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Guan KW, Adlung C, Keijsers L, Smit CR, Vreeker A, Thalassinou E, van Roekel E, de Reuver M, Figueroa CA. Just-in-time adaptive interventions for adolescent and young adult health and well-being: protocol for a systematic review. BMJ Open 2024; 14:e083870. [PMID: 38955365 PMCID: PMC11218018 DOI: 10.1136/bmjopen-2024-083870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 06/14/2024] [Indexed: 07/04/2024] Open
Abstract
INTRODUCTION Health behaviours such as exercise and diet strongly influence well-being and disease risk, providing the opportunity for interventions tailored to diverse individual contexts. Precise behaviour interventions are critical during adolescence and young adulthood (ages 10-25), a formative period shaping lifelong well-being. We will conduct a systematic review of just-in-time adaptive interventions (JITAIs) for health behaviour and well-being in adolescents and young adults (AYAs). A JITAI is an emerging digital health design that provides precise health support by monitoring and adjusting to individual, specific and evolving contexts in real time. Despite demonstrated potential, no published reviews have explored how JITAIs can dynamically adapt to intersectional health factors of diverse AYAs. We will identify the JITAIs' distal and proximal outcomes and their tailoring mechanisms, and report their effectiveness. We will also explore studies' considerations of health equity. This will form a comprehensive assessment of JITAIs and their role in promoting health behaviours of AYAs. We will integrate evidence to guide the development and implementation of precise, effective and equitable digital health interventions for AYAs. METHODS AND ANALYSIS In adherence to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, we will conduct a systematic search across multiple databases, including CENTRAL, MEDLINE and WHO Global Index Medicus. We will include peer-reviewed studies on JITAIs targeting health of AYAs in multiple languages. Two independent reviewers will conduct screening and data extraction of study and participant characteristics, JITAI designs, health outcome measures and equity considerations. We will provide a narrative synthesis of findings and, if data allows, conduct a meta-analysis. ETHICS AND DISSEMINATION As we will not collect primary data, we do not require ethical approval. We will disseminate the review findings through peer-reviewed journal publication, conferences and stakeholder meetings to inform participatory research. PROSPERO REGISTRATION NUMBER CRD42023473117.
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Affiliation(s)
- Kathleen W Guan
- Department of Engineering Systems and Services, Faculty of Technology, Policy and Management, Delft University of Technology, Delft, Netherlands
| | - Christopher Adlung
- Department of Multi-Actor Systems, Faculty of Technology, Policy and Management, Delft University of Technology, Delft, Netherlands
| | - Loes Keijsers
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Crystal R Smit
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Annabel Vreeker
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Eva Thalassinou
- Department of Research and Development, Gro-up, Berkel en Rodenrijs, Netherlands
| | - Eeske van Roekel
- Department of Developmental Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Mark de Reuver
- Department of Engineering Systems and Services, Faculty of Technology, Policy and Management, Delft University of Technology, Delft, Netherlands
| | - Caroline A Figueroa
- Department of Engineering Systems and Services, Faculty of Technology, Policy and Management, Delft University of Technology, Delft, Netherlands
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Angeli M, Hassandra M, Krommidas C, Morres I, Theodorakis Y. Assessing the Impact of a Health Education Anti-Smoking Program for Students: A Follow-Up Investigation. CHILDREN (BASEL, SWITZERLAND) 2024; 11:387. [PMID: 38671604 PMCID: PMC11049245 DOI: 10.3390/children11040387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/16/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024]
Abstract
In this follow-up study, we aimed to assess the effectiveness of the "I do not smoke, I exercise" anti-smoking preventive health education program. The program was based on the theory of planned behavior supplemented with life skills teaching and targeted at high school students. The intervention comprised ten one-hour online sessions, administered by physical education instructors. The study cohort comprised 222 students (109 boys, 113 girls) from 11 secondary schools, with an average age of 16.42 ± 1.36 years. Data collection involved pre- and post-intervention self-assessment questionnaires. The examined variables included attitudes towards smoking, intention to smoke, subjective norm, perceived behavioral control (PBC), knowledge about smoking, smoking behavior, exercise behavior, attitudes toward the program's implementation, and satisfaction with the program. A separate paired samples t-test revealed a significant improvement in students' knowledge about smoking (t217 = -5.605, p < 0.001, d = 0.38) and perceived behavioral control (t220 = -2.166, p < 0.05, d = 0.15) following the intervention. However, no significant changes were observed in the remaining variables. In addition, students' overall satisfaction with the implementation of the present health education program was high (M = 5.72 ± 1.39). These findings suggest that the health education smoking prevention intervention incorporates techniques and strategies that influence the perceived behavioral control variable, emphasizing students' strong interest in educationally theorized programs integrating technology into their design. Future studies should consider further examination of tobacco control strategies within the high school context.
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Affiliation(s)
| | | | | | | | - Yannis Theodorakis
- Department of Physical Education and Sport Science, University of Thessaly, 42100 Trikala, Greece; (M.A.); (M.H.); (C.K.); (I.M.)
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Vishwakarma G, Singh S, Marani SK, Arya A, Calabro K, Gupta G, Mehta A, Alexander V. Evaluation and Impact of ASPIRE: An Interactive Tobacco Prevention Curriculum among University Students in India. South Asian J Cancer 2021; 10:144-150. [PMID: 34938675 PMCID: PMC8687867 DOI: 10.1055/s-0041-1731900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Online education approach provides innovative opportunities for engaging youths. Web-based, multimedia smoking prevention programs have been tested in high-income countries; however, efficacy of such programs is not well-investigated in low- and middle-income countries. The aim of this study was to evaluate the impact of A Smoking Prevention Interactive Experience (ASPIRE), an interactive tobacco prevention curriculum, among university students in India. A single-subject cohort study where each subject serves as their own control was conducted among university student participants engaged in ASPIRE, 60 minutes per week for five consecutive weeks during July to August of 2019. Assessments were conducted at baseline and immediately after exposure to ASPIRE. To evaluate the program, a structured instrument was specifically designed to measure the outcomes.
A total of 103 university students participated voluntarily. Average age of the participants was 18.3±0.9 ranging from 17 to 20 years. Eighteen percent of students were curious to know about the various smoking products. More males were more susceptible to cigarette smoking as compared to females. The majority of participants felt that ASPIRE was culturally appropriate for young adults in India, but a modified version targeted toward Indian youth would be more acceptable. Pre- to postintervention knowledge of tobacco-related hazards increased from 70 to 97% (
p
< 0.001).
ASPIRE, a multimedia interactive program, demonstrated its considerable potential to discourage smoking initiation among Indian youth.
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Affiliation(s)
| | - Sohini Singh
- Department of Biotechnology, Amity University, Noida, Uttar Pradesh, India
| | - Salma K Marani
- Youth and Family Cancer Prevention Program, University of Texas, M D Anderson Cancer Center, Houston, Texas, United States
| | - Ashish Arya
- Youth and Family Cancer Prevention Program, University of Texas, M D Anderson Cancer Center, Houston, Texas, United States
| | - Karen Calabro
- Department of Behavioral Sciences, University of Texas, M D Anderson Cancer Center, Houston, Texas, United States
| | - Garima Gupta
- Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Anurag Mehta
- Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - V Alexander
- Youth and Family Cancer Prevention Program, University of Texas, MD Anderson Cancer Center, Houston, Texas, United States
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Zijlstra DN, Bolman CAW, Muris JWM, de Vries H. The Usability of an Online Tool to Promote the Use of Evidence-Based Smoking Cessation Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10836. [PMID: 34682582 PMCID: PMC8535528 DOI: 10.3390/ijerph182010836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/01/2021] [Accepted: 10/08/2021] [Indexed: 01/23/2023]
Abstract
To increase usage of evidence-based smoking cessation interventions (EBSCIs) among smokers, an online decision aid (DA) was developed. The aims of this study were (1) to conduct a usability evaluation; (2) to conduct a program evaluation and evaluate decisional conflict after using the DA and (3) to determine the possible change in the intention to use EBSCIs before and directly after reviewing the DA. A cross-sectional study was carried out in September 2020 by recruiting smokers via the Internet (n = 497). Chi-squared tests and t-tests were conducted to test the differences between smokers who differed in the perceived usability of the DA on the program evaluation and in decisional conflict. The possible changes in intention to use EBSCIs during a cessation attempt before and after reviewing the DA were tested using t-tests, McNemar's test and χ2 analysis. The participants evaluated the usability of the DA as moderate (MU; n = 393, 79.1%) or good (GU; n = 104, 20.9%). GU smokers rated higher on all the elements of the program evaluation and experienced less decisional conflict, but also displayed a higher intention to quit. After reviewing the DA, the participants on average had a significantly higher intention to use more EBSCIs, in particular in the form of eHealth. Recommendations to make the DA more usable could include tailoring, using video-based information and including value clarification methods. Furthermore, a hybrid variant in which smokers can use the DA independently and with the guidance of a primary care professional could aid both groups in choosing a fitting EBSCI option.
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Affiliation(s)
- Daniëlle N. Zijlstra
- Department of Health Promotion, Maastricht University/CAPHRI, Peter Debyeplein 1, 6229 HA Maastricht, The Netherlands;
| | - Catherine A. W. Bolman
- Department of Psychology, Open University of the Netherlands, Valkenburgerweg 177, 6419 AT Heerlen, The Netherlands;
| | - Jean W. M. Muris
- Department of General Practice, Maastricht University/CAPHRI, Peter Debyeplein 1, 6229 HA Maastricht, The Netherlands;
| | - Hein de Vries
- Department of Health Promotion, Maastricht University/CAPHRI, Peter Debyeplein 1, 6229 HA Maastricht, The Netherlands;
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Leavens ELS, Carpenter MJ, Smith TT, Nollen NL. Exploratory evaluation of online brief education for JUUL pod-mod use and prevention. Addict Behav 2021; 119:106942. [PMID: 33866224 DOI: 10.1016/j.addbeh.2021.106942] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Initiation of e-cigarette use by young adults is a significant public health issue within the debate on vaping. The current study is an exploratory evaluation of brief educational information among young adults and investigated outcomes as a function of JUUL use and smoking status. METHODS Participants (N = 947) were young adults (<30 years old) recruited from Amazon's Mechanical Turk based on smoking and JUUL use status. Participants completed baseline assessments, viewed a brief JUUL educational handout, and completed post-assessments. RESULTS There was a significant Time X Group interaction for JUUL-related knowledge (p < .001), with never JUUL/never smokers showing the greatest increase in knowledge. Brief education increased JUUL-related knowledge and risk perceptions and had a modest impact on commitment to quitting and readiness to quit JUUL (all p ≤ 0.001; ds = 0.06-0.74; time × group p > .05 for all contrasts except JUUL-related knowledge). Participants showed modest decreases in interest in future JUUL use, interest in purchasing, and interest in future regular use (all p ≤ 0.001; ds = 0.07-0.08; time × group p > .05 for all contrasts). In terms of smoking outcomes, participants reported reduced perceived harm to others (p < .001; d = 0.09) and decreased intentions to smoke regularly (p = .001; d = 0.07). CONCLUSIONS Brief education was effective in increasing knowledge and risk perceptions while showing a modest effect on intentions for future use. The information was most effective in increasing knowledge among non-users, suggesting that brief education may be useful for preventing initiation. Analysis of group differences suggest current JUUL use status is more important in informing JUUL-related attitudes than smoking status.
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Affiliation(s)
- Eleanor L S Leavens
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences and Hollings Cancer Center, United States; University of Kansas School of Medicine, Department of Population Health, United States.
| | - Matthew J Carpenter
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences and Hollings Cancer Center, United States
| | - Tracy T Smith
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences and Hollings Cancer Center, United States
| | - Nicole L Nollen
- University of Kansas School of Medicine, Department of Population Health, United States
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Peiris-John R, Dizon L, Sutcliffe K, Kang K, Fleming T. Co-creating a large-scale adolescent health survey integrated with access to digital health interventions. Digit Health 2020; 6:2055207620947962. [PMID: 32922828 PMCID: PMC7453446 DOI: 10.1177/2055207620947962] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 07/13/2020] [Indexed: 11/16/2022] Open
Abstract
Aim This paper describes how we engaged with adolescents and health providers to integrate access to digital health interventions as part of a large-scale secondary school health and wellbeing survey in New Zealand. Methods We conducted nine participatory, iterative co-design sessions involving 29 adolescents, and two workshops with young people (n = 11), digital and health service providers (n = 11) and researchers (n = 9) to gain insights into end-user perspectives on the concept and how best to integrate digital interventions in to the survey. Results Students’ perceived integrating access to digital health interventions into a large-scale youth health survey as acceptable and highly beneficial. They did not want personalized/normative feedback, but thought that every student should be offered all the help options. Participants identified key principles: assurance of confidentiality, usability, participant choice and control, and language. They highlighted wording as important for ease and comfort, and emphasised the importance of user control. Participants expressed that it would be useful and acceptable for survey respondents to receive information about digital help options addressing a range of health and wellbeing topics. Conclusion The methodology of adolescent-practitioner-researcher collaboration and partnership was central to this research and provided useful insights for the development and delivery of adolescent health surveys integrated with digital help options. The results from the ongoing study will provide useful data on the impact of digital health interventions integrated in large-scale surveys, as a novel methodology. Future research on engaging with adolescents once interventions are delivered will be useful to explore benefits over time.
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Affiliation(s)
- Roshini Peiris-John
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lovely Dizon
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kylie Sutcliffe
- Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Kristy Kang
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Theresa Fleming
- Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
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7
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Grace-Farfaglia P. Social Cognitive Theories and Electronic Health Design: Scoping Review. JMIR Hum Factors 2019; 6:e11544. [PMID: 31325290 PMCID: PMC6676794 DOI: 10.2196/11544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/24/2018] [Accepted: 03/31/2019] [Indexed: 12/30/2022] Open
Abstract
Background There are several social cognitive theories (SCTs) and models that support platform design in electronic health (eHealth) promotion trials. The rationale for this scoping review was to determine how social design features (informational aid, expressive support, gaming, and tailored content) are used to promote self-efficacy, engagement, knowledge, and behavior change. Objective This study aimed to review a broad spectrum of digital health interventions in the literature seeking trials that use SCTs for the design of eHealth applications. Methods The author conducted a systematic scoping review of 161 Web-based health interventions from published randomized clinical trials using 1 or more tools to address the social cognitive determinants in their website design from January 2006 to April 2016. An iterative approach was used in the selection of studies and data extraction. The studies were analyzed for quality and coded for type of social design features employed. Results Expressive interaction tools were found in 48.6% (54/111) of studies categorized as a strong recommendation by the Joanna Briggs Institute criteria. Overall, less than half of the studies addressed participant social support and motivational needs (43.8%). The vast majority of studies (100%) relied on the use of the Web for delivery of informational aid and tailored content for the individual participant (75.9%). Conclusions This review fills a research gap by linking social theory to Web strategy to improve the impact and sustainability of eHealth interventions. A Digital Health Intervention Model was developed to provide a framework to enhance future Web-based health intervention design and execution.
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Nădăşan V, Ferencz L, Ábrám Z, Foley K. Predictors of High Program Exposure Among Adolescents Participating in a Smoking Prevention Intervention in Romania. Tob Use Insights 2019; 12:1179173X19845337. [PMID: 31065218 PMCID: PMC6487747 DOI: 10.1177/1179173x19845337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 04/01/2019] [Indexed: 11/24/2022] Open
Abstract
Introduction: Web-based smoking prevention programs can be delivered to large groups of adolescents under relatively private conditions at a convenient cost, but their effectiveness is highly dependent on the level of exposure to the educational content. The objective of the study was to identify the predictors of high program exposure among a group of adolescents participating in a web-based smoking prevention cluster randomized trial in Romania. Methods: The study sample included 675 adolescents from Târgu Mureş, Romania. The level of exposure to the ASPIRE web-based smoking prevention program was monitored using data automatically saved on the system server. High program exposure was defined as watching 75% to 100% of the educational content. Associations between adolescents’ sociodemographic, psychological, and behavioral variables collected online at the beginning of the intervention and high program exposure were tested using chi-square test and logistic regression. Results: In all, 68.3% of students were highly exposed to the program. There were 4 significant predictors of high program exposure in the multivariable logistic regression model: participant’s father’s lower level of education (odds ratio [OR]: 1.75; 95% confidence interval [CI]: 1.19-2.44), participant’s brother’s nonsmoking status (OR: 1.76; 95% CI: 1.13-2.72), never trying e-cigarettes (OR: 1.73; 95% CI: 1.22-2.45), and considering the health of others an important reason not to smoke (OR: 2.46; 95% CI: 1.54-3.93). Conclusions: The analysis identified sociodemographic, psychological, and behavioral factors that may be useful in project management of such intervention to improve program effectiveness.
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Affiliation(s)
- Valentin Nădăşan
- Department of Hygiene, University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - Loránd Ferencz
- Department of Hygiene, University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - Zoltán Ábrám
- Department of Hygiene, University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - Kristie Foley
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Nahar VK, Wilkerson AH, Patel FC, Kim RW, Stephens PM, Sharma M. Utilizing Multi-Theory Model in Determining Intentions to Smoking Cessation Among Smokers. Tob Use Insights 2019; 12:1179173X19843524. [PMID: 31065217 PMCID: PMC6487755 DOI: 10.1177/1179173x19843524] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/19/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Smoking is a risk factor for lung cancers, and a myriad of other acute and chronic ailments. The purpose of this study was to predict initiation and sustenance of smoking cessation among smokers using a fourth-generation behavioral framework, multi-theory model (MTM) of health behavior change. Methods: A convenience sample of smokers from a shopping mall in rural, Appalachian Kentucky county was invited to participate in this cross-sectional study. A 38-item, face and content validated, MTM-based survey instrument was administered to the participants. Results: A total of 148 participants completed the study. The mean age of the participants was 35.53 (SD = 14.52) years. Most were male (58.1%) and Caucasian (95.9%). Participants reported smoking for an average of 16.45 (SD = 13.12) years. Participatory dialogue (β = 0.235, P = .003) and behavioral confidence (β = 0.305, P = .005) were significant predictors of intention for initiation for smoking cessation behavior. Emotional transformation (β = 0.319, P = .001) was a significant predictor of intention for sustenance for smoking cessation behavior. Discussion: Two of the MTM constructs for initiation and one of the MTM constructs for sustenance of change accounted for a moderate amount of variance in initiation and sustenance of smoking cessation behavior among community members in a rural, Kentucky county. MTM has utility for predicting both initiation and sustenance of smoking cessation behavior. Future interventions using MTM constructs should be developed for smoking cessation behavior change.
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Affiliation(s)
- Vinayak K Nahar
- Center for Animal and Human Health in Appalachia, College of Veterinary Medicine, DeBusk College of Osteopathic Medicine and School of Mathematics and Sciences, Lincoln Memorial University, Harrogate, TN, USA.,Department of Dermatology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Amanda H Wilkerson
- Community Physical Activity and Health Lab, Department of Health and Exercise Science, College of Arts and Sciences, The University of Oklahoma, Norman, OK, USA
| | - Falguni C Patel
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN, USA
| | - Richard W Kim
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN, USA
| | - Philip M Stephens
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN, USA
| | - Manoj Sharma
- Department of Behavioral and Environmental Health, School of Public Health, Jackson State University, MS, USA.,Health for All, Inc., Omaha, NE, USA
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Pradhan AM, Park L, Shaya FT, Finkelstein J. Consumer Health Information Technology in the Prevention of Substance Abuse: Scoping Review. J Med Internet Res 2019; 21:e11297. [PMID: 30698526 PMCID: PMC6372939 DOI: 10.2196/11297] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/08/2018] [Accepted: 10/20/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Addiction is one of the most rapidly growing epidemics that currently plagues nations around the world. In the United States, it has cost the government more than US $700 billion a year in terms of health care and other associated costs and is also associated with serious social, physical, and mental consequences. Increasing efforts have been made to tackle this issue at different levels, from primary prevention to rehabilitation across the globe. With the use of digital technology rapidly increasing, an effort to leverage the consumer health information technologies (CHITs) to combat the rising substance abuse epidemic has been underway. CHITs are identified as patient-focused technological platforms aimed to improve patient engagement in health care and aid them in navigating the complex health care system. OBJECTIVE This review aimed to provide a holistic and overarching view of the breadth of research on primary prevention of substance abuse using CHIT conducted over nearly past five decades. It also aimed to map out the changing landscape of CHIT over this period. METHODS We conducted a scoping review using the Arksey and O'Malley's modified methodological framework. We searched 4 electronic databases (PubMed, Cochrane, Scopus, and EMBASE). Papers were included if the studies addressed the use of CHIT for primary prevention of substance abuse and were published in English between 1809 and 2018. Studies that did not focus solely on primary prevention or assessed additional comorbid conditions were eliminated. RESULTS Forty-two papers that met our inclusion criteria were included in the review. These studies were published between 1970 and 2018 and were not restricted by geography, age, race, or sex. The review mapped studies using the most commonly used CHIT platforms for substance abuse prevention from mass media in the 1970s to mobile and social media in 2018. Moreover, 191 studies that were exclusively focused on alcohol prevention were excluded and will be addressed in a separate paper. The studies included had diverse research designs although the majority were randomized controlled trials (RCT) or review papers. Many of the RCTs used interventions based on different behavioral theories such as family interactions, social cognitive theories, and harm-minimization framework. CONCLUSIONS This review found CHIT platforms to be efficacious and cost-effective in the real-world settings. We also observed a gradual shift in the types and use of CHIT platforms over the past few decades and mapped out their progression. In addition, the review detected a shift in consumer preferences and behaviors from face-to-face interactions to technology-based platforms. However, the studies included in this review only focused on the aspect of primary prevention. Future reviews could assess the effectiveness of platforms for secondary prevention and for prevention of substance abuse among comorbid populations.
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Affiliation(s)
- Apoorva Milind Pradhan
- Department of Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, United States
| | - Leah Park
- Department of Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, United States
| | - Fadia T Shaya
- Department of Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, United States
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Khatib MN, Sinha A, Gaidhane AM, Simkhada P, Behere PB, Saxena D, Unnikrishnan B, Khatib A, Ahmed M, Syed ZQ. A Systematic Review on Effect of Electronic Media among Children and Adolescents on Substance Abuse. Indian J Community Med 2019; 43:S66-S72. [PMID: 30686878 PMCID: PMC6324037 DOI: 10.4103/ijcm.ijcm_116_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Substance abuse is one of the most significant global public health issues among youths. Electronic media has become a part of day-to-day life for all. This systematic review is undertaken to comprehensively explore the effect of electronic media on substance abuse among children and adolescents. Methodology: Two review authors independently searched various electronic databases and other sources. Selection Criteria: Randomized control trials that assessed the effect of exposure of electronic media (defined as television, internet, gaming, mobile phones/phones, and radio) among participants in the age range of 5–19 years on substance abuse were included in the review. Data Collection and Analysis: Two reviewers independently extracted data. We used an approach proposed by the Cochrane Collaboration. We used GRADE profiler to assess the overall quality of the evidence. Main Results: We retrieved 6003 studies and found 15 studies that fulfilled our inclusion criteria. Since included studies differed in the type of intervention and reporting of outcomes, we did not undertake meta-analysis and choose to describe studies narratively. Quality of evidence was rated as “very low” due to too little information or too few data to be able to reach any conclusions. Authors' Conclusions: Clinicians, policymakers, and educators to partner with caregivers and youth to support electronic media use that promotes positive outcome in these areas. Registration of Systematic Review: This systematic review has been registered at PROSPERO International prospective register of systematic reviews (Registration number: PROSPERO 2018 CRD42018086935) available at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID = 86935.
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Affiliation(s)
- Mahalaqua Nazli Khatib
- Division of Evidence Synthesis, School of Epidemiology and Public Health, Wardha, Maharashtra, India.,Department of Physiology, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Anju Sinha
- Division of Reproductive, Maternal and Child Health, Indian Council of Medical Research Hqrs, New Delhi, India
| | - Abhay M Gaidhane
- Division of Evidence Synthesis, School of Epidemiology and Public Health, Wardha, Maharashtra, India.,Department of Community Medicine, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Padam Simkhada
- Centre for Public Health Institute, Liverpool John Moores University, Liverpool, England
| | - Prakash B Behere
- Department of Psychiatry, DY Patil University, Kolhapur, Maharashtra, India
| | - Deepak Saxena
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Bhaskaran Unnikrishnan
- Kasturba Medical College, Mangalore, Karnataka, India.,Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Afroz Khatib
- Department of Community Medicine, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Mahjabeen Ahmed
- Department of Community Medicine, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Zahiruddin Quazi Syed
- Department of Community Medicine, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
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12
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Lima-Serrano M, Martínez-Montilla JM, Lima-Rodríguez JS, Mercken L, de Vries H. Design, implementation and evaluation of a web-based computer-tailored intervention to prevent binge drinking in adolescents: study protocol. BMC Public Health 2018; 18:449. [PMID: 29618331 PMCID: PMC5885294 DOI: 10.1186/s12889-018-5346-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 03/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Binge-drinking in adolescents is a highly prevalent healthcare problem that associates physical and mental health complications with community implications. This paper describes the design, implementation and evaluation of the first web-based computer tailored intervention aimed at the prevention of binge drinking in Spanish adolescents. METHODS The Alerta Alcohol program is based on the I-Change Model. First, feedback from focus and Delphi groups are used for cultural adaptation and to obtain further information on the items to be included on the program. A pilot study is then conducted to assess feasibility and to identify strengths and weaknesses. Second, a Cluster Randomized Controlled Trial is conducted to test the effectiveness of Alerta Alcohol in students aged 16 to 18 years. The study is performed in 16 high schools from Andalusia (southern Spain), which are randomized either to the experimental or the control condition (EC and CC). The EC receives the Alerta Alcohol intervention, which consists of four sessions at school (baseline questionnaire, two sessions in three scenarios: at home, celebrations, and public places, and a final evaluation). The adolescents are provided with answers related to their views of each scenario; this information is used to provide highly specific feedback regarding their knowledge, risk perception, self-esteem, attitude, social influence, and self-efficacy. In addition, two booster sessions are given at home to reinforce the previous messages. The CC just completes the baseline and the final evaluation questionnaires and then they are allowed to receive the intervention as well (as a waiting list). Evaluation takes place after four months. The primary endpoint is binge drinking within 30 days prior to the evaluation and alcohol use in the previous week. It is expected that Alerta Alcohol reduce the prevalence of binge drinking by 10%. Follow up analyses are carried out to determine the differences in effectiveness according to the compliance of the program (quality of the implementation). DISCUSSION The results are expected to be applicable and may incorporate improvements in the practice of the Healthcare and Education Systems. If the program proves to be effective, regional and eventual national implementation should be considered. TRIAL REGISTRATION Trial registration number (ClinicalTrials.gov): NCT03288896 . This study was retrospectively registered on 19/09/2017.
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Affiliation(s)
- Marta Lima-Serrano
- Department of Nursing, School of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - José Manuel Martínez-Montilla
- Department of Nursing, School of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain. .,Department of Health Promotion, Maastricht University, School for Public Health and Primary Care CAPHRI, Maastricht, The Netherlands.
| | - Joaquín S Lima-Rodríguez
- Department of Nursing, School of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - Liesbeth Mercken
- Department of Health Promotion, Maastricht University, School for Public Health and Primary Care CAPHRI, Maastricht, The Netherlands
| | - Hein de Vries
- Department of Health Promotion, Maastricht University, School for Public Health and Primary Care CAPHRI, Maastricht, The Netherlands
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13
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Leavens EL, Meier E, Tackett AP, Miller MB, Tahirkheli NN, Brett EI, Carroll DM, Driskill LM, Anderson MP, Wagener TL. The impact of a brief cessation induction intervention for waterpipe tobacco smoking: A pilot randomized clinical trial. Addict Behav 2018; 78:94-100. [PMID: 29128712 DOI: 10.1016/j.addbeh.2017.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 10/22/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Waterpipe (WP) tobacco smoking delivers many of the same harmful toxicants as cigarette smoking and is on the rise in the US. This study evaluated the feasibility and efficacy of a brief personalized feedback intervention in affecting changes in WP smoking among current WP smokers. METHODS Participants (N=109) were recruited as they entered WP lounges and completed a questionnaire and exhaled carbon monoxide (eCO) testing before entering the WP lounge. Participants were cluster-randomized to assessment-only control (AOC) or intervention conditions. The intervention condition received health risk information and personalized feedback on pre- and post-WP session eCO levels. Participants completed a survey at the end of the WP session and at 3-month follow-up. RESULTS Compared to control, the intervention was effective in increasing knowledge of WP-related harms, correcting risk perceptions, increasing importance of quitting WP smoking, and increasing confidence in ability to quit WP smoking at post-WP session (p<0.05). Differences were maintained for knowledge of WP-related harms, risk perceptions, and commitment to quitting WP at 3-month follow-up; however, no significant difference (p>0.05) was observed in WP smoking (i.e., days smoked and number of WPs smoked) at 3-month follow-up between the intervention (M=3.97days, SD=9.83; M=6.45 bowls, SD=19.60) and control conditions (M=3.32days, SD=5.24; M=3.49 bowls, SD=5.10). CONCLUSIONS The current research supports the use of personalized feedback as a useful intervention method to increase commitment to quit WP, but suggests more intensive interventions may be necessary to achieve WP cessation.
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14
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Bobrow K, Farmer A, Cishe N, Nwagi N, Namane M, Brennan TP, Springer D, Tarassenko L, Levitt N. Using the Medical Research Council framework for development and evaluation of complex interventions in a low resource setting to develop a theory-based treatment support intervention delivered via SMS text message to improve blood pressure control. BMC Health Serv Res 2018; 18:33. [PMID: 29361934 PMCID: PMC5782371 DOI: 10.1186/s12913-017-2808-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/15/2017] [Indexed: 11/18/2022] Open
Abstract
Background Several frameworks now exist to guide intervention development but there remains only limited evidence of their application to health interventions based around use of mobile phones or devices, particularly in a low-resource setting. We aimed to describe our experience of using the Medical Research Council (MRC) Framework on complex interventions to develop and evaluate an adherence support intervention for high blood pressure delivered by SMS text message. We further aimed to describe the developed intervention in line with reporting guidelines for a structured and systematic description. Methods We used a non-sequential and flexible approach guided by the 2008 MRC Framework for the development and evaluation of complex interventions. Results We reviewed published literature and established a multi-disciplinary expert group to guide the development process. We selected health psychology theory and behaviour change techniques that have been shown to be important in adherence and persistence with chronic medications. Semi-structured interviews and focus groups with various stakeholders identified ways in which treatment adherence could be supported and also identified key features of well-regarded messages: polite tone, credible information, contextualised, and endorsed by identifiable member of primary care facility staff. Direct and indirect user testing enabled us to refine the intervention including refining use of language and testing of interactive components. Conclusions Our experience shows that using a formal intervention development process is feasible in a low-resource multi-lingual setting. The process enabled us to pre-test assumptions about the intervention and the evaluation process, allowing the improvement of both. Describing how a multi-component intervention was developed including standardised descriptions of content aimed to support behaviour change will enable comparison with other similar interventions and support development of new interventions. Even in low-resource settings, funders and policy-makers should provide researchers with time and resources for intervention development work and encourage evaluation of the entire design and testing process. Trial registration The trial of the intervention is registered with South African National Clinical Trials Register number (SANCTR DOH-27-1212-386; 28/12/2012); Pan Africa Trial Register (PACTR201411000724141; 14/12/2013); ClinicalTrials.gov (NCT02019823; 24/12/2013).
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Affiliation(s)
- Kirsten Bobrow
- Chronic Disease Initiative for Africa, Cape Town, South Africa. .,Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa. .,Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK.
| | - Andrew Farmer
- Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nomazizi Cishe
- Women's Health Research Unit, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Ntobeko Nwagi
- Women's Health Research Unit, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Mosedi Namane
- Western Cape Province Department of Health, Cape Town, South Africa
| | - Thomas P Brennan
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - David Springer
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Naomi Levitt
- Chronic Disease Initiative for Africa, Cape Town, South Africa.,Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
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Schinke S, Schwinn TM. Computer-Based Prevention and Intervention to Reduce Substance Use in Youth. CURRENT ADDICTION REPORTS 2017; 4:410-421. [PMID: 29354389 DOI: 10.1007/s40429-017-0171-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Purpose of Review Computer-based programs for substance use prevention and intervention among youth are on the ascendancy. Whether delivered by computer per se or by electronic tablet or smartphone, technology-driven programs are harmonious with how young people access information and interact with their worlds. This review examines recent evidence on computer-based programs aimed at substance use among youth, with particular attention to results from randomized trials. Recent Findings Outcome studies of computer-based, substance use-related programs published over the past 5 years reveal mixed results amidst diverse intervention approaches and delivery settings. Many studies are marred by high attrition. Notable in the recent literature is the international nature of technology-driven substance use prevention and intervention programs. With some exceptions, most programs appear to not have been customized for their recipient populations. Though few in number, the highest-quality studies of computer-based programs show positive outcomes in reduced substance use rates. Summary Based on recent findings, considerable work needs to happen before computer-delivered approaches are a proven means for reducing substance use among youth. Original programs, expressly developed for subgroups of youth, are in short supply. Though controlled designs are becoming commonplace, too many studies of computer-based programs suffer from flaws-including high rates of attrition-that limit the discovery of positive outcomes.
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Affiliation(s)
- Steven Schinke
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY 10027
| | - Traci Marie Schwinn
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY 10027
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16
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Nădăşan V, Foley KL, Pénzes M, Paulik E, Mihăicuţă Ş, Ábrám Z, Bálint J, Csibi M, Urbán R. The Short-term Effects of ASPIRA: A Web-based, Multimedia Smoking Prevention Program for Adolescents in Romania: A Cluster Randomized Trial. Nicotine Tob Res 2017; 19:908-915. [PMID: 27838661 PMCID: PMC5896509 DOI: 10.1093/ntr/ntw308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 11/11/2016] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Although web-based, multimedia smoking prevention programs have been tested in several high-income countries, their efficacy in Central and Eastern Europe is unknown. The aim of this trial was to assess the short-term effects of ASPIRA, among Romanian and Hungarian speaking ninth graders in Tirgu Mures, Romania. ASPIRA is the Romanian acronym for the translated and adapted version of ASPIRE, "A Smoking Prevention Interactive Experience," an evidence-based smoking prevention program originally developed to prevent tobacco use among high school students in the United States. METHODS Sixteen high schools in Tirgu Mures, Romania were randomized to receive five weekly sessions of the ASPIRA web-based, multimedia program or to a control condition. Socio-demographic data, psychosocial characteristics, and smoking behavior were collected from students at baseline and at 6 months. A hierarchical logistic regression analysis was conducted to test the efficacy of the intervention on smoking initiation and current smoking among 1369 students. RESULTS Never-smoker students in the intervention arm were 35% less likely to report smoking initiation 6 months after the baseline assessment (OR = 0.65, 95%CI: 0.44-0.97). Reduced smoking initiation was observed most notably among students who were exposed to at least 75% of the ASPIRA program. There was no statistically significant effect of the intervention on current tobacco use (OR = 0.80, 95%CI: 0.44-1.46). CONCLUSIONS ASPIRA, an adapted version of the evidence-based, multimedia ASPIRE program that was originally developed and tested in the United States may decrease smoking initiation among multi-ethnic adolescents in Central and Eastern Europe. IMPLICATIONS (1). Web-based, multimedia smoking prevention programs may be effective tools to prevent smoking initiation among multi-ethnic adolescent communities in Central and Eastern Europe. (2). The degree of exposure is critical, only high exposure to the multimedia smoking prevention program is associated with reduced smoking initiation.
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Affiliation(s)
- Valentin Nădăşan
- Department of Hygiene, University of Medicine and Pharmacy Tîrgu Mureş, Tîrgu Mureş, Romania
| | - Kristie L Foley
- Social Sciences and Health Policy, Cancer Prevention and Control, Wake Forest University Medical School, Medical Center Blvd., Winston-Salem, NC
| | - Melinda Pénzes
- Institute of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Edit Paulik
- Department of Public Health, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Ştefan Mihăicuţă
- Department of Pulmonology, University of Medicine and Pharmacy, Timişoara, Romania
| | - Zoltán Ábrám
- Department of Hygiene, University of Medicine and Pharmacy Tîrgu Mureş, Tîrgu Mureş, Romania
| | - Jozsef Bálint
- Department of Hygiene, University of Medicine and Pharmacy Tîrgu Mureş, Tîrgu Mureş, Romania
| | - Monika Csibi
- Department of Hygiene, University of Medicine and Pharmacy Tîrgu Mureş, Tîrgu Mureş, Romania
| | - Robert Urbán
- Institute of Psychology, Eötvös Loránd University, Budapest, Budapest, Hungary
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Cheung KL, Wijnen B, de Vries H. A Review of the Theoretical Basis, Effects, and Cost Effectiveness of Online Smoking Cessation Interventions in the Netherlands: A Mixed-Methods Approach. J Med Internet Res 2017. [PMID: 28645889 PMCID: PMC5501927 DOI: 10.2196/jmir.7209] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Tobacco smoking is a worldwide public health problem. In 2015, 26.3% of the Dutch population aged 18 years and older smoked, 74.4% of them daily. More and more people have access to the Internet worldwide; approximately 94% of the Dutch population have online access. Internet-based smoking cessation interventions (online cessation interventions) provide an opportunity to tackle the scourge of tobacco. OBJECTIVE The goal of this paper was to provide an overview of online cessation interventions in the Netherlands, while exploring their effectivity, cost effectiveness, and theoretical basis. METHODS A mixed-methods approach was used to identify Dutch online cessation interventions, using (1) a scientific literature search, (2) a grey literature search, and (3) expert input. For the scientific literature, the Cochrane review was used and updated by two independent researchers (n=651 identified studies), screening titles, abstracts, and then full-text studies between 2013 and 2016 (CENTRAL, MEDLINE, and EMBASE). For the grey literature, the researchers conducted a Google search (n=100 websites), screening for titles and first pages. Including expert input, this resulted in six interventions identified in the scientific literature and 39 interventions via the grey literature. Extracted data included effectiveness, cost effectiveness, theoretical factors, and behavior change techniques used. RESULTS Overall, many interventions (45 identified) were offered. Of the 45 that we identified, only six that were included in trials provided data on effectiveness. Four of these were shown to be effective and cost effective. In the scientific literature, 83% (5/6) of these interventions included changing attitudes, providing social support, increasing self-efficacy, motivating smokers to make concrete action plans to prepare their attempts to quit and to cope with challenges, supporting identity change and advising on changing routines, coping, and medication use. In all, 50% (3/6) of the interventions included a reward for abstinence. Interventions identified in the grey literature were less consistent, with inclusion of each theoretical factor ranging from 31% to 67% and of each behavior change technique ranging from 28% to 54%. CONCLUSIONS Although the Internet may provide the opportunity to offer various smoking cessation programs, the user is left bewildered as far as efficacy is concerned, as most of these data are not available nor offered to the smokers. Clear regulations about the effectiveness of these interventions need to be devised to avoid disappointment and failed quitting attempts. Thus, there is a need for policy regulations to regulate the proliferation of these interventions and to foster their quality in the Netherlands.
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Affiliation(s)
- Kei Long Cheung
- Department of Health Services Research, Maastricht University, Maastricht, Netherlands.,Department of Health Promotion, Maastricht University, Maastricht, Netherlands
| | - Ben Wijnen
- Department of Health Services Research, Maastricht University, Maastricht, Netherlands
| | - Hein de Vries
- Department of Health Promotion, Maastricht University, Maastricht, Netherlands
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Latulippe K, Hamel C, Giroux D. Social Health Inequalities and eHealth: A Literature Review With Qualitative Synthesis of Theoretical and Empirical Studies. J Med Internet Res 2017; 19:e136. [PMID: 28450271 PMCID: PMC5427250 DOI: 10.2196/jmir.6731] [Citation(s) in RCA: 202] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 02/09/2017] [Accepted: 03/02/2017] [Indexed: 01/08/2023] Open
Abstract
Background eHealth is developing rapidly and brings with it a promise to reduce social health inequalities (SHIs). Yet, it appears that it also has the potential to increase them. Objectives The general objective of this review was to set out how to ensure that eHealth contributes to reducing SHIs rather than exacerbating them. This review has three objectives: (1) identifying characteristics of people at risk of experiencing social inequality in health; (2) determining the possibilities of developing eHealth tools that avoid increasing SHI; and (3) modeling the process of using an eHealth tool by people vulnerable to SHI. Methods Following the EPPI approach (Evidence for Policy and Practice of Information of the Institute of Education at the University of London), two databases were searched for the terms SHIs and eHealth and their derivatives in titles and abstracts. Qualitative, quantitative, and mixed articles were included and evaluated. The software NVivo (QSR International) was employed to extract the data and allow for a metasynthesis of the data. Results Of the 73 articles retained, 10 were theoretical, 7 were from reviews, and 56 were based on empirical studies. Of the latter, 40 used a quantitative approach, 8 used a qualitative approach, 4 used mixed methods approach, and only 4 were based on participatory research-action approach. The digital divide in eHealth is a serious barrier and contributes greatly to SHI. Ethnicity and low income are the most commonly used characteristics to identify people at risk of SHI. The most promising actions for reducing SHI via eHealth are to aim for universal access to the tool of eHealth, become aware of users’ literacy level, create eHealth tools that respect the cultural attributes of future users, and encourage the participation of people at risk of SHI. Conclusions eHealth has the potential to widen the gulf between those at risk of SHI and the rest of the population. The widespread expansion of eHealth technologies calls for rigorous consideration of interventions, which are not likely to exacerbate SHI.
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Affiliation(s)
- Karine Latulippe
- Department of Studies of Teaching and Learning, Laval University, Québec, QC, Canada
| | - Christine Hamel
- Department of Studies of Teaching and Learning, Laval University, Québec, QC, Canada
| | - Dominique Giroux
- Faculté de médecine, Département de réadaptation, Laval University, Québec, QC, Canada.,Centre d'Excellence du Vieillissement de Québec, Chu de Québec, Québec, QC, Canada
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19
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Khalil GE, Wang H, Calabro KS, Mitra N, Shegog R, Prokhorov AV. From the Experience of Interactivity and Entertainment to Lower Intention to Smoke: A Randomized Controlled Trial and Path Analysis of a Web-Based Smoking Prevention Program for Adolescents. J Med Internet Res 2017; 19:e44. [PMID: 28209560 PMCID: PMC5334517 DOI: 10.2196/jmir.7174] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/24/2017] [Accepted: 01/24/2017] [Indexed: 11/13/2022] Open
Abstract
Background Web-based programs for smoking prevention are being increasingly used with some success among adolescents. However, little is known about the mechanisms that link the experience of such programs to intended nicotine or tobacco control outcomes. Objective Based on the experiential learning theory and extended elaboration likelihood model, this study aimed to evaluate the impact of a Web-based intervention, A Smoking Prevention Interactive Experience (ASPIRE), on adolescents’ intention to smoke, while considering the experience of interactivity and entertainment as predictors of reduced intention to smoke, under a transitional user experience model. Methods A total of 101 adolescents were recruited from after-school programs, provided consent, screened, and randomized in a single-blinded format to 1 of 2 conditions: the full ASPIRE program as the experimental condition (n=50) or an online , text-based version of ASPIRE as the control condition (n=51). Data were collected at baseline and immediate follow-up. Repeated-measures mixed-effects models and path analyses were conducted. Results A total of 82 participants completed the study and were included in the analysis. Participants in the experimental condition were more likely to show a decrease in their intention to smoke than those in the control condition (beta=−0.18, P=.008). Perceived interactivity (beta=−0.27, P=.004) and entertainment (beta=−0.20, P=.04) were each associated with a decrease in intention to smoke independently. Results of path analyses indicated that perceived interactivity and perceived entertainment mediated the relationship between ASPIRE use and emotional involvement. Furthermore, perceived presence mediated the relationship between perceived interactivity and emotional involvement. There was a direct relationship between perceived entertainment and emotional involvement. Emotional involvement predicted a decrease in intention to smoke (beta=−0.16, P=.04). Conclusions Adolescents’ experience of interactivity and entertainment contributed to the expected outcome of lower intention to smoke. Also, emphasis needs to be placed on the emotional experience during Web-based interventions in order to maximize reductions in smoking intentions. Going beyond mere evaluation of the effectiveness of a Web-based smoking prevention program, this study contributes to the understanding of adolescents’ psychological experience and its effect on their intention to smoke. With the results of this study, researchers can work to (1) enhance the experience of interactivity and entertainment and (2) amplify concepts of media effects (eg, presence and emotional involvement) in order to better reach health behavior outcomes. Trial Registration Clinicaltrials.gov NCT02469779; https://clinicaltrials.gov/ct2/show/NCT02469779 (Archived by WebCite at http://www.webcitation.org/6nxyZVOf0)
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Affiliation(s)
- Georges Elias Khalil
- MD Anderson Cancer Center, Department of Behavioral Sciences, University of Texas, Houston, TX, United States
| | - Hua Wang
- University at Buffalo, Department of Communication, Buffalo, NY, United States
| | - Karen Sue Calabro
- MD Anderson Cancer Center, Department of Behavioral Sciences, University of Texas, Houston, TX, United States
| | - Natasha Mitra
- Health Science Center at San Antonio, School of Public Health, University of Texas, San Antonio, TX, United States
| | - Ross Shegog
- Health Science Center at Houston, Center for Health Promotion and Prevention Research, University of Texas, Houston, TX, United States
| | - Alexander V Prokhorov
- MD Anderson Cancer Center, Department of Behavioral Sciences, University of Texas, Houston, TX, United States
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Prevention of alcohol and other drug use and related harm in the digital age: what does the evidence tell us? Curr Opin Psychiatry 2016; 29:242-9. [PMID: 27153124 DOI: 10.1097/yco.0000000000000258] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Alcohol and other drug use are major contributors to the global burden of disease. Prevention is critical and evidence is beginning to support the use of online mediums to prevent alcohol and other drug use and harms among adolescents. This study aims to expand the evidence base by conducting a systematic review of recent universal prevention programs delivered by computers and the Internet. RECENT FINDINGS A total of 12 papers reporting outcomes from trials of nine universal online prevention programs were identified. Of the identified interventions, five targeted multiple substances, two focused solely on alcohol, one targeted only cannabis and one primarily addressed smoking. The majority of programs were delivered at school; however one was implemented in a primary care setting. Six programs demonstrated significant, but modest, effects for alcohol and/or other drug use outcomes. SUMMARY Evidence to support the efficacy of computer and Internet-based prevention programs for alcohol and other drug use and related harms among adolescents is rapidly emerging, demonstrating that online prevention is an area of increasing promise. Further replication work, longer-term trials and attempts to increase the impact are required.
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Cremers HP, Mercken L, de Vries H, Oenema A. A longitudinal study on determinants of the intention to start smoking among Non-smoking boys and girls of high and low socioeconomic status. BMC Public Health 2015; 15:648. [PMID: 26163878 PMCID: PMC4499438 DOI: 10.1186/s12889-015-1917-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 06/09/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study identifies differences in socio-cognitive factors as they relate to the intention to smoke among boys and girls living in high socioeconomic status (HSES) and low socioeconomic status (LSES) neighborhoods. METHODS A total of 1,643 children (aged 10-12 years) completed a web-based questionnaire assessing their intention, attitude, social influences, and self-efficacy toward smoking at baseline and at one year follow-up. Logistic regression analyses were conducted to examine the relations between intention and predictor variables (i.e. attitude, social influence, and self-efficacy). Three-way interaction terms were added to the first analysis to examine potential interactions of gender, socioeconomic status and predictor variables. A 3-way interaction effect was present, and therefore subgroup analyses for HSES and LSES boys and girls were warranted. RESULTS The results indicated that positive attitudes toward smoking were related to the intention to smoke among HSES boys, whereas HSES girls had higher intentions to smoke if they perceived fewer disadvantages of smoking (OR: 0.42; 95 % CI: 0.22-0.82). The intention to smoke among LSES boys was predicted by perceived social norms (OR: 0.49; 95 % CI: 0.25-0.93); in LSES girls, the smoking behavior of people in their environment was most strongly related to their smoking intention (OR: 5.55; 95 % CI: 2.81-10.93). CONCLUSIONS To prevent youth smoking, HSES boys and girls may benefit from interventions that address attitudes. Boys from an LSES neighborhood may profit from smoking prevention interventions that target social norms, while LSES girls may benefit from strategies aimed at resisting the influence of smokers in their environment. TRIAL REGISTRATION The 'Fun without Smokes' study is approved by the Medical Ethics Committee of the Atrium-Orbis-Zuyd Hospital (NL32093.096.11/MEC 11-T-25) and registered in the Dutch Trial Register ( NTR3116 ).
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Affiliation(s)
- Henricus-Paul Cremers
- Department of Health Promotion, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Liesbeth Mercken
- Department of Health Promotion, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Hein de Vries
- Department of Health Promotion, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Anke Oenema
- Department of Health Promotion, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
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Reinwand DA, Schulz DN, Crutzen R, Kremers SP, de Vries H. Who Follows eHealth Interventions as Recommended? A Study of Participants' Personal Characteristics From the Experimental Arm of a Randomized Controlled Trial. J Med Internet Res 2015; 17:e115. [PMID: 25963607 PMCID: PMC4468602 DOI: 10.2196/jmir.3932] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/10/2014] [Accepted: 01/14/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Computer-tailored eHealth interventions to improve health behavior have been demonstrated to be effective and cost-effective if they are used as recommended. However, different subgroups may use the Internet differently, which might also affect intervention use and effectiveness. To date, there is little research available depicting whether adherence to intervention recommendations differs according to personal characteristics. OBJECTIVE The aim was to assess which personal characteristics are associated with using an eHealth intervention as recommended. METHODS A randomized controlled trial was conducted among a sample of the adult Dutch population (N=1638) testing an intervention aimed at improving 5 healthy lifestyle behaviors: increasing fruit and vegetable consumption, increasing physical activity, reducing alcohol intake, and promoting smoking cessation. Participants were asked to participate in those specific online modules for which they did not meet the national guideline(s) for the respective behavior(s). Participants who started with fewer than the recommended number of modules of the intervention were defined as users who did not follow the intervention recommendation. RESULTS The fewer modules recommended to participants, the better participants adhered to the intervention modules. Following the intervention recommendation increased when participants were older (χ(2)1=39.8, P<.001), female (χ(2)1=15.8, P<.001), unemployed (χ(2)1=7.9, P=.003), ill (χ(2)1=4.5, P=.02), or in a relationship (χ(2)1=7.8, P=.003). No significant relevant differences were found between groups with different levels of education, incomes, or quality of life. CONCLUSION Our findings indicate that eHealth interventions were used differently by subgroups. The more frequent as-recommended intervention use by unemployed, older, and ill participants may be an indication that these eHealth interventions are attractive to people with a greater need for health care information. Further research is necessary to make intervention use more attractive for people with unhealthy lifestyle patterns.
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Affiliation(s)
- Dominique A Reinwand
- CAPHRI School for Public Health and Primary Care, Department of Health Promotion, Maastricht University, Maastricht, Netherlands.
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Cremers HP, Mercken L, Candel M, de Vries H, Oenema A. A Web-based, computer-tailored smoking prevention program to prevent children from starting to smoke after transferring to secondary school: randomized controlled trial. J Med Internet Res 2015; 17:e59. [PMID: 25759248 PMCID: PMC4371791 DOI: 10.2196/jmir.3794] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 11/06/2014] [Accepted: 11/23/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Smoking prevalence rates among Dutch children increase rapidly after they transit to secondary school, in particular among children with a low socioeconomic status (SES). Web-based, computer-tailored programs supplemented with prompt messages may be able to empower children to prevent them from starting to smoke when they transit to secondary school. OBJECTIVE The main aim of this study is to evaluate whether computer-tailored feedback messages, with and without prompt messages, are effective in decreasing children's smoking intentions and smoking behavior after 12 and 25 months of follow-up. METHODS Data were gathered at baseline (T0), and after 12 months (T1) and 25 months (T2) of follow-up of a smoking prevention intervention program called Fun without Smokes. A total of 162 schools were randomly allocated to a no-intervention control group, an intervention prompt group, or an intervention no-prompt group. A total of 3213 children aged 10 to 12 years old participated in the study and completed a Web-based questionnaire assessing their smoking intention, smoking behavior, and sociocognitive factors, such as attitude, social influence, and self-efficacy, related to smoking. After completion, children in the intervention groups received computer-tailored feedback messages in their own email inbox and those messages could be accessed on the intervention website. Children in the prompt group received prompt messages, via email and short message service (SMS) text messaging, to stimulate them to reuse the intervention website with nonsmoking content. Multilevel logistic regression analyses were performed using multiple imputations to assess the program effects on smoking intention and smoking behavior at T1 and T2. RESULTS A total of 3213 children participated in the Fun without Smokes study at T0. Between T0 and T1 a total of 1067 children out of the original 3213 (33.21%) dropped out of the study. Between T0 and T2 the number of children that did not participate in the final measurement was 1730 out of the original 3213 (53.84%). No significant program effects were observed for any of the intervention groups compared to the control group at T1 for the intention to engage in smoking-prompt, OR 0.67 (95% CI 0.30-1.50), no-prompt, OR 0.76 (95% CI 0.34-1.67)-or for smoking behavior-prompt, OR 1.13 (95% CI 0.13-9.98), no-prompt, OR 0.50 (95% CI 0.04-5.59). Similar nonsignificant program effects were found at T2 for the intention to start smoking-prompt, OR 0.78 (95% CI 0.26-2.32), no-prompt, OR 1.31 (95% CI 0.45-3.82)-and smoking behavior-prompt, OR 0.53 (95% CI 0.12-2.47), no-prompt, OR 1.01 (95% CI 0.24-4.21). CONCLUSIONS This study showed that the Web-based, computer-tailored feedback messages with and without prompt messages were not effective in modifying children's smoking intentions and smoking behavior as compared to no information. Future smoking prevention interventions are recommended to start closer to the age of actual smoking uptake. Furthermore, future studies on Web-based, computer-tailored smoking prevention programs should focus on assessing and controlling exposure to the educational content and the response to the prompt messages. TRIAL REGISTRATION Netherlands Trial Register NTR3116; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3116 (Archived by WebCite at http://www.webcitation.org/6O0wQYuPI).
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Affiliation(s)
- Henricus-Paul Cremers
- Maastricht University, Department of Health Promotion, School for Public Health and Primary Care (CAPHRI), Maastricht, Netherlands.
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