Behavior science in the evolving world of digital health: considerations on anticipated opportunities and challenges

Development and refinement of a novel end-of-life planning website for patients with advanced cancer: a mixed methods approach

PURPOSE

Despite known benefits of planning for end-of-life, no digital tool exists to help patients with advanced cancer and their loved ones plan for death comprehensively. To address this unmet need, we developed a preliminary version of an innovative website to help patients with advanced cancer prepare for end-of-life tasks.

METHODS

Guided by the Obesity-Related Behavioral Intervention Trials (ORBIT) model for behavioral intervention development, patients with advanced cancer (n = 10) and their caregivers (n = 10) participated in a "Think Aloud" exercise and usability protocols to optimize the end-of-life planning website. The website was iteratively refined throughout the study in collaboration with the partnering company, Peacefully, Inc. Participants also completed the Acceptability E-Scale and System Usability Scale, with a priori benchmarks established for acceptability (scores of ≥ 24 on the Acceptability E-Scale) and usability (scores of ≥ 68 on the System Usability Scale).

RESULTS

Patients (N = 10) and caregivers (N = 10) completed usability testing. Patients were majority female (80%), White (100%), and had a mean age of 58 years. Caregivers (N = 10) were majority male (60%), spouse/partner (90%), White (90%), and had a mean age of 59 years. For patients, a priori hypotheses were met for both acceptability (mean score of 24.7, SD = 4.35) and usability (mean score of 73.8, SD = 6.15). For caregivers, acceptability was just below the cutoff (mean score of 22.9, SD = 4.07) and usability exceeded the cutoff (mean score of 70.0, SD = 8.42). Overall, patients and caregivers reported high levels of satisfaction and found the website helpful, with specific suggestions for changes (e.g., add more information about information security, improve text legibility).

CONCLUSIONS

The findings from this study will inform modifications to optimize an innovative website to support patients with advanced cancer to prepare holistically for end-of-life tasks.

From Raising Awareness to a Behavioural Change: A Case Study of Indoor Air Quality Improvement Using IoT and COM-B Model

The topic of indoor air pollution has yet to receive the same level of attention as ambient pollution. We spend considerable time indoors, and poorer indoor air quality affects most of us, particularly people with respiratory and other health conditions. There is a pressing need for methodological case studies focusing on informing households about the causes and harms of indoor air pollution and supporting changes in behaviour around different indoor activities that cause it. The use of indoor air quality (IAQ) sensor data to support behaviour change is the focus of our research in this paper. We have conducted two studies-first, to evaluate the effectiveness of the IAQ data visualisation as a trigger for the natural reflection capability of human beings to raise awareness. This study was performed without the scaffolding of a formal behaviour change model. In the second study, we showcase how a behaviour psychology model, COM-B (Capability, Opportunity, and Motivation-Behaviour), can be operationalised as a means of digital intervention to support behaviour change. We have developed four digital interventions manifested through a digital platform. We have demonstrated that it is possible to change behaviour concerning indoor activities using the COM-B model. We have also observed a measurable change in indoor air quality. In addition, qualitative analysis has shown that the awareness level among occupants has improved due to our approach of utilising IoT sensor data with COM-B-based digital interventions.

Making Sense of Theories, Models, and Frameworks in Digital Health Behavior Change Design: Qualitative Descriptive Study

BACKGROUND

Digital health interventions are increasingly being designed to support health behaviors. Although digital health interventions informed by behavioral science theories, models, and frameworks (TMFs) are more likely to be effective than those designed without them, design teams often struggle to use these evidence-informed tools. Until now, little work has been done to clarify the ways in which behavioral science TMFs can add value to digital health design.

OBJECTIVE

The aim of this study was to better understand how digital health design leaders select and use TMFs in design practice. The questions that were addressed included how do design leaders perceive the value of TMFs in digital health design, what considerations do design leaders make when selecting and applying TMFs, and what do design leaders think is needed in the future to advance the utility of TMFs in digital health design?

METHODS

This study used a qualitative description design to understand the experiences and perspectives of digital health design leaders. The participants were identified through purposive and snowball sampling. Semistructured interviews were conducted via Zoom software. Interviews were audio-recorded and transcribed using Otter.ai software. Furthermore, 3 researchers coded a sample of interview transcripts and confirmed the coding strategy. One researcher completed the qualitative analysis using a codebook thematic analysis approach.

RESULTS

Design leaders had mixed opinions on the value of behavioral science TMFs in digital health design. Leaders suggested that TMFs added the most value when viewed as a starting point rather than the final destination for evidence-informed design. Specifically, these tools added value when they acted as a gateway drug to behavioral science, supported health behavior conceptualization, were balanced with expert knowledge and user-centered design principles, were complementary to existing design methods, and supported both individual- and systems-level thinking. Design leaders also felt that there was a considerable nuance in selecting the most value-adding TMFs. Considerations should be made regarding their source, appropriateness, complexity, accessibility, adaptability, evidence base, purpose, influence, audience, fit with team expertise, fit with team culture, and fit with external pressures. Design leaders suggested multiple opportunities to advance the use of TMFs. These included improving TMF reporting, design, and accessibility, as well as improving design teams' capacity to use TMFs appropriately in practice.

CONCLUSIONS

When designing a digital health behavior change intervention, using TMFs can help design teams to systematically integrate behavioral insights. The future of digital health behavior change design demands an easier way for designers to integrate evidence-based TMFs into practice.

Benefits, Facilitators, and Recommendations for Digital Health Academic-Industry Collaboration: A Mini Review

Digital health remains a growing and challenging niche in public health practice. Academic-industry collaboration (AIC) offers a mechanism to bring disparate sectors together to alleviate digital health challenges of engagement, reach, sustainability, dissemination, evaluation, and equity. Despite the ongoing endorsements for AIC in digital health, limited understanding exists of successful AIC exists. Most published research highlights the barriers of collaboration rather than efficacy, leaving collaborators asking: What are the benefits and facilitators of AIC and do they apply in digital health? As an initial effort to fill the gap in the literature, the purpose of this mini review outlines the benefits and facilitators from previous AIC and offers recommendations specific to digital health.

Effectiveness of an Integrated Engagement Support System to Facilitate Patient Use of Digital Diabetes Prevention Programs: Protocol for a Randomized Controlled Trial

Background

Digital diabetes prevention programs (dDPPs) are effective behavior change tools to prevent disease progression in patients at risk for diabetes. At present, these programs are poorly integrated into existing health information technology infrastructure and clinical workflows, resulting in barriers to provider-level knowledge of, interaction with, and support of patients who use dDPPs. Tools that can facilitate patient-provider interaction around dDPPs may contribute to improved patient engagement and adherence to these programs and improved health outcomes.

Objective

This study aims to use a rigorous, user-centered design (UCD) methodology to develop a theory-driven system that supports patient engagement with dDPPs and their primary care providers with their care.

Methods

This study will be conducted in 3 phases. In phase 1, we will use systematic UCD, Agile software development, and qualitative research methods to identify key user (patients, providers, clinical staff, digital health technologists, and content experts) requirements, constraints, and prioritization of high-impact features to design, develop, and refine a viable intervention prototype for the engagement system. In phase 2, we will conduct a single-arm feasibility pilot of the engagement system among patients with prediabetes and their primary care providers. In phase 3, we will conduct a 2-arm randomized controlled trial using the engagement system. Primary outcomes will be weight, BMI, and A_1c at 6 and 12 months. Secondary outcomes will be patient engagement (use and activity) in the dDPP. The mediator variables (self-efficacy, digital health literacy, and patient-provider relationship) will be measured.

Results

The project was initiated in 2018 and funded in September 2019. Enrollment and data collection for phase 1 began in September 2019 under an Institutional Review Board quality improvement waiver granted in July 2019. As of December 2020, 27 patients have been enrolled and first results are expected to be submitted for publication in early 2021. The study received Institutional Review Board approval for phases 2 and 3 in December 2020, and phase 2 enrollment is expected to begin in early 2021.

Conclusions

Our findings will provide guidance for the design and development of technology to integrate dDPP platforms into existing clinical workflows. This will facilitate patient engagement in digital behavior change interventions and provider engagement in patients’ use of dDPPs. Integrated clinical tools that can facilitate patient-provider interaction around dDPPs may contribute to improved patient adherence to these programs and improved health outcomes by addressing barriers faced by both patients and providers. Further evaluation with pilot testing and a clinical trial will assess the effectiveness and implementation of these tools.

Trial Registration

ClinicalTrials.gov NCT04049500; https://clinicaltrials.gov/ct2/show/NCT04049500

International Registered Report Identifier (IRRID)

DERR1-10.2196/26750

Riding the Wave of Digital Transformation in Behavioral Medicine

BACKGROUND

Digital technologies provide a platform for accelerating science and broadening impact in behavioral medicine.

PURPOSE

The objective of this invited keynote presentation or paper is to offer a blueprint for navigating the rapidly changing waters of digital health.

METHODS

A strategic literature review on digital health technologies in behavioral medicine was combined with a review of relevant policy initiatives to yield insights on: (a) knowledge building, (b) collaboration, and (c) public health stewardship.

RESULTS

Digital platforms offer unprecedented leverage for accelerating science, facilitating collaboration, and advancing public health. Early successes in behavioral medicine demonstrated how digital platforms could extend the reach of theory-based behavioral therapeutics through increases in efficiency and scale. As medical investments in health information technology increased, the field of behavioral informatics emerged as the collaborative glue binding behavioral theory into a new generation of patient-facing applications, clinical decision support tools, evidence-based communication programs, and population health management strategies. As a leader within the interstitial space between medicine, psychology, and engineering, the Society of Behavioral Medicine is in a distinct position to exert influence on the ways in which our science is utilized to eliminate health disparities; improve support for patients, caregivers, and communities; to promote general health and well-being; and to offer relief when confronted with psychological pain or addiction.

CONCLUSION

Riding the wave of digital transformation has less to do with mastering the complexities of the latest technologies and more to do with adhering closely to established principles for navigating a rapidly changing information environment.