 3.3% of CO samples were negative for smoking, which suggests that self-monitoring and access to the online discussion forum were insufficient to initiate abstinence. When the group contingencies were instituted 41.3% of CO samples were negative. There were no statistically significant differences between the 2 arrangements in the percentage of negative CO samples or point prevalence at the end of treatment or at the 3-month follow-up. Participants posted an average of 25 comments on the discussion forum, most of which were rated as positive by independent observers. The mean cost of vouchers per participant was lower in the full group ($33) relative to the mixed group ($190). The present results replicate and extend previous findings on group contingencies to promote abstinence and social support.
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Affiliation(s)
| | | | | | - Paul A Nuzzo
- Department of Psychiatry, University of Kentucky
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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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