Using Behavior Change Techniques to Guide Selections of Mobile Applications to Promote Fluid Consumption

Leveraging behavioral modification technology for the prevention of kidney stones

PURPOSE OF REVIEW

The purpose of this review is to examine the use of technology to help promote and maintain behaviors that decrease stone recurrence.

RECENT FINDINGS

Behavior change is a complex process with various interacting components. Recent developments have sought to utilize technology in combination with behavioral change techniques to promote behavior that lowers stone recurrence risk. Smart water bottles are becoming a popular way to accurately measure fluid intake with variable impact on adherence to the recommended daily fluid intake. Mobile apps have also been explored as a method to improve fluid intake. Interventions that combine smart water bottles, mobile apps, and behavioral change techniques have shown the most promise in promoting increased daily fluid intake. Other technologies, such as smart pill dispensers and hydration monitors, have potential applications in promoting behavioral change for stone disease but have yet to be evaluated for this purpose.

SUMMARY

There is a limited number of studies exploring technology as a means to promote and maintain behaviors that decrease urinary stone recurrence. Future research is needed to elucidate how to maximize the potential of these technologies and better understand which behavioral change techniques best promote habit formation for the prevention of stones.

Feasibility of Mini sipIT Behavioral Intervention to Increase Urine Volume in Patients With Kidney Stones

OBJECTIVE

To determine the feasibility and acceptability of mini sipIT, a context-sensitive reminder system that incorporates a connected water bottle and mobile app with text messaging, for kidney stone patients who have poor adherence to increasing fluid intake for prevention.

METHODS

Patients with a history of kidney stones and urine volume <2L/d participated in a 1-month single-group feasibility trial. Patients used a connected water bottle and received text message reminders when fluid intake goals weren't met. Perceptions of drinking behavior, intervention acceptability, and 24-hour urine volumes were obtained at baseline and 1-month.

RESULTS

Patients with a history of kidney stones were enrolled (n = 26, 77% female, age=50.4 ± 14.2years). Over 90% of patients used the bottle or app daily. Most patients perceived that mini sipIT intervention helped them to increase their fluid intake (85%) and reach their fluid intake goals (65%). There was a significant increase in average 24-hour urine volume after the 1-month intervention compared to baseline (2006.5 ± 980.8 mL vs 1352.7 ± 449.9 mL, t (25)= 3.66, P = .001, g= 0.78), with 73% of patients having higher 24-hour urine volumes at the end of the trial.

CONCLUSION

Mini sipIT behavioral intervention and outcome assessments are feasible for patients and may lead to significant increases in 24-hour urine volume. Digital tools in combination with behavioral science may improve adherence to fluid intake recommendations for kidney stone prevention, however, rigorous efficacy trials are necessary.

Changes in patient perceptions regarding ChatGPT-written explanations on lifestyle modifications for preventing urolithiasis recurrence

Purpose

Artificial Intelligence (AI) imitating human-like language, such as ChatGPT, has impacted lives throughout various multidisciplinary fields. However, despite these innovations, it is unclear how well its implementation will assist patients in clinical situations. We evaluated changes in patient perceptions regarding AI before and after reading a ChatGPT-written explanation.

Materials and methods

In total, 24 South Korean patients receiving urolithiasis treatment were surveyed through questionnaires. The ChatGPT explanatory note was provided between the first and second questionnaires, detailing lifestyle modifications for preventing urolithiasis recurrence. The study questionnaire was the Korean version of the General Attitudes toward Artificial Intelligence Scale, including positive and negative attitude items. Wilcoxon signed-rank tests were accomplished to compare questionnaire scores before and after receiving the explanatory note. A linear regression analysis with stepwise elimination was used to assess variable (demographic data) accuracy in predicting outcomes.

Results

There were significant differences between total negative questionnaire scores pre- and post-surveys of ChatGPT, but not in the positive scores. Among variables, only education level significantly influenced mean score differences in the negative questionnaires.

Conclusions

The negative perception change among urolithiasis patients after receiving the explanatory note provided by the AI chatbot program was observed, evidencing that patients with lower education levels expressed a more negative response. The explanatory note provided by the AI chatbot program could provoke an adverse change in AI perception. Negative human responses must be considered to improve and adapt new technology in health care. Only through changing patient perspectives will upgraded AI technology integrate into medical healthcare.

Prevention and control of urinary tract stones using a smartphone-based self-care application: design and evaluation

BACKGROUND

Self-care and participation of patients in improving health and increasing awareness about the risk factors that affect the development of disease in patients with urinary tract stones are influential factors in controlling and improving the quality of life in these patients. In this regard, the availability and capability of smartphones increase patients' self-care ability. The present study aimed to develop and evaluate a self-care application based on smartphones for patients with urinary tract stones.

METHODS

The present study is a developmental and applied study that was conducted in three phases. First, the information needs and functionalities of the self-care application were determined by surveying 101 patients, 32 urologists and nephrologists, 11 nurses, and six other specialists. In the second phase, the initial sample of the smartphone-based application was created, and in the third phase, the designed application was evaluated by 15 experts using the standard Post-Study System Usability Questionnaire (PSSUQ 18.3) and Nielsen's Attributes of Usability (NAU) questionnaire. Results of the questionnaires were entered into SPSS-23 software for analysis using descriptive statistics.

RESULTS

In the first phase, 21 information elements and nine critical functionalities for the self-care application were identified, and then this application was designed by Java programming language. The evaluation of experts showed that two aspects of the quality of system user interface from the user's point of view and the overall performance of the application together obtained the highest score (6.43 from 7), which was equal to 91.85%. Then according to the experts, aspects of the degree of convenience and user-friendliness of the application received the highest score (6.10 from 7), which was equal to 87.14%, and also all aspects of the application were evaluated at an acceptable level. In general, results of the evaluation of application's usability by experts showed that the usability of the application for patients with urinary tract stones was at an acceptable level.

CONCLUSION

According to the results obtained from evaluating the smartphone-based application for patients with urinary tract stones, this self-care application can be used to prevent and control urinary tract stones and facilitate self-care and active patient participation in care.

Just-in-time adaptive intervention to promote fluid consumption in patients with kidney stones

OBJECTIVE

Kidney stones are painful and costly. Prevention guidelines emphasize a simple behavior change: increasing fluid intake and urine output. Unfortunately, adherence to those prevention guidelines is limited, and patients report forgetting or not being thirsty enough. This study evaluated the acceptability of using semiautomated tracking of fluid consumption to trigger just-in-time reminders to drink and increase the experienced automaticity of fluid intake.

METHOD

In a single-group trial, participants with a history of kidney stones (n = 31) used the sip^IT digital tools (H2OPal connected water bottle, H2OPal mobile app for self-tracking, Fitbit smartwatch app for gesture detection) for 3 months.

RESULTS

The semiautomated monitoring system detected 46,654 drinking events. From baseline to 1-month follow-up, the experienced automaticity of fluid intake increased significantly (d = 0.50) and remained elevated at 3-month follow-up (d = 0.64). A major barrier to adherence (lack of thirst) decreased from baseline to follow-ups. Retention rates and participant feedback indicated that this digital tool was acceptable to patients.

CONCLUSION

Semiautomated tracking of fluid consumption can be used to trigger just-in-time reminders. Based on this demonstration, the sip^IT tools are ready for testing in a rigorous Phase II trial to evaluate efficacy for increasing fluid consumption and urine output as recommended for preventing the recurrence of kidney stones. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Feasibility and Preliminary Outcomes of a Physical Therapist-Administered Physical Activity Intervention After Total Knee Replacement

OBJECTIVE

To explore the feasibility, fidelity, safety, and preliminary outcomes of a physical therapist-administered physical activity (PA) intervention after total knee replacement (TKR).

METHODS

People who had undergone a unilateral TKR and were receiving outpatient physical therapy (PT) were randomized to a control or intervention group. Both groups received standard PT for TKR. The intervention included being provided with a Fitbit Zip, step goals, and 1 phone call a month for 6 months after discharge from PT. Feasibility was measured by rates of recruitment and retention, safety was measured by the frequency of adverse events, and fidelity was measured by adherence to the weekly steps/day goal created by the physical therapist and participant monitoring of steps/day. An Actigraph GT3X measured PA, which was quantified as steps/day and minutes/week of engaging in moderate-to-vigorous PA. Our preliminary outcome was the difference in PA 6 months after discharge from PT between the control and intervention groups.

RESULTS

Of the 43 individuals who were enrolled, 53.4% were women, the mean ± SD age was 67.0 ± 7.0 years, and the mean ± SD body mass index was 31.5 ± 5.9 kg/m² . For both the control and intervention groups, the recruitment and retention rates were 64% and 83.7%, respectively, and adherence to the intervention ranged from 45% to 60%. No study-related adverse events occurred. The patients in the intervention group accumulated a mean 1,798 more steps/day (95% confidence interval [95% CI] 240, 3,355) and spent 73.4 more minutes/week (95% CI -14.1, 160.9) engaging in moderate-to-vigorous PA at 6 months than those in the control group.

CONCLUSION

A physical therapist-administered PA intervention is feasible and safe, demonstrates treatment fidelity, and may increase PA after TKR. Future research is needed to establish the effectiveness of the intervention.

Smartphone technology and its applications in urology: a review of the literature

PURPOSE

Smartphone technology has propelled the evolution of health-related mobile technology, referred to as mobile health (mHealth). With the rise of smartphone ownership and the growing popularity of health-related smartphone usage, mHealth offers potential benefits for both patients and health care providers. The objective of this review is to assess the current state of smartphone technology in urology.

METHODS

A literature search of PubMed database was conducted to identify articles reporting on smartphone technology in urology. Publications were included if they focused on smartphone mHealth technology pertinent to the field of urology or included an evaluation of urological applications in digital stores.

RESULTS

We identified 50 publications focused on the use of smartphones in urology. Studies were then grouped into the following categories: smartphones employing the built-in camera and light source, applications specific to prostate cancer, urolithiasis, pediatric urology, and as educational tools for urologists. In 23/50 (46%) studies, smartphone technology/intervention was compared to a control group or to standard of care. In this regard, smartphone technology did not demonstrate benefit over standard of care in 13 studies. In contrast, in 10 studies, smartphone interventions were proven beneficial over current practice.

CONCLUSIONS

Smartphone technology is constantly evolving and has the potential to improve urological care and education. Of concern to consumer and urologist alike is that these downloadable programs are limited due to the accuracy of their content, risk of confidentiality breach, and the lack of central regulation and professional involvement in their development.

Effects of Mobile Health Prompts on Self-Monitoring and Exercise Behaviors Following a Diabetes Prevention Program: Secondary Analysis From a Randomized Controlled Trial

Background

A number of mobile health (mHealth) apps exist that focus specifically on promoting exercise behavior. To increase user engagement, prompts, such as text messages, emails, or push notifications, are often used. To date, little research has been done to understand whether, and for how long, these prompts influence exercise behavior.

Objective

This study aimed to assess the impact of prompts on mHealth self-monitoring and self-reported exercise in the days following a prompt and whether these effects differ based on exercise modality.

Methods

Of the possible 99 adults at risk for developing type II diabetes who participated in a diabetes prevention program, 69 were included in this secondary analysis. Participants were randomly assigned to 1 of the following 2 exercise conditions: high-intensity interval training or moderate-intensity continuous training. In the year following a brief, community-based diabetes prevention program involving counseling and supervised exercise sessions, all participants self-monitored their daily exercise behaviors on an mHealth app in which they were sent personalized prompts at varying frequencies. mHealth self-monitoring and self-reported exercise data from the app were averaged over 1, 3, 5, and 7 days preceding and following a prompt and subsequently compared using t tests.

Results

In the year following the diabetes prevention program, self-monitoring (t₆₈=6.82; P<.001; d=0.46) and self-reported exercise (t₆₈=2.16; P=.03; d=0.38) significantly increased in the 3 days following a prompt compared with the 3 days preceding. Prompts were most effective in the first half of the year, and there were no differences in self-monitoring or self-reported exercise behaviors between exercise modalities (P values >.05). In the first half of the year, self-monitoring was significant in the 3 days following a prompt (t₆₈=8.61; P<.001; d=0.60), and self-reported exercise was significant in the 3 days (t₆₈=3.7; P<.001; d=0.37), 5 days (t₆₇=2.15; P=.04; d=0.14), and 7 days (t₆₈=2.46; P=.02; d=0.15) following a prompt, whereas no significant changes were found in the second half of the year.

Conclusions

This study provides preliminary evidence regarding the potential influence of prompts on mHealth self-monitoring and self-reported exercise and the duration for which prompts may be effective as exercise behavior change tools. Future studies should determine the optimal prompting frequency for influencing self-reported exercise behaviors. Optimizing prompt frequency can potentially reduce intervention costs and promote user engagement. Furthermore, it can encourage consumers to self-monitor using mHealth technology while ensuring prompts are sent when necessary and effective.

International Registered Report Identifier (IRRID)

DERR2-10.2196/11226

Acceptability of Mobile Health Technology for Promoting Fluid Consumption in Patients With Nephrolithiasis

OBJECTIVE

To evaluate kidney stone patients' interest in lifestyle behavior modification and a variety of mobile health (mHealth) technologies to improve adherence to fluid consumption recommendations for the prevention of nephrolithiasis. Of particular interest was the acceptability of various intervention components for the design of a stone-specific mHealth technology.

MATERIALS AND METHODS

Using a cross-sectional design, adult patients with a diagnosis of kidney stones (n = 94) were recruited from outpatient clinics to complete a three-part questionnaire.

RESULTS

Patients reported being willing to make lifestyle changes to prevent kidney stones (97%). The majority of the patients recalled the recommendation to increase fluid intake (93%) but few monitored their daily fluid intake (30%). Most patients had never installed an app (95%) or owned a device (100%) to help with increasing fluid consumption, but believed an app or device could improve their adherence (72%) and would be interested in using an app or device (86%). The mHealth intervention components most widely perceived as useful included automated lapse detection with notifications, educational materials, self-monitoring tools, scheduler with prompts and/or reminders and/or notifications, connected water bottles and text message reminders to drink.

CONCLUSION

Patients are interested in lifestyle behavior change to prevent stones but technology has not been widely adopted to improve adherence to fluid intake recommendations for stone prevention. This study identified a number of viable mHealth intervention components that should be considered when designing a stone-specific mHealth technology to support adherence to increased fluid consumption recommendations.

The Role of Social Media and Internet Search Engines in Information Provision and Dissemination to Patients with Kidney Stone Disease: A Systematic Review from European Association of Urologists Young Academic Urologists

INTRODUCTION

Kidney stone disease (KSD) affects millions of people worldwide and has an increasing incidence. Social media (SoMe) and search engines are both gaining in usage, while also being used by patients to research their conditions and aid in managing them. With this in mind, many authors have expressed the belief that SoMe and search engines can be used by patients and healthcare professionals to improve treatment compliance and help counseling and management of conditions such as KSD. We wanted to determine whether SoMe and search engines play a role in the management and/or prevention of KSD.

MATERIALS AND METHODS

The databases MEDLINE, Embase, CINAHL, Scopus, and Cochrane Library were used to search for relevant English language literature from inception to December 2017. Results were screened by title, abstract, and then full text, according to the inclusion and exclusion criteria. The data were then analyzed independently by the authors not involved in the original study.

RESULTS

After initial identification of 2137 records and screening of 42 articles, 10 studies met the inclusion and exclusion criteria. The articles included focused on a variety of SoMe forms, including two articles each on twitter, YouTube, smartphone apps, and Google search engine and one article on Google insights and Google analytics. Regarding patient centered advice, while two articles covered advice on dietary, fluid intake, and management options, two additional articles each covered advice on fluid advice and management options only, while no such advice was given by three of the SoMe published articles.

CONCLUSIONS

SoMe and search engines provide valuable information to patients with KSD. However, while the information provided regarding dietary aspects and fluid management was good, it was not comprehensive enough to include advice on other aspects of KSD prevention.

Accuracy of daily fluid intake measurements using a "smart" water bottle

High fluid intake is an effective preventative strategy against recurrent kidney stones but is known to be challenging to achieve. Recently, a smart water bottle (Hidrate Spark™, Minneapolis, MN) was developed as a non-invasive fluid intake monitoring system. This device could help patients who form stones from low urine volume achieve sustainable improvements in hydration, but has yet to be validated in a clinical setting. Hidrate Spark™ uses capacitive touch sensing via an internal sensor. It calculates volume measurements by detecting changes in water level and sends data wirelessly to users' smartphones through an application. A pilot study was conducted to assess accuracy of measured fluid intake over 24 h periods when used in a real life setting. Subjects were provided smart bottles and given short tutorials on their use. Accuracy was determined by comparing 24-h fluid intake measurements calculated through the smart bottle via sensor to standard volume measurements calculated by the patient from hand over the same 24 h period. Eight subjects performed sixty-two 24-h measurements (range 4-14). Mean hand measurement was 57.2 oz/1692 mL (21-96 oz/621-2839 mL). Corresponding mean smart bottle measurement underestimated true fluid intake by 0.5 ozs. (95% CI -1.9, 0.9). Percent difference between hand and smart bottle measurements was 0.0% (95% CI - 3%, 3%). Intraclass correlation coefficient (ICC), calculated to assess consistency between hand measures and bottle measures, was 0.97 (0.95, 0.98) indicating an extremely high consistency between measures. 24-h fluid intake measurements from a novel fluid monitoring system (Hidrate Spark™) are accurate to within 3%. Such technology may be useful as a behavioral aide and/or research tool particularly among recurrent stone formers with low urinary volume.

Applying and advancing behavior change theories and techniques in the context of a digital health revolution: proposals for more effectively realizing untapped potential

As more behavioral health interventions move from traditional to digital platforms, the application of evidence-based theories and techniques may be doubly advantageous. First, it can expedite digital health intervention development, improving efficacy, and increasing reach. Second, moving behavioral health interventions to digital platforms presents researchers with novel (potentially paradigm shifting) opportunities for advancing theories and techniques. In particular, the potential for technology to revolutionize theory refinement is made possible by leveraging the proliferation of "real-time" objective measurement and "big data" commonly generated and stored by digital platforms. Much more could be done to realize this potential. This paper offers proposals for better leveraging the potential advantages of digital health platforms, and reviews three of the cutting edge methods for doing so: optimization designs, dynamic systems modeling, and social network analysis.