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Dunn Navarra AM, Gormley M, Liang E, Loughran C, Vorderstrasse A, Garcia DR, Rosenberg MG, Fletcher J, Goldsamt LA. Developing and testing a web-based platform for antiretroviral therapy (ART) adherence support among adolescents and young adults (AYA) living with HIV. PEC INNOVATION 2024; 4:100263. [PMID: 38463238 PMCID: PMC10920727 DOI: 10.1016/j.pecinn.2024.100263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 03/12/2024]
Abstract
Objective Describe the development and testing of a web-based platform for antiretroviral treatment (ART) adherence support among HIV+ adolescents and young adults (AYA) in a randomized controlled trial (RCT). Methods A seven-member multi-disciplinary team operationalized the flat, password protected, web-based platform. Manualized protocols guided the objectives and content for each of the eight web-based sessions. Team members evaluated usability and content validity. Client satisfaction and perceived ease of use was evaluated with the first ten HIV+ AYA participants. Results The web-based platform was developed, evaluated, refined, implemented and pilot tested between September 2020 to April 2022. Usability was rated as high; the evaluation of content validity showed an excellent fit between session content and objectives. HIV+ AYA participants (mean age = 24.2 years) were satisfied with the quality, type, and amount of support/education received, and found the platform easy to use, operate, and navigate. Average time spent per session was 6.5 min. Conclusion Findings support the usability, validity, acceptability, and feasibility of this web-based platform for ART adherence support among HIV+ AYA. Innovation Our research and findings are responsive to research gaps and the need for transparency in the methodological development and testing of web-based control arms for ART adherence support among HIV+ AYA.
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Affiliation(s)
- Ann-Margaret Dunn Navarra
- StonyBrook University, School of Nursing, 101 Nicolls Road, Health Sciences Center, Level 2, StonyBrook, NY 11794, USA
| | - Maurade Gormley
- University of Connecticut, School of Nursing, 231 Glenbrook Road, Storrs, CT 06269, USA
| | - Eva Liang
- New York University, Rory Meyers College of Nursing, 380 Second Avenue, New York, NY 10010, USA
| | - Claire Loughran
- New York University, Rory Meyers College of Nursing, 380 Second Avenue, New York, NY 10010, USA
| | - Allison Vorderstrasse
- University of Massachusetts Amherst, Elaine Marieb College of Nursing, 651 N Pleasant St., Amherst, MA 01003, USA
| | - David R. Garcia
- New York University, Rory Meyers College of Nursing, 433 First Avenue, New York, NY 10010, USA
| | - Michael G. Rosenberg
- Division of Infectious Diseases, Department of Pediatrics, Jacobi Medical Center, Bronx, NY, 10461, USA
| | - Jason Fletcher
- New York University, Rory Meyers College of Nursing, 433 First Avenue, New York, NY 10010, USA
| | - Lloyd A. Goldsamt
- New York University, Rory Meyers College of Nursing, 433 First Avenue, New York, NY 10010, USA
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Fleszar-Pavlovic SE, Esquives BN, Brito AE, Sia AM, Kauffman MA, Lopes M, Moreno PI, Koru-Sengul T, Gong R, Wang T, Wieder ED, Rueda-Lara M, Antoni M, Komanduri K, Lesiuk T, Penedo FJ. eHealth mindfulness-based music therapy for patients undergoing allogeneic hematopoietic stem cell transplantation: A pilot randomized controlled trial protocol. Contemp Clin Trials 2024; 142:107577. [PMID: 38763308 DOI: 10.1016/j.cct.2024.107577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/12/2024] [Accepted: 05/16/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Allogeneic stem cell transplantation (allo-SCT) is the preferred therapy for patients with high-risk or relapsed hematologic malignancies, but may be complicated by psychological distress (e.g., depression, anxiety) and symptom burden (e.g., fatigue, pain). Mindfulness-based music therapy (MBMT), a relatively novel integrative medicine intervention that draws from mindfulness and music therapy principles, has shown promise in improving psychosocial outcomes and symptom burden in cancer patients. We outline an eHealth-based MBMT (eMBMT) intervention protocol examining: (1) feasibility, acceptability, and intended effects of eMBMT in improving HRQOL, symptom burden, and clinical markers of disease activity (e.g., infections), and (2) the extent to which eMBMT music therapy component-associated improvements in HRQOL, symptom burden, and disease activity are mediated by improvements in psychosocial and physiological (e.g., systemic inflammation, immune recovery) adaptation. METHODS Participants (n = 60) with a hematologic malignancy undergoing allo-SCT will be randomized to receive eMBMT or an eHealth-based mindfulness meditation (eMM) intervention. eMBMT includes eight 60-min sessions facilitated by a music therapist focusing on mindfulness and music therapy. eMM includes eight 60-min self-led MM practices. RESULTS Feasibility, acceptability, HRQOL, symptom burden, disease activity, and mediation effects of psychosocial and physiological adaptation will be assessed at baseline, pre-infusion, and post-engraftment with blood collection at baseline and post-engraftment. CONCLUSION The current pilot RCT is the first eMBMT intervention to address the HRQOL and symptom burden of patients who are undergoing allo-SCT. Results will inform a fully powered RCT to establish preliminary efficacy of eMBMT on improvements in HRQOL, symptom burden, and disease activity.
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Affiliation(s)
- Sara E Fleszar-Pavlovic
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Blanca Noriega Esquives
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Arianna E Brito
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Ann Marie Sia
- Department of Undergraduate Research, University of Miami, Coral Gables, FL, USA.
| | - Mary Adelyn Kauffman
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Maria Lopes
- Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, FL, USA.
| | - Patricia I Moreno
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Tulay Koru-Sengul
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Rui Gong
- Department of Medicine and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Trent Wang
- Department of Medicine and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Eric D Wieder
- Department of Medicine and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Maria Rueda-Lara
- Department of Psychiatry and Behavioral Sciences and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Michael Antoni
- Department of Psychology and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Krishna Komanduri
- Department of Medicine, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.
| | - Teresa Lesiuk
- Frost School of Music and Sylvester Comprehensive Cancer Center, University of Miami, Coral Gables, FL, USA.
| | - Frank J Penedo
- Departments of Psychology and Medicine, and Sylvester Comprehensive Cancer Center, University of Miami, Coral Gables, FL, USA.
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Lehmann M, Jones L, Schirmann F. App Engagement as a Predictor of Weight Loss in Blended-Care Interventions: Retrospective Observational Study Using Large-Scale Real-World Data. J Med Internet Res 2024; 26:e45469. [PMID: 38848556 PMCID: PMC11193074 DOI: 10.2196/45469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 10/02/2023] [Accepted: 03/23/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Early weight loss is an established predictor for treatment outcomes in weight management interventions for people with obesity. However, there is a paucity of additional, reliable, and clinically actionable early predictors in weight management interventions. Novel blended-care weight management interventions combine coach and app support and afford new means of structured, continuous data collection, informing research on treatment adherence and outcome prediction. OBJECTIVE Against this backdrop, this study analyzes app engagement as a predictor for weight loss in large-scale, real-world, blended-care interventions. We hypothesize that patients who engage more frequently in app usage in blended-care treatment (eg, higher logging activity) lose more weight than patients who engage comparably less frequently at 3 and 6 months of intervention. METHODS Real-world data from 19,211 patients in obesity treatment were analyzed retrospectively. Patients were treated with 3 different blended-care weight management interventions, offered in Switzerland, the United Kingdom, and Germany by a digital behavior change provider. The principal component analysis identified an overarching metric for app engagement based on app usage. A median split informed a distinction in higher and lower engagers among the patients. Both groups were matched through optimal propensity score matching for relevant characteristics (eg, gender, age, and start weight). A linear regression model, combining patient characteristics and app-derived data, was applied to identify predictors for weight loss outcomes. RESULTS For the entire sample (N=19,211), mean weight loss was -3.24% (SD 4.58%) at 3 months and -5.22% (SD 6.29%) at 6 months. Across countries, higher app engagement yielded more weight loss than lower engagement after 3 but not after 6 months of intervention (P3 months<.001 and P6 months=.59). Early app engagement within the first 3 months predicted percentage weight loss in Switzerland and Germany, but not in the United Kingdom (PSwitzerland<.001, PUnited Kingdom=.12, and PGermany=.005). Higher age was associated with stronger weight loss in the 3-month period (PSwitzerland=.001, PUnited Kingdom=.002, and PGermany<.001) and, for Germany, also in the 6-month period (PSwitzerland=.09, PUnited Kingdom=.46, and PGermany=.03). In Switzerland, higher numbers of patients' messages to coaches were associated with higher weight loss (P3 months<.001 and P6 months<.001). Messages from coaches were not significantly associated with weight loss (all P>.05). CONCLUSIONS Early app engagement is a predictor of weight loss, with higher engagement yielding more weight loss than lower engagement in this analysis. This new predictor lends itself to automated monitoring and as a digital indicator for needed or adapted clinical action. Further research needs to establish the reliability of early app engagement as a predictor for treatment adherence and outcomes. In general, the obtained results testify to the potential of app-derived data to inform clinical monitoring practices and intervention design.
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Affiliation(s)
| | - Lucy Jones
- Oviva UK Limited, London, United Kingdom
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Fakhoury H, Trochez R, Kripalani S, Choma N, Blessinger E, Nelson LA. Patient engagement with an automated postdischarge text messaging program for improving care transitions. J Hosp Med 2024; 19:513-517. [PMID: 38497416 DOI: 10.1002/jhm.13334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/19/2024] [Accepted: 03/07/2024] [Indexed: 03/19/2024]
Abstract
Automated text messaging is a promising approach to monitor patients after hospital discharge and avert readmissions; however, it is not known to what extent patients would engage with this type of program and whether engagement may vary based on patients' characteristics. Using data from a 30-day postdischarge texting program at a large university hospital, we examined engagement over time (operationalized as response rate to text messages) and patient characteristics associated with engagement. Of the 1324 patients in the study sample, 838 (63%) stayed in the program for the full duration. Among those retained, the median response rate was 33% (interquartile range: 11%-77%) and decreased over time. Patients who were male (p < .05), were Black/African American (p < .001), had lower health literacy (p < .01), or had not recently logged into the patient portal (p < .001), all had lower response rates. Results support closer examinations of patient engagement in hospital-based texting programs and who is positioned to benefit.
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Affiliation(s)
- Hassan Fakhoury
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ricardo Trochez
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sunil Kripalani
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Neesha Choma
- Department of Quality, Safety, and Risk Prevention, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Emily Blessinger
- Vanderbilt Discharge Care Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Milne-Ives M, Homer S, Andrade J, Meinert E. The conceptualisation and measurement of engagement in digital health. Internet Interv 2024; 36:100735. [PMID: 38558760 PMCID: PMC10979253 DOI: 10.1016/j.invent.2024.100735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/12/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
Digital tools are an increasingly important component of healthcare, but their potential impact is commonly limited by a lack of user engagement. Digital health evaluations of engagement are often restricted to system usage metrics, which cannot capture a full understanding of how and why users engage with an intervention. This study aimed to examine how theory-based, multifaceted measures of engagement with digital health interventions capture different components of engagement (affective, cognitive, behavioural, micro, and macro) and to consider areas that are unclear or missing in their measurement. We identified and compared two recently developed measures that met these criteria (the Digital Behaviour Change Intervention Engagement Scale and the TWente Engagement with Ehealth Technologies Scale). Despite having similar theoretical bases and being relatively strongly correlated, there are key differences in how these scales aim to capture engagement. We discuss the implications of our analysis for how affective, cognitive, and behavioural components of engagement can be conceptualised and whether there is value in distinguishing between them. We conclude with recommendations for the circumstances in which each scale may be most useful and for how future measure development could supplement existing scales.
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Affiliation(s)
- Madison Milne-Ives
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Centre for Health Technology, University of Plymouth, Plymouth, UK
| | - Sophie Homer
- School of Psychology, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Jackie Andrade
- School of Psychology, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Edward Meinert
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Centre for Health Technology, University of Plymouth, Plymouth, UK
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Schläpfer S, Schneider F, Santhanam P, Eicher M, Kowatsch T, Witt CM, Barth J. Engagement With a Relaxation and Mindfulness Mobile App Among People With Cancer: Exploratory Analysis of Use Data and Self-Reports From a Randomized Controlled Trial. JMIR Cancer 2024; 10:e52386. [PMID: 38819907 PMCID: PMC11179041 DOI: 10.2196/52386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 02/01/2024] [Accepted: 04/14/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Mobile health (mHealth) apps offer unique opportunities to support self-care and behavior change, but poor user engagement limits their effectiveness. This is particularly true for fully automated mHealth apps without any human support. Human support in mHealth apps is associated with better engagement but at the cost of reduced scalability. OBJECTIVE This work aimed to (1) describe the theory-informed development of a fully automated relaxation and mindfulness app to reduce distress in people with cancer (CanRelax app 2.0), (2) describe engagement with the app on multiple levels within a fully automated randomized controlled trial over 10 weeks, and (3) examine whether engagement was related to user characteristics. METHODS The CanRelax app 2.0 was developed in iterative processes involving input from people with cancer and relevant experts. The app includes evidence-based relaxation exercises, personalized weekly coaching sessions with a rule-based conversational agent, 39 self-enactable behavior change techniques, a self-monitoring dashboard with gamification elements, highly tailored reminder notifications, an educational video clip, and personalized in-app letters. For the larger study, German-speaking adults diagnosed with cancer within the last 5 years were recruited via the web in Switzerland, Austria, and Germany. Engagement was analyzed in a sample of 100 study participants with multiple measures on a micro level (completed coaching sessions, relaxation exercises practiced with the app, and feedback on the app) and a macro level (relaxation exercises practiced without the app and self-efficacy toward self-set weekly relaxation goals). RESULTS In week 10, a total of 62% (62/100) of the participants were actively using the CanRelax app 2.0. No associations were identified between engagement and level of distress at baseline, sex assigned at birth, educational attainment, or age. At the micro level, 71.88% (3520/4897) of all relaxation exercises and 714 coaching sessions were completed in the app, and all participants who provided feedback (52/100, 52%) expressed positive app experiences. At the macro level, 28.12% (1377/4897) of relaxation exercises were completed without the app, and participants' self-efficacy remained stable at a high level. At the same time, participants raised their weekly relaxation goals, which indicates a potential relative increase in self-efficacy. CONCLUSIONS The CanRelax app 2.0 achieved promising engagement even though it provided no human support. Fully automated social components might have compensated for the lack of human involvement and should be investigated further. More than one-quarter (1377/4897, 28.12%) of all relaxation exercises were practiced without the app, highlighting the importance of assessing engagement on multiple levels.
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Affiliation(s)
- Sonja Schläpfer
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Fabian Schneider
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Prabhakaran Santhanam
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Manuela Eicher
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
- Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St.Gallen, St.Gallen, Switzerland
| | - Claudia M Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Vandelanotte C, Short CE, Plotnikoff RC, Schoeppe S, Alley SJ, To Q, Rebar AL, Duncan MJ. Does intervention engagement mediate physical activity change in a web-based computer-tailored physical activity intervention?-Secondary outcomes from a randomised controlled trial. Front Digit Health 2024; 6:1356067. [PMID: 38835671 PMCID: PMC11148347 DOI: 10.3389/fdgth.2024.1356067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/09/2024] [Indexed: 06/06/2024] Open
Abstract
Introduction The relationship between intervention engagement and behaviour change may vary depending on the specific engagement metric being examined. To counter this composite engagement measures may provide a deeper understanding of the relationship between engagement and behaviour change, though few studies have applied such multidimensional engagement metrics. The aim of this secondary analysis of RCT data was to examine how a composite engagement score mediates the effect of a web-based computer-tailored physical activity intervention. Methods 501 inactive Australian adults were randomised to a no-treatment control or intervention group. Intervention participants received 8 sessions of web-based personalised physical activity advice over a 12-week intervention period and the ability to complete action plans. Change in physical activity was assessed using Actigraph accelerometers at baseline, 3-months and 9-months. Engagement with the intervention (i.e., a composite score including frequency, intensity, duration and type) was continuously assessed during the intervention period using website tracking software and database metrics. Generalised structural equation models were used to examine how a composite engagement score mediated intervention effects at 3 months and 9 months. Results At 3 months, mediation analysis revealed that the intervention group had significantly higher engagement scores than the control group [a-path exp(b) = 6.462, 95% CI = 5.121-7.804, p < 0.001]. Further, increased engagement with the intervention platform was associated with an increased time spent in moderate-to-vigorous physical activity [ab-coefficient exp(b) = 1.008, 95% CI = 1.004-1.014, P < 0.001]; however, the magnitude of this effect was small. There were no significant mediation effects at the 9-month time point. Discussion The findings suggest that a composite intervention engagement score has a small positive influence on physical activity changes and that other factors (e.g., behaviour change techniques) are likely to be more important drivers of behaviour change.
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Affiliation(s)
- Corneel Vandelanotte
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Rockhampton, QLD, Australia
| | - Camille E Short
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Science and Melbourne School of Health Science, University of Melbourne, Melbourne, VIC, Australia
| | - Ronald C Plotnikoff
- Centre of Active Living and Learning, College of Human and Social Futures, University of Newcastle, Newcastle, NSW, Australia
| | - Stephanie Schoeppe
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Rockhampton, QLD, Australia
| | - Stephanie J Alley
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Rockhampton, QLD, Australia
| | - Quyen To
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Rockhampton, QLD, Australia
| | - Amanda L Rebar
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Rockhampton, QLD, Australia
| | - Mitch J Duncan
- Centre of Active Living and Learning, College of Human and Social Futures, University of Newcastle, Newcastle, NSW, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia
- Active Living Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
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Marier-Deschenes P, Pinard AM, Jalbert L, LeBlanc A. Assessing the Feasibility and Preliminary Effects of a Web-Based Self-Management Program for Chronic Noncancer Pain: Mixed Methods Study. JMIR Hum Factors 2024; 11:e50747. [PMID: 38701440 PMCID: PMC11102036 DOI: 10.2196/50747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/23/2023] [Accepted: 03/20/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND In Canada, adults with chronic noncancer pain face a persistent insufficiency of publicly funded resources, with the gold standard multidisciplinary pain treatment facilities unable to meet the high clinical demand. Web-based self-management programs cost-effectively increase access to pain management and can improve several aspects of physical and emotional functioning. Aiming to meet the demand for accessible, fully automated resources for individuals with chronic noncancer pain, we developed a French web- and evidence-based self-management program, Agir pour moi (APM). This program includes pain education and strategies to reduce stress, practice mindfulness, apply pacing, engage in physical activity, identify and manage thinking traps, sleep better, adapt diet, and sustain behavior change. OBJECTIVE This study aims to assess the APM self-management program's feasibility, acceptability, and preliminary effects in adults awaiting specialized services from a center of expertise in chronic pain management. METHODS We conducted a mixed methods study with an explanatory sequential design, including a web-based 1-arm trial and qualitative semistructured interviews. We present the results from both phases through integrative tables called joint displays. RESULTS Response rates were 70% (44/63) at postintervention and 56% (35/63) at 3-month follow-up among the 63 consenting participants who provided self-assessed information at baseline. In total, 46% (29/63) of the participants completed the program. We interviewed 24% (15/63) of the participants. The interview's first theme revolved around the overall acceptance, user-friendliness, and engaging nature of the program. The second theme emphasized the differentiation between microlevel and macrolevel engagements. The third theme delved into the diverse effects observed, potentially influenced by the macrolevel engagements. Participants highlighted the features that impacted their self-efficacy and the adoption of self-management strategies. We observed indications of improvement in self-efficacy, pain intensity, pain interference, depression, and catastrophizing. Interviewees described these and various other effects as potentially influenced by macrolevel engagement through behavioral change. CONCLUSIONS These findings provided preliminary evidence that the APM self-management program and research methods are feasible. However, some participants expressed the need for at least phone reminders and minimal support from a professional available to answer questions over the first few weeks of the program to engage. Recruitment strategies of a future randomized controlled trial should focus on attracting a broader representation of individuals with chronic pain in terms of gender and ethnicity. TRIAL REGISTRATION ClinicalTrials.gov NCT05319652; https://clinicaltrials.gov/study/NCT05319652.
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Affiliation(s)
- Pascale Marier-Deschenes
- Laval University, Medicine Faculty, Québec, QC, Canada
- CIRRIS, Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, QC, Canada
| | - Anne Marie Pinard
- Laval University, Medicine Faculty, Québec, QC, Canada
- CIRRIS, Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Québec, QC, Canada
- CHU de Québec, Université Laval, Québec, QC, Canada
| | - Laura Jalbert
- VITAM, Centre de recherche en santé durable, Québec, QC, Canada
| | - Annie LeBlanc
- Laval University, Medicine Faculty, Québec, QC, Canada
- VITAM, Centre de recherche en santé durable, Québec, QC, Canada
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Kwok G, Sharma A, Mandato I, Devine KA. Feasibility and Acceptability of a Meditation Mobile App Intervention for Adolescent and Young Adult Survivors of Childhood Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:584. [PMID: 38791797 PMCID: PMC11121627 DOI: 10.3390/ijerph21050584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Adolescent and young adult (AYA) survivors of childhood cancer are increasingly recognized as a vulnerable group with unique emotional, social, and practical needs due to the intersection of cancer survivorship and normal developmental processes. Mindfulness meditation has shown early efficacy in improving psychological distress among cancer patients. However, the overall scientific study of app-based mindfulness-based interventions is still in its early stages. The goal of this study was to evaluate the feasibility and acceptability of a commercially available mindfulness mobile app intervention "Ten Percent Happier" among AYA survivors of childhood cancer. METHODS We conducted a single-arm pilot intervention with 25 AYA survivors of childhood cancer ages 18-29 years. RESULTS A total of 108 potentially eligible individuals were initially identified for screening. Of the 45 individuals reached (contact rate = 41.67%), 20 declined to participate; 25 were enrolled in the study and completed the baseline survey (enrollment rate = 55.56%). Twenty-one participants completed the study (retention rate = 84%). Changes in several outcomes were promising, with medium to large effect sizes: Mindfulness (d = 0.74), Negative Emotion (d = 0.48), Perceived Stress (d = 0.52), and Mental Health (d = 0.45). Furthermore, results suggested that participants with consistent app usage showed greater improvement in reported outcomes than those who stopped their usage (e.g., Mindfulness: d = 0.74, Perceived Stress: d = 0.83, Mental Health: d = 0.51; Meaning and Purpose: d = 0.84; and Sleep Disturbance: d = 0.81). Qualitative feedback indicated high satisfaction, but participants suggested adding group or individual peer support to improve their experience with the app. CONCLUSIONS AYA survivors can be difficult to reach, but a mindfulness app was feasible and acceptable to this group. In particular, the robust retention rate and high satisfaction ratings indicate that the meditation mobile app was well received. Preliminary results suggest positive changes in health-related quality of life outcomes, warranting a larger efficacy trial.
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Affiliation(s)
- Gary Kwok
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
- Pediatric Population Science, Outcomes, and Disparities Research Section, Division of Pediatric Hematology/Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
| | - Archana Sharma
- Pediatric Population Science, Outcomes, and Disparities Research Section, Division of Pediatric Hematology/Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
| | - Ivelisse Mandato
- Pediatric Population Science, Outcomes, and Disparities Research Section, Division of Pediatric Hematology/Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
| | - Katie A. Devine
- Pediatric Population Science, Outcomes, and Disparities Research Section, Division of Pediatric Hematology/Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
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10
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Smith A'B, Bamgboje-Ayodele A, Jegathees S, Butow P, Klein B, Salter M, Turner J, Fardell J, Thewes B, Sharpe L, Beatty L, Pearce A, Beith J, Costa D, Rincones O, Wu VS, Garden FL, Kiely BE, Lim K, Morstyn L, Hanley B, Hodgkin R, Beattie A, Girgis A. Feasibility and preliminary efficacy of iConquerFear: a self-guided digital intervention for fear of cancer recurrence. J Cancer Surviv 2024; 18:425-438. [PMID: 35876964 PMCID: PMC9309991 DOI: 10.1007/s11764-022-01233-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/07/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Approximately 50% of cancer survivors experience moderate-severe fear of cancer recurrence (FCR). Self-guided digital interventions have potential to address the high level of FCR-related unmet needs at scale, but existing digital interventions have demonstrated variable engagement and efficacy. This study aimed to evaluate the feasibility and preliminary efficacy of iConquerFear, a five-module self-guided digital FCR intervention. METHODS Eligible curatively treated breast cancer survivors were recruited. Participants reporting clinically significant FCR (≥ 13 on the Fear of Cancer Recurrence Inventory-Short Form; FCRI-SF) were given access to iConquerFear. Feasibility was indicated by > 50% of eligible participants enrolling in iConquerFear and recording moderate (≥ 120 min) or greater usage. Preliminary efficacy was evaluated via changes in self-reported FCR severity, anxiety, depression, intrusions and metacognitions from baseline to immediately and 3 months post-intervention. RESULTS Fifty-four (83%) of 65 eligible participants enrolled in iConquerFear; six subsequently withdrew. Thirty-nine (83%) participants recorded moderate (n = 24; 120-599 min) or high (n = 15; ≥ 600 min) usage. Engagement levels increased with participant age (p = 0.043), but were lower in participants with higher baseline FCR (p = 0.028). Qualitative feedback indicated engagement was sometimes limited by difficulties with navigation and relating to featured survivors. Participants reported significantly improved FCR (mean reduction (95%CI): baseline to post-intervention - 3.44 (- 5.18, - 1.71), baseline to 3-month follow-up - 4.52 (- 6.25, - 2.78), p = < 0.001). CONCLUSION iConquerFear is a feasible and potentially efficacious intervention for reducing FCR in breast cancer survivors. Easier navigation and more relatable examples may enhance engagement. IMPLICATIONS FOR CANCER SURVIVORS iConquerFear may help address moderate but burdensome FCR levels in cancer survivors.
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Affiliation(s)
- Allan 'Ben' Smith
- Faculty of Medicine and Health, South West Sydney Clinical Campuses, University of New South Wales (UNSW Sydney), Liverpool, Australia.
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Locked Bag 7103, Liverpool, BC NSW, 1871, Australia.
| | - Adeola Bamgboje-Ayodele
- Faculty of Medicine and Health, South West Sydney Clinical Campuses, University of New South Wales (UNSW Sydney), Liverpool, Australia
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sharuja Jegathees
- Faculty of Medicine and Health, South West Sydney Clinical Campuses, University of New South Wales (UNSW Sydney), Liverpool, Australia
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Locked Bag 7103, Liverpool, BC NSW, 1871, Australia
| | - Phyllis Butow
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, NSW, Australia
| | - Britt Klein
- Health Innovation & Transformation Centre (HITC) & Biopsychosocial and eHealth Research & Innovation (BeRI), DVC-R&I Portfolio, Federation University Australia, Churchill, Australia
| | - Marj Salter
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Locked Bag 7103, Liverpool, BC NSW, 1871, Australia
| | - Jane Turner
- Department of Psychiatry, University of Queensland, Brisbane, Australia
| | - Joanna Fardell
- School of Clinical Medicine, Discipline of Paediatrics, UNSW Medicine & Health, UNSW Sydney, Sydney, Australia
- Western Sydney Youth Cancer Service, Westmead Hospital, Westmead, Australia
| | - Belinda Thewes
- School of Psychology, University of Sydney NSW, Sydney, Australia
| | - Louise Sharpe
- School of Psychology, University of Sydney NSW, Sydney, Australia
| | - Lisa Beatty
- College of Education, Psychology & Social Work, Flinders University, Adelaide, Australia
| | - Alison Pearce
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Jane Beith
- Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Daniel Costa
- School of Psychology, University of Sydney NSW, Sydney, Australia
| | - Orlando Rincones
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Locked Bag 7103, Liverpool, BC NSW, 1871, Australia
| | - Verena S Wu
- Faculty of Medicine and Health, South West Sydney Clinical Campuses, University of New South Wales (UNSW Sydney), Liverpool, Australia
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Locked Bag 7103, Liverpool, BC NSW, 1871, Australia
| | - Frances L Garden
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Locked Bag 7103, Liverpool, BC NSW, 1871, Australia
| | - Belinda E Kiely
- South Western Sydney Local Health District, Campbelltown Hospital, Campbelltown, NSW, Australia
| | - Karen Lim
- South Western Sydney Local Health District, Liverpool Hospital, Liverpool, NSW, Australia
| | - Lisa Morstyn
- Breast Cancer Network Australia (BCNA), Camberwell, Australia
| | - Brigid Hanley
- Cancer Council Queensland, Fortitude Valley, Australia
| | | | | | - Afaf Girgis
- Faculty of Medicine and Health, South West Sydney Clinical Campuses, University of New South Wales (UNSW Sydney), Liverpool, Australia
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Locked Bag 7103, Liverpool, BC NSW, 1871, Australia
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Gryglewicz K, Orr VL, McNeil MJ, Taliaferro LA, Hines S, Duffy TL, Wisniewski PJ. Translating Suicide Safety Planning Components Into the Design of mHealth App Features: Systematic Review. JMIR Ment Health 2024; 11:e52763. [PMID: 38546711 PMCID: PMC11009854 DOI: 10.2196/52763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/19/2023] [Accepted: 12/31/2023] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Suicide safety planning is an evidence-based approach used to help individuals identify strategies to keep themselves safe during a mental health crisis. This study systematically reviewed the literature focused on mobile health (mHealth) suicide safety planning apps. OBJECTIVE This study aims to evaluate the extent to which apps integrated components of the safety planning intervention (SPI), and if so, how these safety planning components were integrated into the design-based features of the apps. METHODS Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we systematically analyzed 14 peer-reviewed studies specific to mHealth apps for suicide safety planning. We conducted an analysis of the literature to evaluate how the apps incorporated SPI components and examined similarities and differences among the apps by conducting a comparative analysis of app features. An independent review of SPI components and app features was conducted by downloading the available apps. RESULTS Most of the mHealth apps (5/7, 71%) integrated SPI components and provided customizable features that expanded upon traditional paper-based safety planning processes. App design features were categorized into 5 themes, including interactive features, individualized user experiences, interface design, guidance and training, and privacy and sharing. All apps included access to community supports and revisable safety plans. Fewer mHealth apps (3/7, 43%) included interactive features, such as associating coping strategies with specific stressors. Most studies (10/14, 71%) examined the usability, feasibility, and acceptability of the safety planning mHealth apps. Usability findings were generally positive, as users often found these apps easy to use and visually appealing. In terms of feasibility, users preferred using mHealth apps during times of crisis, but the continuous use of the apps outside of crisis situations received less support. Few studies (4/14, 29%) examined the effectiveness of mHealth apps for suicide-related outcomes. Positive shifts in attitudes and desire to live, improved coping strategies, enhanced emotional stability, and a decrease in suicidal thoughts or self-harm behaviors were examined in these studies. CONCLUSIONS Our study highlights the need for researchers, clinicians, and app designers to continue to work together to align evidence-based research on mHealth suicide safety planning apps with lessons learned for how to best deliver these technologies to end users. Our review brings to light mHealth suicide safety planning strategies needing further development and testing, such as lethal means guidance, collaborative safety planning, and the opportunity to embed more interactive features that leverage the advanced capabilities of technology to improve client outcomes as well as foster sustained user engagement beyond a crisis. Although preliminary evidence shows that these apps may help to mitigate suicide risk, clinical trials with larger sample sizes and more robust research designs are needed to validate their efficacy before the widespread adoption and use.
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Affiliation(s)
- Kim Gryglewicz
- School of Social Work, University of Central Florida, Orlando, FL, United States
| | - Victoria L Orr
- Center for Behavioral Health Research & Training, University of Central Florida, Orlando, FL, United States
| | - Marissa J McNeil
- Center for Behavioral Health Research & Training, University of Central Florida, Orlando, FL, United States
| | - Lindsay A Taliaferro
- Department of Population Health Sciences, University of Central Florida, Orlando, FL, United States
| | - Serenea Hines
- Center for Behavioral Health Research & Training, University of Central Florida, Orlando, FL, United States
| | - Taylor L Duffy
- Center for Behavioral Health Research & Training, University of Central Florida, Orlando, FL, United States
| | - Pamela J Wisniewski
- Department of Computer Science, Vanderbilt University, Nashville, TN, United States
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12
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Wähnke L, Plück J, Bodden M, Ernst A, Klemp MT, Mühlenmeister J, Döpfner M. Acceptance and utilization of web-based self-help for caregivers of children with externalizing disorders. Child Adolesc Psychiatry Ment Health 2024; 18:40. [PMID: 38528607 DOI: 10.1186/s13034-024-00724-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 02/27/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Web-based self-help interventions for parents of children with ADHD and other externalizing disorders have been proven to be effective. In order to recommend individualized and optimized interventions, a better understanding of the acceptance and utilization of this innovative treatment approach is needed. Previous research has frequently employed subjective reports of utilization, but the validity of these studies may be limited. METHODS Data from the German WASH study were used. Participants (n = 276) were randomly assigned to the intervention condition (a) web-based self-help or (b) web-based self-help with optional telephone-based support calls. Data collection took place at baseline (T1) and 12 weeks later (T2). Utilization data were tracked using a log file generated for each participant at T2. Prediction models were calculated using CART (Classification and Regression Trees), a method known mostly from the field of machine learning. RESULTS Acceptance, of the intervention as defined in this paper was very high on objective (89.4% have taken up the intervention) and subjective measures (91.4% reported having used the intervention and 95.3% reported they would recommend the intervention to a friend). The average number of logins corresponded to recommendations. Predictors of acceptance and predictors of utilization were similar and included, e.g., child's externalizing symptoms, parental psychopathology, and above all additional telephone-based support by counselors. CONCLUSIONS Through a detailed identification of acceptance and utilization, and the predictors thereof, we were able to gain a better understanding of the acceptance and utilization of web-assisted self-help for a parent management intervention in the treatment of children with ADHD and ODD. These findings can be used to recommend web-based interventions to particularly suitable families. It should be noted that some form of support is required for an intensive engagement with the content of the program. TRIAL REGISTRATION The protocol of the study (German Clinical Trials Register DRKS00013456 conducted on January 3rd, 2018) was approved by the Ethics Committee of the University Hospital, Cologne.
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Affiliation(s)
- Laura Wähnke
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Julia Plück
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Mikel Bodden
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Angela Ernst
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marie-Theres Klemp
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Judith Mühlenmeister
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Manfred Döpfner
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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13
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Materia FT, Smyth JM. Acceptability and concerns about innovative wearable health sensors in persons with and without chronic disease diagnosis. Internet Interv 2024; 35:100702. [PMID: 38221944 PMCID: PMC10787257 DOI: 10.1016/j.invent.2023.100702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/19/2023] [Accepted: 12/17/2023] [Indexed: 01/16/2024] Open
Abstract
Advances in biomedical engineering continue to produce innovative wearable health sensors capable of real-time ambulatory assessments (e.g., of physiology, the environment), holding great potential for advancing precision monitoring and interventions through the integration of such devices and data into eHealth systems. As with any novel device, however, user views on acceptability and concerns about the technology must be evaluated to facilitate widespread implementation and user adoption of such devices. One factor that may strongly influence user views is the potential relevance to, and need for, self-care for chronic disease management. We examined if acceptability and concerns regarding innovative wearable devices differed between individuals living with or without chronic disease. A U.S. adult sample (N = 448; 20-70 yrs.; 34 % Female; 60 % White, 35 % Hispanic) completed a web-based survey regarding their thoughts/opinions related to innovative wearable sensors. Two-thirds (67 %, N = 298) reported at least one chronic disease; one-third (33 %, N = 150) reported no chronic health conditions. Participants viewed learning modules about two innovative devices: a watch to detect environmental gases for respiratory health, and a chest-patch monitoring real-time ECG. For each device, participants rated acceptability across multiple dimensions, and then rated potential concerns (including general concerns and specific worries about negative health impacts). Respondents with and without chronic disease differed in education, race, and ethnicity. Controlling for these differences, individuals with chronic disease reported significantly higher acceptability for the watch and for the chest-patch. Healthy participants reported significantly higher general concerns about technology. However, when concern questions were asked specifically about the potential negative impacts of the two study devices on physical health and well-being, participants with chronic disease reported significantly higher concerns. Overall, results show that living with chronic disease influences acceptability and concerns associated with adoption of innovative sensors. These findings suggest it is essential to take potential users' health status into account when studying the design and implementation of innovative wearable sensors. Dissemination strategies may benefit from emphasizing the beneficial features of these devices, addressing hesitations, and customizing implementation approaches by user group.
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Affiliation(s)
- Frank T. Materia
- Departments of Otolaryngology and Population Health, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Joshua M. Smyth
- Department of Psychology, The Ohio State University, Columbus, OH, United States of America
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14
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Lukka L, Karhulahti VM, Bergman VR, Palva JM. Measuring digital intervention user experience with a novel ecological momentary assessment (EMA) method, CORTO. Internet Interv 2024; 35:100706. [PMID: 38274123 PMCID: PMC10808917 DOI: 10.1016/j.invent.2023.100706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/22/2023] [Accepted: 12/30/2023] [Indexed: 01/27/2024] Open
Abstract
Digital interventions often suffer from low usage, which may reflect insufficient attention to user experience. Moreover, the existing evaluation methods have limited applicability in the remote study of user experience of complex interventions that have expansive content and that are used over an extensive period of time. To alleviate these challenges, we describe here a novel qualitative Ecological Momentary Assessment (EMA) method: the CORTO method (Contextual, One-item, Repeated, Timely, Open-ended). We used it to gather digital intervention user experience data from Finnish adults (n = 184) who lived with interview-confirmed major depressive disorder (MDD) and took part in a randomized controlled trial (RCT) that studied the efficacy of a novel 12-week game-based digital intervention for depression. A second dataset on user experience was gathered with retrospective interviews (n = 22). We inductively coded the CORTO method and retrospective interview data, which led to four user experience categories: (1) contextual use, (2) interaction-elicited emotional experience, (3) usability, and (4) technical issues. Then, we used the created user experience categories and Template Analysis to analyze both datasets together, and reported the results qualitatively. Finally, we compared the two datasets with each other. We found that the data generated with the CORTO method offered more insights into usability and technical categories than the interview data that particularly illustrated the contextual use. The emotional valence of the interview data was more positive compared with the CORTO data. Both the CORTO and interview data detected 55 % of the micro-level categories; 20 % of micro-level categories were only detected by the CORTO data and 25 % only by the interview data. We found that the during-intervention user experience measurement with the CORTO method can provide intervention-specific insights, and thereby further the iterative user-centered intervention development. Overall, these findings highlight the impact of evaluation methods on the categories and qualities of insights acquired in intervention research.
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Affiliation(s)
- Lauri Lukka
- Department of Neuroscience and Biomedical Engineering, Aalto University, Finland
| | | | - Vilma-Reetta Bergman
- Department of Neuroscience and Biomedical Engineering, Aalto University, Finland
| | - J. Matias Palva
- Department of Neuroscience and Biomedical Engineering, Aalto University, Finland
- Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, Finland
- Centre for Cognitive Neuroimaging, Institute of Neuroscience and Psychology, University of Glasgow, United Kingdom
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15
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Buller DB, Sussman AL, Thomson CA, Kepka D, Taren D, Henry KL, Warner EL, Walkosz BJ, Woodall WG, Nuss K, Blair CK, Guest DD, Borrayo EA, Gordon JS, Hatcher J, Wetter DW, Kinsey A, Jones CF, Yung AK, Christini K, Berteletti J, Torres JA, Barraza Perez EY, Small A. #4Corners4Health Social Media Cancer Prevention Campaign for Emerging Adults: Protocol for a Randomized Stepped-Wedge Trial. JMIR Res Protoc 2024; 13:e50392. [PMID: 38386396 PMCID: PMC10921336 DOI: 10.2196/50392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Many emerging adults (EAs) are prone to making unhealthy choices, which increase their risk of premature cancer morbidity and mortality. In the era of social media, rigorous research on interventions to promote health behaviors for cancer risk reduction among EAs delivered over social media is limited. Cancer prevention information and recommendations may reach EAs more effectively over social media than in settings such as health care, schools, and workplaces, particularly for EAs residing in rural areas. OBJECTIVE This pragmatic randomized trial aims to evaluate a multirisk factor intervention using a social media campaign designed with community advisers aimed at decreasing cancer risk factors among EAs. The trial will target EAs from diverse backgrounds living in rural counties in the Four Corners states of Arizona, Colorado, New Mexico, and Utah. METHODS We will recruit a sample of EAs (n=1000) aged 18 to 26 years residing in rural counties (Rural-Urban Continuum Codes 4 to 9) in the Four Corners states from the Qualtrics' research panel and enroll them in a randomized stepped-wedge, quasi-experimental design. The inclusion criteria include English proficiency and regular social media engagement. A social media intervention will promote guideline-related goals for increased physical activity, healthy eating, and human papillomavirus vaccination and reduced nicotine product use, alcohol intake, and solar UV radiation exposure. Campaign posts will cover digital and media literacy skills, responses to misinformation, communication with family and friends, and referral to community resources. The intervention will be delivered over 12 months in Facebook private groups and will be guided by advisory groups of community stakeholders and EAs and focus groups with EAs. The EAs will complete assessments at baseline and at 12, 26, 39, 52, and 104 weeks after randomization. Assessments will measure 6 cancer risk behaviors, theoretical mediators, and participants' engagement with the social media campaign. RESULTS The trial is in its start-up phase. It is being led by a steering committee. Team members are working in 3 subcommittees to optimize community engagement, the social media intervention, and the measures to be used. The Stakeholder Organization Advisory Board and Emerging Adult Advisory Board were formed and provided initial input on the priority of cancer risk factors to target, social media use by EAs, and community resources available. A framework for the social media campaign with topics, format, and theoretical mediators has been created, along with protocols for campaign management. CONCLUSIONS Social media can be used as a platform to counter misinformation and improve reliable health information to promote health behaviors that reduce cancer risks among EAs. Because of the popularity of web-based information sources among EAs, an innovative, multirisk factor intervention using a social media campaign has the potential to reduce their cancer risk behaviors. TRIAL REGISTRATION ClinicalTrials.gov NCT05618158; https://classic.clinicaltrials.gov/ct2/show/NCT05618158. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/50392.
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Affiliation(s)
| | - Andrew L Sussman
- University of New Mexico Comprehensive Cancer Care Center, Albuquerque, NM, United States
| | - Cynthia A Thomson
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Deanna Kepka
- College of Nursing and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Douglas Taren
- Section of Nutrition, University of Colorado Denver, Aurora, CO, United States
| | - Kimberly L Henry
- Department of Psychology, College of Natural Sciences, Colorado State University, Fort Collins, CO, United States
| | - Echo L Warner
- College of Nursing and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | | | | | - Kayla Nuss
- Klein Buendel, Golden, CO, United States
| | - Cindy K Blair
- University of New Mexico Comprehensive Cancer Care Center, Albuquerque, NM, United States
| | - Dolores D Guest
- University of New Mexico Comprehensive Cancer Care Center, Albuquerque, NM, United States
| | - Evelinn A Borrayo
- University of Colorado Cancer Center, University of Colorado Denver, Aurora, CO, United States
| | - Judith S Gordon
- College of Nursing, University of Arizona, Tucson, AZ, United States
| | | | - David W Wetter
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | | | - Christopher F Jones
- University of Colorado Cancer Center, University of Colorado Denver, Aurora, CO, United States
| | - Angela K Yung
- College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Kaila Christini
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | | | - John A Torres
- University of New Mexico Comprehensive Cancer Care Center, Albuquerque, NM, United States
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Stephan J, Gehrmann J, Stullich A, Hoffmann L, Richter M. Development, piloting and evaluation of an app-supported psychosocial prevention intervention to strengthen participation in working life: a study protocol of a mixed-methods approach. BMJ Open 2024; 14:e081390. [PMID: 38367971 PMCID: PMC10875476 DOI: 10.1136/bmjopen-2023-081390] [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: 10/26/2023] [Accepted: 02/02/2024] [Indexed: 02/19/2024] Open
Abstract
INTRODUCTION Rates of incapacity to work due to mental disorders have increased in many European countries. The consequences of persistent stress can impact individuals' physical and psychological well-being and gradually develop into chronic stress. Mental disorders or symptoms of burn-out syndrome can have severe consequences. Mental disorders leading to work incapacity significantly burden the health system. Prevention interventions can protect against burn-out, depression, anxiety and other mental health disorders. Digital health is a promising approach to increase the utilisation of effective prevention interventions. This mixed-methods study evaluates a newly developed app-supported psychosocial prevention intervention called 'RV Fit Mental Health' to strengthen participation in working life. METHODS AND ANALYSIS The study uses a three-stage parallel mixed-methods design. This study accompanies the development (stage 1), piloting (stage 2) and evaluation (stage 3) of the new intervention. Within the stages, there is a quantitative as well as a qualitative research strand. Employed persons with an incipient mental disorder will be included. Additionally, experts within the project or connected areas will be included. Quantitative data will be analysed using multifactorial variance analyses in a pre-post design. Qualitative data will be analysed using qualitative content analysis. The study is a comprehensive research approach to investigate the development, piloting and evaluation of an app-supported psychosocial app-based prevention intervention. The rigour of the study will be achieved through data triangulation. ETHICS AND DISSEMINATION All participants will receive detailed study information and give written informed consent before data collection. Ethical approval was obtained from the Technical University of Munich Ethics Committee. All data collection will follow all legislative rules regarding data protection, also following the Declaration of Helsinki. The study results will be disseminated in peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBERS DRKS00030818 and DRKS00033080.
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Affiliation(s)
- Johannes Stephan
- Chair of Social Determinants of Health, TUM School of Medicine and Health, Department Health and Sport Sciences, Technical University of Munich, Munich, Germany
| | - Jan Gehrmann
- Chair of Social Determinants of Health, TUM School of Medicine and Health, Department Health and Sport Sciences, Technical University of Munich, Munich, Germany
- Institute of General Practice and Health Services Research, TUM School of Medicine and Health, Department Clinical Medicine, Technical University of Munich, Munich, Germany
| | - Ananda Stullich
- Chair of Social Determinants of Health, TUM School of Medicine and Health, Department Health and Sport Sciences, Technical University of Munich, Munich, Germany
| | - Laura Hoffmann
- Chair of Social Determinants of Health, TUM School of Medicine and Health, Department Health and Sport Sciences, Technical University of Munich, Munich, Germany
| | - Matthias Richter
- Chair of Social Determinants of Health, TUM School of Medicine and Health, Department Health and Sport Sciences, Technical University of Munich, Munich, Germany
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17
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Robertson MC, Cox-Martin E, Basen-Engquist K, Lyons EJ. Reflective Engagement With a Digital Physical Activity Intervention Among People Living With and Beyond Breast Cancer: Mixed Methods Study. JMIR Mhealth Uhealth 2024; 12:e51057. [PMID: 38335025 PMCID: PMC10891490 DOI: 10.2196/51057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/21/2023] [Accepted: 12/07/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND People living with and beyond breast cancer can face internal barriers to physical activity (eg, fatigue and pain). Digital interventions that promote psychological acceptance and motivation may help this population navigate these barriers. The degree to which individuals (1) adhere to intervention protocols and (2) reflect on and internalize intervention content may predict intervention efficacy. OBJECTIVE The objective of this study was to characterize the nature of reflective processes brought about by an 8-week acceptance- and mindfulness-based physical activity intervention for insufficiently active survivors of breast cancer (n=75). Furthermore, we explored the potential utility of a metric of reflective processes for predicting study outcomes. METHODS Of the intervention's 8 weekly modules, 7 (88%) included an item that asked participants to reflect on what they found to be most useful. Two coders conducted directed content analysis on participants' written responses. They assessed each comment's depth of reflection using an existing framework (ranging from 0 to 4, with 0=simple description and 4=fundamental change with consideration of social and ethical issues). The coders identified themes within the various levels of reflection. We fit multiple linear regression models to evaluate whether participants' (1) intervention adherence (ie, number of modules completed) and (2) the mean level of the depth of reflection predicted study outcomes. RESULTS Participants were aged on average 57.2 (SD 11.2) years, mostly non-Hispanic White (58/75, 77%), and mostly overweight or obese (54/75, 72%). Of the 407 responses to the item prompting personal reflection, 70 (17.2%) were rated as reflection level 0 (ie, description), 247 (60.7%) were level 1 (ie, reflective description), 74 (18.2%) were level 2 (ie, dialogic reflection), 14 (3.4%) were level 3 (ie, transformative reflection), and 2 (0.5%) were level 4 (ie, critical reflection). Lower levels of reflection were characterized by the acquisition of knowledge or expressing intentions. Higher levels were characterized by personal insight, commentary on behavior change processes, and a change of perspective. Intervention adherence was associated with increases in self-reported weekly bouts of muscle-strengthening exercise (B=0.26, SE 0.12, 95% CI 0.02-0.50) and decreases in sleep disturbance (B=-1.04, SE 0.50, 95% CI -0.06 to -2.02). The mean level of reflection was associated with increases in psychological acceptance (B=3.42, SE 1.70, 95% CI 0.09-6.75) and motivation for physical activity (ie, integrated regulation: B=0.55, SE 0.25, 95% CI 0.06-1.04). CONCLUSIONS We identified a useful method for understanding the reflective processes that can occur during digital behavior change interventions serving people living with and beyond breast cancer. Intervention adherence and the depth of reflection each predicted changes in study outcomes. Deeper reflection on intervention content was associated with beneficial changes in the determinants of sustained behavior change. More research is needed to investigate the relations among digital behavior change intervention use, psychological processes, and intervention efficacy.
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Affiliation(s)
- Michael C Robertson
- Department of Family and Preventive Medicine, TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | | | - Karen Basen-Engquist
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Elizabeth J Lyons
- Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch at Galveston, Galveston, TX, United States
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Schäfer SK, von Boros L, Schaubruch LM, Kunzler AM, Lindner S, Koehler F, Werner T, Zappalà F, Helmreich I, Wessa M, Lieb K, Tüscher O. Digital interventions to promote psychological resilience: a systematic review and meta-analysis. NPJ Digit Med 2024; 7:30. [PMID: 38332030 PMCID: PMC10853230 DOI: 10.1038/s41746-024-01017-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 01/18/2024] [Indexed: 02/10/2024] Open
Abstract
Societies are exposed to major challenges at an increasing pace. This underscores the need for preventive measures such as resilience promotion that should be available in time and without access barriers. Our systematic review summarizes evidence on digital resilience interventions, which have the potential to meet these demands. We searched five databases for randomized-controlled trials in non-clinical adult populations. Primary outcomes were mental distress, positive mental health, and resilience factors. Multilevel meta-analyses were performed to compare intervention and control groups at post-intervention and follow-up assessments. We identified 101 studies comprising 20,010 participants. Meta-analyses showed small favorable effects on mental distress, SMD = -0.24, 95% CI [-0.31, -0.18], positive mental health, SMD = 0.27, 95% CI [0.13, 0.40], and resilience factors, SMD = 0.31, 95% CI [0.21, 0.41]. Among middle-aged samples, older age was associated with more beneficial effects at follow-up, and effects were smaller for active control groups. Effects were comparable to those of face-to-face interventions and underline the potential of digital resilience interventions to prepare for future challenges.
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Affiliation(s)
- Sarah K Schäfer
- Leibniz Institute for Resilience Research, Mainz, Germany.
- Department of Clinical Psychology, Psychotherapy and Diagnostics - Child and Adolescent Psychology and Psychotherapy, Technische Universität Braunschweig, Braunschweig, Germany.
| | - Lisa von Boros
- Leibniz Institute for Resilience Research, Mainz, Germany
| | | | - Angela M Kunzler
- Leibniz Institute for Resilience Research, Mainz, Germany
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Saskia Lindner
- Department of Psychiatry and Psychotherapy, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
| | - Friederike Koehler
- Leibniz Institute for Resilience Research, Mainz, Germany
- Department of Clinical Psychology and Neuropsychology, Institute for Psychology, Johannes Gutenberg University Mainz, Mainz, Germany
- Centre of Excellence in Music, Mind, Body and Brain, University of Jyväskylä, Jyväskylä, Finland
| | - Tabea Werner
- Leibniz Institute for Resilience Research, Mainz, Germany
- Department of Clinical Psychology and Neuropsychology, Institute for Psychology, Johannes Gutenberg University Mainz, Mainz, Germany
| | | | | | - Michèle Wessa
- Leibniz Institute for Resilience Research, Mainz, Germany
- Department of Clinical Psychology and Neuropsychology, Institute for Psychology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Klaus Lieb
- Leibniz Institute for Resilience Research, Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
| | - Oliver Tüscher
- Leibniz Institute for Resilience Research, Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
- Institute for Molecular Biology, Johannes Gutenberg University Mainz, Mainz, Germany
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19
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Walsh EA, Safren SA, Penedo FJ, Antoni MH. If we build it, will they come? A scoping review of objective engagement metrics in asynchronous psychosocial telehealth interventions for breast cancer survivors. Clin Psychol Rev 2024; 107:102374. [PMID: 38171138 DOI: 10.1016/j.cpr.2023.102374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024]
Abstract
Burgeoning technologies and the COVID-19 pandemic resulted in a boom of telehealth for immunocompromised patients, such as those with cancer. Telehealth modalities overcome barriers and promote accessibility to care. Currently, efficacious psychosocial interventions exist to address negative aftereffects of a cancer diagnosis and treatment. Many of these interventions often incorporate asynchronous telehealth (e.g., web-based, smartphone mobile app) features. However, asynchronous platforms are limited by suboptimal engagement. Subjective indicators of perceived engagement in the forms of acceptability, feasibility, and adherence are often captured, yet prior research has found discrepancies between perceived and actual engagement. The FITT (frequency, intensity, time/duration, type of engagement) model, originally developed for use to quantify engagement within exercise trials, provides a framework to assess objective engagement of psychosocial interventions for breast cancer. Using 14 keywords and searching six databases through 11/2023, 56 studies that used asynchronous telehealth interventions in breast cancer were identified. All FITT domains were reported at least once across studies with intensity metrics most commonly reported. Nine metrics were described across FITT domains. Human-centered design principles to guide telehealth development and privacy considerations are discussed. Findings offer suggestions for how to represent and optimize objective engagement in asynchronous telehealth cancer care.
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Affiliation(s)
- Emily A Walsh
- Department of Psychology, University of Miami, Coral Gables, FL, USA.
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Frank J Penedo
- Department of Psychology, University of Miami, Coral Gables, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Michael H Antoni
- Department of Psychology, University of Miami, Coral Gables, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
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Livingston PM, Winter N, Ugalde A, Orellana L, Mikocka-Walus A, Jefford M, Zalcberg J, Orford N, Hutchinson AM, Barbour A, Kiss N, Smithers BM, Watson DI, McCaffrey N, White V. iCare - a self-directed, interactive online program to improve health and wellbeing for people living with upper gastrointestinal or hepato-pancreato-biliary cancers, and their informal carers: the study protocol for a Phase II randomised controlled trial. BMC Cancer 2024; 24:144. [PMID: 38287317 PMCID: PMC10826031 DOI: 10.1186/s12885-024-11861-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/20/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Up to 70% of people diagnosed with upper gastrointestinal (GI) tract or hepato-pancreato-biliary (HPB) cancers experience substantial reductions in quality of life (QoL), including high distress levels, pain, fatigue, sleep disturbances, weight loss and difficulty swallowing. With few advocacy groups and support systems for adults with upper GI or HPB cancers (i.e. pancreas, liver, stomach, bile duct and oesophageal) and their carers, online supportive care programs may represent an alternate cost-effective mechanism to support this patient group and carers. iCare is a self-directed, interactive, online program that provides information, resources, and psychological packages to patients and their carers from the treatment phase of their condition. The inception and development of iCare has been driven by consumers, advocacy groups, government and health professionals. The aims of this study are to determine the feasibility and acceptability of iCare, examine preliminary efficacy on health-related QoL and carer burden at 3- and 6-months post enrolment, and the potential cost-effectiveness of iCare, from health and societal perspectives, for both patients and carers. METHODS AND ANALYSIS A Phase II randomised controlled trial. Overall, 162 people with newly diagnosed upper GI or HPB cancers and 162 carers will be recruited via the Upper GI Cancer Registry, online advertisements, or hospital clinics. Patients and carers will be randomly allocated (1:1) to the iCare program or usual care. Participant assessments will be at enrolment, 3- and 6-months later. The primary outcomes are i) feasibility, measured by eligibility, recruitment, response and attrition rates, and ii) acceptability, measured by engagement with iCare (frequency of logins, time spent using iCare, and use of features over the intervention period). Secondary outcomes are patient changes in QoL and unmet needs, and carer burden, unmet needs and QoL. Linear mixed models will be fitted to obtain preliminary estimates of efficacy and variability for secondary outcomes. The economic analysis will include a cost-consequences analysis where all outcomes will be compared with costs. DISCUSSION iCare provides a potential model of supportive care to improve QoL, unmet needs and burden of disease among people living with upper GI or HPB cancers and their carers. AUSTRALIAN AND NEW ZEALAND CLINICAL TRIALS REGISTRY ACTRN12623001185651. This protocol reflects Version #1 26 April 2023.
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Affiliation(s)
- Patricia M Livingston
- Deakin University, Geelong, VIC, 3220, Australia.
- Faculty of Health, Deakin University, Geelong, VIC, Australia.
- School of Nursing &, Midwifery Deakin University, Geelong, VIC, Australia.
| | - Natalie Winter
- Deakin University, Geelong, VIC, 3220, Australia
- Faculty of Health, Deakin University, Geelong, VIC, Australia
- School of Nursing &, Midwifery Deakin University, Geelong, VIC, Australia
| | - Anna Ugalde
- Deakin University, Geelong, VIC, 3220, Australia
- Faculty of Health, Deakin University, Geelong, VIC, Australia
- School of Nursing &, Midwifery Deakin University, Geelong, VIC, Australia
| | - Liliana Orellana
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | | | - Michael Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | - John Zalcberg
- Department of Medical Oncology, Alfred Health and School of Public Health, Faculty of Medicine, Monash University, Melbourne, Australia
| | - Neil Orford
- Monash University, Melbourne, Australia
- Barwon Health, Geelong, VIC, Australia
- Australia and New Zealand Intensive Care Research Centre (ANZICS-RC), SPHPM, Monash University, Melbourne, Australia
| | - Alison M Hutchinson
- Deakin University, Geelong, VIC, 3220, Australia
- School of Nursing &, Midwifery Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
| | - Andrew Barbour
- Upper GI Unit, Princess Alexandra Hospital, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Nicole Kiss
- Institute for Physical Activity & Nutrition, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Bernard Mark Smithers
- Upper GI Unit, Princess Alexandra Hospital, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - David I Watson
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Nikki McCaffrey
- Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Victoria White
- School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia
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21
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Nelson LA, Spieker AJ, LeStourgeon LM, Greevy Jr RA, Molli S, Roddy MK, Mayberry LS. The Goldilocks Dilemma on Balancing User Response and Reflection in mHealth Interventions: Observational Study. JMIR Mhealth Uhealth 2024; 12:e47632. [PMID: 38297891 PMCID: PMC10850735 DOI: 10.2196/47632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 02/02/2024] Open
Abstract
Background Mobile health (mHealth) has the potential to radically improve health behaviors and quality of life; however, there are still key gaps in understanding how to optimize mHealth engagement. Most engagement research reports only on system use without consideration of whether the user is reflecting on the content cognitively. Although interactions with mHealth are critical, cognitive investment may also be important for meaningful behavior change. Notably, content that is designed to request too much reflection could result in users' disengagement. Understanding how to strike the balance between response burden and reflection burden has critical implications for achieving effective engagement to impact intended outcomes. Objective In this observational study, we sought to understand the interplay between response burden and reflection burden and how they impact mHealth engagement. Specifically, we explored how varying the response and reflection burdens of mHealth content would impact users' text message response rates in an mHealth intervention. Methods We recruited support persons of people with diabetes for a randomized controlled trial that evaluated an mHealth intervention for diabetes management. Support person participants assigned to the intervention (n=148) completed a survey and received text messages for 9 months. During the 2-year randomized controlled trial, we sent 4 versions of a weekly, two-way text message that varied in both reflection burden (level of cognitive reflection requested relative to that of other messages) and response burden (level of information requested for the response relative to that of other messages). We quantified engagement by using participant-level response rates. We compared the odds of responding to each text and used Poisson regression to estimate associations between participant characteristics and response rates. Results The texts requesting the most reflection had the lowest response rates regardless of response burden (high reflection and low response burdens: median 10%, IQR 0%-40%; high reflection and high response burdens: median 23%, IQR 0%-51%). The response rate was highest for the text requesting the least reflection (low reflection and low response burdens: median 90%, IQR 61%-100%) yet still relatively high for the text requesting medium reflection (medium reflection and low response burdens: median 75%, IQR 38%-96%). Lower odds of responding were associated with higher reflection burden (P<.001). Younger participants and participants who had a lower socioeconomic status had lower response rates to texts with more reflection burden, relative to those of their counterparts (all P values were <.05). Conclusions As reflection burden increased, engagement decreased, and we found more disparities in engagement across participants' characteristics. Content encouraging moderate levels of reflection may be ideal for achieving both cognitive investment and system use. Our findings provide insights into mHealth design and the optimization of both engagement and effectiveness.
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Affiliation(s)
- Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, NashvilleTN, United States
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, NashvilleTN, United States
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, NashvilleTN, United States
| | - Lauren M LeStourgeon
- Department of Medicine, Vanderbilt University Medical Center, NashvilleTN, United States
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, NashvilleTN, United States
| | - Robert A Greevy Jr
- Department of Biostatistics, Vanderbilt University Medical Center, NashvilleTN, United States
| | - Samuel Molli
- Department of Medicine, Vanderbilt University Medical Center, NashvilleTN, United States
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, NashvilleTN, United States
| | - McKenzie K Roddy
- Department of Medicine, Vanderbilt University Medical Center, NashvilleTN, United States
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, NashvilleTN, United States
| | - Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, NashvilleTN, United States
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, NashvilleTN, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, NashvilleTN, United States
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22
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Aldridge G, Tomaselli A, Nowell C, Reupert A, Jorm A, Yap MBH. Engaging Parents in Technology-Assisted Interventions for Childhood Adversity: Systematic Review. J Med Internet Res 2024; 26:e43994. [PMID: 38241066 PMCID: PMC10837762 DOI: 10.2196/43994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/28/2023] [Accepted: 11/30/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Youth mental health problems are a major public health concern and are strongly associated with adverse childhood experiences (ACEs). Technology-assisted parenting programs can intervene with ACEs that are within a parent's capacity to modify. However, engagement with such programs is suboptimal. OBJECTIVE This review aims to describe and appraise the efficacy of strategies used to engage parents in technology-assisted parenting programs targeting ACEs on the behavioral and subjective outcomes of engagement. METHODS Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines, we conducted a systematic review of peer-reviewed papers that described the use of at least 1 engagement strategy in a technology-assisted parenting program targeting ACEs that are within a parent's capacity to modify. A total of 8 interdisciplinary bibliographic databases (CENTRAL, CINAHL, Embase, OVID MEDLINE, OVID PsycINFO, Scopus, ACM, and IEEE Xplore) and gray literature were searched. The use of engagement strategies and measures was narratively synthesized. Associations between specific engagement strategies and engagement outcomes were quantitatively synthesized using the Stouffer method of combining P values. RESULTS We identified 13,973 articles for screening. Of these, 156 (1.12%) articles were eligible for inclusion, and 29 (18.2%) of the 156 were associated with another article; thus, 127 studies were analyzed. Preliminary evidence for a reliable association between 5 engagement strategies (involving parents in a program's design, delivering a program on the web compared to face-to-face, use of personalization or tailoring features, user control features, and provision of practical support) and greater engagement was found. Three engagement strategies (professional support features, use of videos, and behavior change techniques) were not found to have a reliable association with engagement outcomes. CONCLUSIONS This review provides a comprehensive assessment and description of the use of engagement strategies and engagement measures in technology-assisted parenting programs targeting parenting-related ACEs and extends the current evidence with preliminary quantitative findings. Heterogeneous definition and measurement of engagement and insufficient engagement outcome data were caveats to this synthesis. Future research could use integrated definitions and measures of engagement to support robust systematic evaluations of engagement in this context. TRIAL REGISTRATION PROSPERO CRD42020209819; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209819.
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Affiliation(s)
- Grace Aldridge
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Alessandra Tomaselli
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Clare Nowell
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Andrea Reupert
- School of Educational Psychology and Counselling, Monash University, Clayton, Australia
| | - Anthony Jorm
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Marie Bee Hui Yap
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Whitehead L, Robinson S, Arabiat D, Jenkins M, Morelius E. The Report of Access and Engagement With Digital Health Interventions Among Children and Young People: Systematic Review. JMIR Pediatr Parent 2024; 7:e44199. [PMID: 38231560 PMCID: PMC10831666 DOI: 10.2196/44199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 06/06/2023] [Accepted: 11/29/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Digital health interventions are increasingly used to deliver health-related interventions for children and young people to change health behaviors and improve health outcomes. Digital health interventions have the potential to enhance access to and engagement with children and young people; however, they may also increase the divide between those who can access technology and are supported to engage and those who are not. This review included studies that reported on the access to or engagement with digital health interventions among children and young people. OBJECTIVE This review aims to identify and report on access and engagement in studies involving digital health interventions among children and young people. METHODS A systematic review following the Joanna Briggs Institute methods for conducting systematic reviews was conducted. An electronic literature search was conducted for all studies published between January 1, 2010, and August 2022, across sources, including MEDLINE, CINAHL, and PsycINFO. Studies were included if they examined any aspect of access or engagement in relation to interventions among children and young people. The quality of the included papers was assessed, and data were extracted. Data were considered for meta-analysis, where possible. RESULTS A total of 3292 references were identified using search terms. Following the exclusion of duplicates and review by inclusion criteria, 40 studies were independently appraised for their methodological quality. A total of 16 studies were excluded owing to their low assessed quality and flawed critical elements in the study design. The studies focused on a variety of health conditions; type 1 diabetes, weight management and obesity, mental health issues, and sexual health were the predominant conditions. Most studies were conducted in developed countries, with most of them being conducted in the United States. Two studies reported data related to access and considered ethnicity and social determinants. No studies used strategies to enhance or increase access. All studies included in the review reported on at least 1 aspect of engagement. Engagement with interventions was measured in relation to frequency of engagement, with no reference to the concept of effective engagement. CONCLUSIONS Most digital health interventions do not consider the factors that can affect access and engagement. Of those studies that measured either access or engagement or both, few sought to implement strategies to improve access or engagement to address potential disparities between groups. Although the literature to date provides some insight into access and engagement and how these are addressed in digital health interventions, there are major limitations in understanding how both can be enhanced to promote equity. Consideration of both access and engagement is vital to ensure that children and young people have the ability to participate in studies. TRIAL REGISTRATION PROSPERO CRD42020170874; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=170874.
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Affiliation(s)
- Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
- The Centre for Evidence Informed Nursing, Midwifery and Healthcare Practice, Joondalup, Australia
- Australian Research Council Centre of Excellence for the Digital Child, Joondalup, Australia
- Maternal and Child Nursing Department, Faculty of Nursing, The University of Jordan, Amman, Jordan
| | - Suzanne Robinson
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
- The Centre for Evidence Informed Nursing, Midwifery and Healthcare Practice, Joondalup, Australia
| | - Diana Arabiat
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
- Australian Research Council Centre of Excellence for the Digital Child, Joondalup, Australia
- Maternal and Child Nursing Department, Faculty of Nursing, The University of Jordan, Amman, Jordan
| | - Mark Jenkins
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
| | - Evalotte Morelius
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
- Australian Research Council Centre of Excellence for the Digital Child, Joondalup, Australia
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Zhou P, Li Y, Lau PWC, Yan L, Song H, Shi TL. Effectiveness of parent-based electronic health ( eHealth) intervention on physical activity, dietary behaviors, and sleep in preschoolers: A systematic review. J Exerc Sci Fit 2024; 22:1-13. [PMID: 38021206 PMCID: PMC10663681 DOI: 10.1016/j.jesf.2023.10.004] [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: 06/14/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Background The lifestyles of preschoolers have become physically inactive and sedentary, their eating habits unhealthy, and their sleep routines increasingly disturbed. Parental involvement appears crucial to combat the unhealthy lifestyle of preschoolers. Because of the recognized barriers to traditional face-to-face interventions, easy access and lower costs make electronic health (eHealth) interventions appealing. However, whether parent-based eHealth intervention may be harnessed to improve the aforementioned lifestyle behaviors of preschoolers is currently unclear, a gap that this systematic review intends to address. This study aims to systematically review the current literature concerning the effectiveness of parent-based eHealth intervention on the physical activity, dietary behaviors, and sleep of preschoolers. Method This systematic review conforms to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Six databases (EMBASE, PubMed, MEDLINE, Web of Science, SPORTDiscus, and PsycINFO) were retrieved for the period from January 2000 to December 2022. Studies were eligible if 1 they were quantitative study design; 2 eHealth interventions in which parents were the change agents targeted children aged 3-6 years; 3 interventions examined the effectiveness of eHealth or incorporated eHealth as one of the intervention modalities; 4 at least one variable included in either primary or secondary outcome had to concentrate on the physical activity, diet, and sleep of preschoolers; 5 publication type was limited to the English language and peer-reviewed journal articles; 6 study settings were confined to family- or parent-based ones. The risk of bias was assessed, based upon Version 2 of the Cochrane risk-of-tool for randomized trials (RoB2). Results Twelve studies were screened. No significant group-by-time improvement in physical activity was found in studies related to physical activity outcomes. Two studies reported a significant difference between groups concerning motor ability, with one study indicating improved object control with the other reporting improvement in both object control and locomotor skills. Of the studies related to dietary behavior outcomes, six studies reported a significant difference at the posttest compared to the control group, in terms of vegetable and fruit intake, sugar-sweetened drinks, reduced candy consumption, and improved non-core food. Three studies reported a significant difference between groups in sleep duration at the end of the posttest, with the result of one study limited to preference-only participants. None of the reviewed studies found a significant difference between groups for sleep problems. Conclusion Parent-based eHealth interventions were not significantly effective in improving physical activity and reducing sleep problems in preschoolers, but the majority of studies have found that this type of intervention significantly improves the dietary behaviors and sleep duration of preschoolers. High-quality, robustly designed studies to balance the intervention dosage and sequence are needed to investigate the effectiveness of parent-based eHealth intervention on physical activity, dietary behaviors, and sleep in preschoolers, particularly those raised in other cultural background, which may significantly impact their lifestyle. Trial registration International Prospective Register of Systematic Review (PROSPERO): CRD42023418861.
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Affiliation(s)
- Peng Zhou
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China
| | - Yin Li
- Department of Physical Education, Sun Yat-sen University, China
| | - Patrick WC. Lau
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China
| | - Liang Yan
- Department of Physical Education, China Women's University, Beijing, China
| | - Huiqi Song
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China
| | - Tony Lei Shi
- Beijing Normal University-Hong Kong Baptist University United International College, China
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Marcos TA, Crutzen R, Leitner V, Smeddinck JD, Strumegger EM, Wurhofer D, Kulnik ST. Making it transparent: A worked example of articulating programme theory for a digital health application using Intervention Mapping. Digit Health 2024; 10:20552076241260974. [PMID: 38894945 PMCID: PMC11185015 DOI: 10.1177/20552076241260974] [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: 12/27/2023] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Objective Digital health interventions for behaviour change are usually complex interventions, and intervention developers should 'articulate programme theory', that is, they should offer detailed descriptions of individual intervention components and their proposed mechanisms of action. However, such detailed descriptions often remain lacking. The objective of this work was to provide a conceptual case study with an applied example of 'articulating programme theory' for a newly developed digital health intervention. Methods Intervention Mapping methodology was applied to arrive at a detailed description of programme theory for a newly developed digital health intervention that aims to support cardiac rehabilitation patients in establishing heart-healthy physical activity habits. Based on a Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) logic model of the problem, a logic model of change was developed. The proposed mechanisms of action were visualised in an acyclic behaviour change diagram. Results Programme theory for this digital health intervention includes 4 sub-behaviours of the main target behaviour (i.e. habitual heart-healthy physical activity), 8 personal determinants and 12 change objectives (i.e. changes needed at the determinant level to achieve the sub-behaviours). These are linked to 12 distinct features of the digital health intervention and 12 underlying behaviour change methods. Conclusions This case study offers a worked example of articulating programme theory for a digital health intervention using Intervention Mapping. Intervention developers and researchers may draw on this example to replicate the method, or to reflect on most suitable approaches for their own behaviour change interventions.
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Affiliation(s)
- Tamika A. Marcos
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Rik Crutzen
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Veronika Leitner
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Jan D. Smeddinck
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | | | - Daniela Wurhofer
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Stefan T. Kulnik
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
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Grady A, Pearson N, Lamont H, Leigh L, Wolfenden L, Barnes C, Wyse R, Finch M, Mclaughlin M, Delaney T, Sutherland R, Hodder R, Yoong SL. The Effectiveness of Strategies to Improve User Engagement With Digital Health Interventions Targeting Nutrition, Physical Activity, and Overweight and Obesity: Systematic Review and Meta-Analysis. J Med Internet Res 2023; 25:e47987. [PMID: 38113062 PMCID: PMC10762625 DOI: 10.2196/47987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Digital health interventions (DHIs) are effective in improving poor nutrition, physical inactivity, overweight and obesity. There is evidence suggesting that the impact of DHIs may be enhanced by improving user engagement. However, little is known about the overall effectiveness of strategies on engagement with DHIs. OBJECTIVE This study aims to assess the overall effectiveness of strategies to improve engagement with DHIs targeting nutrition, physical activity, and overweight or obesity and explore associations between strategies and engagement outcomes. The secondary aim was to explore the impact of these strategies on health risk outcomes. METHODS The MEDLINE, Embase, PsycINFO, CINAHL, CENTRAL, Scopus, and Academic Source Complete databases were searched up to July 24, 2023. Eligible studies were randomized controlled trials that evaluated strategies to improve engagement with DHIs and reported on outcomes related to DHI engagement (use or user experience). Strategies were classified according to behavior change techniques (BCTs) and design features (eg, supplementary emails). Multiple-variable meta-analyses of the primary outcomes (usage and user experience) were undertaken to assess the overall effectiveness of strategies. Meta-regressions were conducted to assess associations between strategies and use and user experience outcomes. Synthesis of secondary outcomes followed the "Synthesis Without Meta-Analysis" guidelines. The methodological quality and evidence was assessed using the Cochrane risk-of-bias tool, and the Grading of Recommendations Assessment, Development, and Evaluation tool respectively. RESULTS Overall, 54 studies (across 62 publications) were included. Pooled analysis found very low-certainty evidence of a small-to-moderate positive effect of the use of strategies to improve DHI use (standardized mean difference=0.33, 95% CI 0.20-0.46; P<.001) and very low-certainty evidence of a small-to-moderate positive effect on user experience (standardized mean difference=0.29, 95% CI 0.07-0.52; P=.01). A significant positive association was found between the BCTs social support (effect size [ES]=0.40, 95% CI 0.14-0.66; P<.001) and shaping knowledge (ES=0.39, 95% CI 0.03-0.74; P=.03) and DHI use. A significant positive association was found among the BCTs social support (ES=0.70, 95% CI 0.18-1.22; P=.01), repetition and substitution (ES=0.29, 95% CI 0.05-0.53; P=.03), and natural consequences (ES=0.29, 95% CI 0.05-0.53; P=.02); the design features email (ES=0.29, 95% CI 0.05-0.53; P=.02) and SMS text messages (ES=0.34, 95% CI 0.11-0.57; P=.01); and DHI user experience. For secondary outcomes, 47% (7/15) of nutrition-related, 73% (24/33) of physical activity-related, and 41% (14/34) of overweight- and obesity-related outcomes reported an improvement in health outcomes. CONCLUSIONS Although findings suggest that the use of strategies may improve engagement with DHIs targeting such health outcomes, the true effect is unknown because of the low quality of evidence. Future research exploring whether specific forms of social support, repetition and substitution, natural consequences, emails, and SMS text messages have a greater impact on DHI engagement is warranted. TRIAL REGISTRATION PROSPERO CRD42018077333; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=77333.
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Affiliation(s)
- Alice Grady
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Nicole Pearson
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Hannah Lamont
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Lucy Leigh
- Data Sciences, Hunter Medical Research Institute, New Lambton, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Courtney Barnes
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Rebecca Wyse
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
- Equity in Health and Wellbeing Program, Hunter Medical Research Institute, New Lambton, Australia
| | - Meghan Finch
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Matthew Mclaughlin
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Tessa Delaney
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Rebecca Hodder
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Sze Lin Yoong
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Deakin University, Melbourne, Australia
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Oliveira JGRD, Sanders-Pinheiro H, Freitas Filho RAD, Vasconcelos Filho JE, Askari M, Silva Júnior GBD. Evaluación del uso de la Aplicación Renal Health por parte de los receptores de trasplante renal. Rev Lat Am Enfermagem 2023. [DOI: 10.1590/1518-8345.6039.3821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Resumen Objetivo: evaluar el uso de la aplicación Renal Health por parte de los receptores de trasplante renal. Método: estudio observacional retrospectivo con una muestra compuesta por usuarios que se registraron en la sección de trasplantados renales dentro de la aplicación desde julio de 2018 hasta abril de 2021. Se recolectaron las siguientes variables: datos demográficos, ingreso de datos, tiempo de uso, registros de peso, presión arterial, glucosa en sangre, creatinina, esquemas de medicación, consultas y exámenes. Se realizó un análisis descriptivo de los datos. Resultados: Ocurrieron 1.823 descargas de la aplicación y 12,3% se registró en la sección de trasplantados, la mayoría del sudeste de Brasil (44,9%), con edad de 36±11 años y del sexo femenino (59,1%). De la muestra, 35,1% ingresó información como: creatinina (62%), peso (58,2%) y presión arterial (51,8%). La mayoría utilizó la aplicación durante un día (63,3%) y el 13,9% más de cien días. Quienes lo usaron por más de un día (36,7%), agregaron peso (69%), programación de consultas (69%), medicación (65,5%) y creatinina (62%). Conclusión: la sección para trasplantados renales de la aplicación Renal Health despertó interés en la población joven, pero mostró baja adherencia en los meses evaluados. Estos resultados ofrecen una perspectiva relevante en la implementación de tecnologías mHealth en el trasplante renal.
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Oliveira JGRD, Sanders-Pinheiro H, Freitas Filho RAD, Vasconcelos Filho JE, Askari M, Silva Júnior GBD. Avaliação do uso do aplicativo Renal Health por transplantados renais. Rev Lat Am Enfermagem 2023. [DOI: 10.1590/1518-8345.6039.3823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Resumo Objetivo: avaliar o uso do aplicativo Renal Health por transplantados renais. Método: estudo observacional retrospectivo com amostra composta por usuários que realizaram cadastro na seção para transplantados renais do aplicativo de julho de 2018 a abril de 2021. Foram coletadas as seguintes variáveis: dados demográficos, inserção de dados, tempo de uso, registros de peso, pressão arterial, glicemia, creatinina, horários das medicações, consultas e exames. Realizou-se análise descritiva dos dados. Resultados: houve 1.823 downloads do aplicativo e 12,3% cadastraram-se na seção para transplantados renais, a maioria do Sudeste do Brasil (44,9%), com 36±11 anos e do sexo feminino (59,1%). Da amostra, 35,1% inseriram informações como creatinina (62%), peso (58,2%) e pressão arterial (51,8%). A maioria utilizou o aplicativo por um dia (63,3%) e 13,9% por mais de cem dias. Os que utilizaram por mais de um dia (36,7%), inseriram peso (69%), agendaram consultas (69%), medicações (65,5%) e creatinina (62%). Conclusão: a seção para transplantados renais do aplicativo Renal Health despertou interesse na população jovem, mas apresentou baixa adesão ao longo dos meses avaliados. Esses resultados oferecem perspectiva relevante na implementação de tecnologias mHealth no transplante renal.
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Worthington A, Gillies N, Hannaford R, Roy R, Braakhuis A. Implementing multicomponent, eHealth-based behaviour change support within a dietary intervention trial improves adherence to study-related behaviours in healthy young adults. BMC Nutr 2023; 9:134. [PMID: 37990250 PMCID: PMC10664496 DOI: 10.1186/s40795-023-00798-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 11/14/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Behaviour change science is proposed to improve participant retention and enhance the validity of trials. However, researchers seldom systematically consider and implement behaviour change strategies within trials for this purpose. The objective of this article is to evaluate how an eHealth behaviour change support (BCS) program enhances young adults' adherence to behaviours required within a dietary intervention. METHODS The Nine Principles framework was used to develop BCS to implement across both arms of a 10-week randomised parallel-group intervention to enhance adherence to (i) eating healthily and (ii) reporting dietary intake. Key components of the BCS included access to a dietitian-led Facebook group, text reminders, and food delivery. Effectiveness was measured using the following analyses of the 78 participants who completed the study; pre-post change in targeted dietary habits over time using a subscore of the Healthy Diet Habits Index, questionnaire to assess change in perception of barriers to eating healthily over time, Facebook group engagement, and impact evaluation of the BCS. Participants received a dietary reporting score out of 100 to assess adherence across the 10 weeks. RESULTS The total Healthy Diet Habits Index subscore out of 16 significantly increased from baseline to week 10 (10.6 ± 2.6 to 11.2 ± 2.6, p value < 0.05), driven primarily by an increase in vegetable consumption. Overall adherence to reporting was high across the 10 weeks, with the total population mean reporting score 90.4 ± 14.6 out of 100. Relatively low Facebook engagement was observed. Adding objects to the environment, prompts/cues and removing reward appeared to be effective components of the BCS for enhancing adherence to the target behaviours. CONCLUSION Using a behaviour change framework to support the design of randomised trials is a promising way to enhance participant adherence to study requirements that are typically considered burdensome, such as dietary reporting. It also enables researchers to identify and replicate effective components of BCS, including behaviour change techniques and modes of delivery. Further research into the use of different behaviour change frameworks for this purpose is warranted. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04869163; https://clinicaltrials.gov/ct2/show/NCT04869163 . (03/05/2021).
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Affiliation(s)
- Anna Worthington
- Discipline of Nutrition, School of Medical Sciences, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
| | - Nicola Gillies
- Discipline of Nutrition, School of Medical Sciences, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Rina Hannaford
- Bioinformatics & Statistics Team, AgResearch Ltd, Palmerston North, New Zealand
| | - Rajshri Roy
- Discipline of Nutrition, School of Medical Sciences, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Andrea Braakhuis
- Discipline of Nutrition, School of Medical Sciences, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Spilsbury S, Wilk P, Taylor C, Prapavessis H, Mitchell M. Reduction of Financial Health Incentives and Changes in Physical Activity. JAMA Netw Open 2023; 6:e2342663. [PMID: 37938843 PMCID: PMC10632955 DOI: 10.1001/jamanetworkopen.2023.42663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/30/2023] [Indexed: 11/10/2023] Open
Abstract
Importance Governments and others continue to use financial incentives to influence citizen health behaviors like physical activity. However, when delivered on a population scale they can be prohibitively costly, suggesting more sustainable models are needed. Objectives To evaluate the association of incomplete financial incentive withdrawal ("schedule thinning") with physical activity after more than a year of incentive intervention and to explore whether participant characteristics (eg, app engagement and physical activity) are associated with withdrawal outcomes. Design, Setting, and Participants This case-control study with a pre-post quasi-experimental design included users of a government-funded health app focused on financial incentives. Eligible participants were residents in 3 Canadian provinces over 25 weeks in 2018 and 2019. Data were analyzed from July 2021 to December 2022. Exposure Due to fiscal constraints, financial incentives for daily physical activity goals were withdrawn in Ontario in December 2018 (case)-representing a 90% reduction in incentive earnings-but not in British Columbia or Newfoundland and Labrador (controls). Main Outcome and Measures The primary outcome was objectively assessed weekly mean daily step count. Linear regression models were used to compare pre-post changes in daily step counts between provinces (a difference-in-differences approach). Separate models were developed to examine factors associated with changes in daily step count (eg, app engagement and physical activity). Clinically meaningful initial effect sizes were previously reported (approximately 900 steps/d overall and 1800 steps/d among the physically inactive). Results In total there were 584 760 study participants (mean [SD] age, 34.3 [15.5] years; 220 388 women [63.5%]), including 438 731 from Ontario, 124 101 from British Columbia, and 21 928 from Newfoundland and Labrador. Significant physical activity declines were observed when comparing pre-post changes in Ontario to British Columbia (-198 steps/d; 95% CI, -224 to -172 steps/d) and Newfoundland and Labrador (-274 steps/d; 95% CI, -323 to -225 steps/d). The decrease was most pronounced for highly engaged Ontario users (-328 steps/d; 95% CI, -343 to -313 steps/d). Among physically inactive Ontario users, physical activity did not decline following withdrawal (107 steps/d; 95% CI, 90 to 124 steps/d). Conclusions and Relevance In this case-control study of incomplete financial incentive withdrawal, statistically significant daily step count reductions were observed in Ontario; however, these declines were modest and not clinically meaningful. Amidst substantial program savings, the physical activity reductions observed here may be acceptable to decision-makers working within finite budgets.
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Affiliation(s)
- Sean Spilsbury
- School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Piotr Wilk
- Schulich School of Medicine, Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Carolyn Taylor
- Department of Statistics, Faculty of Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Harry Prapavessis
- School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Marc Mitchell
- School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
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Hoffman V, Flom M, Mariano TY, Chiauzzi E, Williams A, Kirvin-Quamme A, Pajarito S, Durden E, Perski O. User Engagement Clusters of an 8-Week Digital Mental Health Intervention Guided by a Relational Agent (Woebot): Exploratory Study. J Med Internet Res 2023; 25:e47198. [PMID: 37831490 PMCID: PMC10612009 DOI: 10.2196/47198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/08/2023] [Accepted: 08/22/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND With the proliferation of digital mental health interventions (DMHIs) guided by relational agents, little is known about the behavioral, cognitive, and affective engagement components associated with symptom improvement over time. Obtaining a better understanding could lend clues about recommended use for particular subgroups of the population, the potency of different intervention components, and the mechanisms underlying the intervention's success. OBJECTIVE This exploratory study applied clustering techniques to a range of engagement indicators, which were mapped to the intervention's active components and the connect, attend, participate, and enact (CAPE) model, to examine the prevalence and characterization of each identified cluster among users of a relational agent-guided DMHI. METHODS We invited adults aged 18 years or older who were interested in using digital support to help with mood management or stress reduction through social media to participate in an 8-week DMHI guided by a natural language processing-supported relational agent, Woebot. Users completed assessments of affective and cognitive engagement, working alliance as measured by goal and task working alliance subscale scores, and enactment (ie, application of therapeutic recommendations in real-world settings). The app passively collected data on behavioral engagement (ie, utilization). We applied agglomerative hierarchical clustering analysis to the engagement indicators to identify the number of clusters that provided the best fit to the data collected, characterized the clusters, and then examined associations with baseline demographic and clinical characteristics as well as mental health outcomes at week 8. RESULTS Exploratory analyses (n=202) supported 3 clusters: (1) "typical utilizers" (n=81, 40%), who had intermediate levels of behavioral engagement; (2) "early utilizers" (n=58, 29%), who had the nominally highest levels of behavioral engagement in week 1; and (3) "efficient engagers" (n=63, 31%), who had significantly higher levels of affective and cognitive engagement but the lowest level of behavioral engagement. With respect to mental health baseline and outcome measures, efficient engagers had significantly higher levels of baseline resilience (P<.001) and greater declines in depressive symptoms (P=.01) and stress (P=.01) from baseline to week 8 compared to typical utilizers. Significant differences across clusters were found by age, gender identity, race and ethnicity, sexual orientation, education, and insurance coverage. The main analytic findings remained robust in sensitivity analyses. CONCLUSIONS There were 3 distinct engagement clusters found, each with distinct baseline demographic and clinical traits and mental health outcomes. Additional research is needed to inform fine-grained recommendations regarding optimal engagement and to determine the best sequence of particular intervention components with known potency. The findings represent an important first step in disentangling the complex interplay between different affective, cognitive, and behavioral engagement indicators and outcomes associated with use of a DMHI incorporating a natural language processing-supported relational agent. TRIAL REGISTRATION ClinicalTrials.gov NCT05672745; https://classic.clinicaltrials.gov/ct2/show/NCT05672745.
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Affiliation(s)
| | - Megan Flom
- Woebot Health, Inc., San Francisco, CA, United States
| | - Timothy Y Mariano
- Woebot Health, Inc., San Francisco, CA, United States
- Rehabilitation Research & Development Service Center for Neurorestoration and Neurotechnology, Department of Veterans Affairs Providence Healthcare System, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Emil Chiauzzi
- Woebot Health, Inc., San Francisco, CA, United States
| | | | | | | | - Emily Durden
- Woebot Health, Inc., San Francisco, CA, United States
| | - Olga Perski
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, United States
- Faculty of Social Sciences, Tampere University, Tampere, Finland
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Fareed N, Swoboda C, Wang Y, Strouse R, Hoseus J, Baker C, Joseph JJ, Venkatesh K. An Evidence-Based Framework for Creating Inclusive and Personalized mHealth Solutions-Designing a Solution for Medicaid-Eligible Pregnant Individuals With Uncontrolled Type 2 Diabetes. JMIR Diabetes 2023; 8:e46654. [PMID: 37824196 PMCID: PMC10603563 DOI: 10.2196/46654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/21/2023] [Accepted: 08/02/2023] [Indexed: 10/13/2023] Open
Abstract
Mobile health (mHealth) apps can be an evidence-based approach to improve health behavior and outcomes. Prior literature has highlighted the need for more research on mHealth personalization, including in diabetes and pregnancy. Critical gaps exist on the impact of personalization of mHealth apps on patient engagement, and in turn, health behaviors and outcomes. Evidence regarding how personalization, engagement, and health outcomes could be aligned when designing mHealth for underserved populations is much needed, given the historical oversights with mHealth design in these populations. This viewpoint is motivated by our experience from designing a personalized mHealth solution focused on Medicaid-enrolled pregnant individuals with uncontrolled type 2 diabetes, many of whom also experience a high burden of social needs. We describe fundamental components of designing mHealth solutions that are both inclusive and personalized, forming the basis of an evidence-based framework for future mHealth design in other disease states with similar contexts.
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Affiliation(s)
- Naleef Fareed
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Christine Swoboda
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Yiting Wang
- Department of Research Information Technology, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Robert Strouse
- Department of Research Information Technology, College of Medicine, The Ohio State University, Columbus, OH, United States
| | | | | | - Joshua J Joseph
- Division of Endocrinology, Diabetes and Metabolism, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Kartik Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, United States
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Salsman JM, McLouth LE, Tooze JA, Little-Greene D, Cohn M, Kehoe MS, Moskowitz JT. An eHealth, Positive Emotion Skills Intervention for Enhancing Psychological Well-Being in Young Adult Cancer Survivors: Results from a Multi-Site, Pilot Feasibility Trial. Int J Behav Med 2023; 30:639-650. [PMID: 36890329 PMCID: PMC10485177 DOI: 10.1007/s12529-023-10162-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Young adult (YA) cancer survivors experience clinically significant distress and have limited access to psychosocial support. Given growing evidence for unique adaptive benefits of positive emotion in the context of health-related and other life stress, we developed an eHealth positive emotion skills intervention for post-treatment survivors called EMPOWER (Enhancing Management of Psychological Outcomes With Emotion Regulation) and evaluated feasibility and proof of concept for reducing distress and enhancing well-being. METHOD In this single-arm pilot feasibility trial, post-treatment YA cancer survivors (ages 18-39) participated in the EMPOWER intervention which included 8 skills (e.g., gratitude, mindfulness, acts of kindness). Participants completed surveys at baseline (pre-intervention), 8 weeks (post-intervention), and 12 weeks (1-month follow-up). Primary outcomes included feasibility (assessed by participation percentage) and acceptability (would recommend EMPOWER skills to a friend). Secondary outcomes included psychological well-being (mental health, positive affect, life satisfaction, meaning/purpose, general self-efficacy) and distress (depression, anxiety, anger). RESULTS We assessed 220 YAs for eligibility; 77% declined. Of those screened, 44 (88%) were eligible and consented, 33 began the intervention, and 26 (79%) completed the intervention. Overall retention was 61% at 12 weeks. Average acceptability ratings were high (8.8/10). Participants (M = 30.8 years, SD = 6.6) were 77% women, 18% racial/ethnic minorities, and 34% breast cancer survivors. At 12 weeks, EMPOWER was associated with improved mental health, positive affect, life satisfaction, meaning/purpose, and general self-efficacy (ps < .05, ds = .45 to .63) and decreased anger (p < .05, d = - 0.41). CONCLUSION EMPOWER demonstrated evidence of feasibility and acceptability as well as proof of concept for enhancing well-being and reducing distress. Self-guided, eHealth interventions show promise for addressing YA cancer survivors' needs and warrant additional research to optimize survivorship care. TRIAL REGISTRATION ClinicalTrials .gov NCT02832154, https://clinicaltrials.gov/ct2/show/NCT02832154.
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Affiliation(s)
- John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine & Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Laurie E McLouth
- Department of Behavioral Science and Center for Health Equity Transformation, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine & Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Denisha Little-Greene
- Health Care Education, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | - Mia Sorkin Kehoe
- Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Lozano A, Fernandez A, Rhodes CA, Estrada Y, Graefe B, Tapia MI, Prado G. Does Binge-Watching eHealth Intervention Content Impact Outcomes? J Adolesc Health 2023; 73:664-671. [PMID: 37422740 PMCID: PMC10526969 DOI: 10.1016/j.jadohealth.2023.05.021] [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: 11/26/2022] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Advancements in technology have made it possible to deliver parenting interventions online, known as eHealth interventions. Little is known about the rate at which parents participate in eHealth interventions, characteristics of parents who watch eHealth interventions at an accelerated pace (i.e., binge-watching), and if binge-watching impacts intervention outcomes. METHODS The sample included 142 Hispanic parents who were randomly assigned to an eHealth family-based intervention and completed 100% of eight online, prerecorded and self-paced video group sessions delivered across 12 weeks. We examined baseline predictors (parent sociodemographic characteristics, report of child's externalizing behaviors, and family functioning) of watching group sessions in two weeks or less (n = 23, 16.2%). Using latent growth curve modeling, we tested the impact of binge-watching on the trajectory of adolescent drug use, condomless sex, and depressive symptoms across 36 months. We also examined the impact of binge-watching on changes in family functioning from baseline to 6 months postbaseline. RESULTS Parents with high levels of education and of children with attention problems were more likely to binge-watch. Conversely, parents of children with conduct disorder symptoms were less likely to binge-watch. The trajectory of depressive symptoms increased for adolescents with parents who binge-watched the intervention, but the trajectory of condomless sex decreased. There was no impact on drug use. Binge-watching was also associated with decreases in parental monitoring. DISCUSSION The findings of this study have implications for eHealth interventions; the pace that parents watch eHealth interventions may subsequently impact adolescent outcomes, such as condomless sex and depressive symptoms.
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Affiliation(s)
- Alyssa Lozano
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida.
| | - Alejandra Fernandez
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center, School of Public Health, Dallas, Texas
| | - C Aubrey Rhodes
- Department of Psychology, REACH Institute, Arizona State University, Tempe, Arizona
| | - Yannine Estrada
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida
| | - Beck Graefe
- Department of Educational and Psychological Studies, University of Miami, Coral Gables, Florida
| | - Maria I Tapia
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida
| | - Guillermo Prado
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida
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Milne-Ives M, Homer SR, Andrade J, Meinert E. Potential associations between behavior change techniques and engagement with mobile health apps: a systematic review. Front Psychol 2023; 14:1227443. [PMID: 37794916 PMCID: PMC10545861 DOI: 10.3389/fpsyg.2023.1227443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023] Open
Abstract
Introduction Lack of engagement is a common challenge for digital health interventions. To achieve their potential, it is necessary to understand how best to support users' engagement with interventions and target health behaviors. The aim of this systematic review was to identify the behavioral theories and behavior change techniques being incorporated into mobile health apps and how they are associated with the different components of engagement. Methods The review was structured using the PRISMA and PICOS frameworks and searched six databases in July 2022: PubMed, Embase, CINAHL, APA PsycArticles, ScienceDirect, and Web of Science. Risk of bias was evaluated using the Cochrane Collaboration Risk of Bias 2 and the Mixed Methods Appraisal Tools. Analysis A descriptive analysis provided an overview of study and app characteristics and evidence for potential associations between Behavior Change Techniques (BCTs) and engagement was examined. Results The final analysis included 28 studies. Six BCTs were repeatedly associated with user engagement: goal setting, self-monitoring of behavior, feedback on behavior, prompts/cues, rewards, and social support. There was insufficient data reported to examine associations with specific components of engagement, but the analysis indicated that the different components were being captured by various measures. Conclusion This review provides further evidence supporting the use of common BCTs in mobile health apps. To enable developers to leverage BCTs and other app features to optimize engagement in specific contexts and individual characteristics, we need a better understanding of how BCTs are associated with different components of engagement. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42022312596.
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Affiliation(s)
- Madison Milne-Ives
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sophie R. Homer
- School of Psychology, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Jackie Andrade
- School of Psychology, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Edward Meinert
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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Lukka L, Palva JM. The Development of Game-Based Digital Mental Health Interventions: Bridging the Paradigms of Health Care and Entertainment. JMIR Serious Games 2023; 11:e42173. [PMID: 37665624 PMCID: PMC10507521 DOI: 10.2196/42173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/24/2023] [Accepted: 07/15/2023] [Indexed: 09/05/2023] Open
Abstract
Game elements are increasingly used to improve user engagement in digital mental health interventions, and specific game mechanics may yield therapeutic effects per se and thereby contribute to digital mental health intervention efficacy. However, only a few commercial game-based interventions are available. We suggest that the key challenge in their development reflects the tension between the 2 underlying paradigms, health care and entertainment, which have disparate goals and processes in digital development. We describe 3 approaches currently used to negotiate the 2 paradigms: the gamification of health care software, designing serious games, and purpose shifting existing entertainment games. We advanced an integrative framework to focus attention on 4 key themes in intervention development: target audience, engagement, mechanisms of action, and health-related effectiveness. On each theme, we show how the 2 paradigms contrast and can complement each other. Finally, we consider the 4 interdependent themes through the new product development phases from concept to production. Our viewpoint provides an integrative synthesis that facilitates the research, design, and development of game-based digital mental health interventions.
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Affiliation(s)
- Lauri Lukka
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
| | - J Matias Palva
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
- Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Centre for Cognitive Neuroimaging, School of Psychology and Neuroscience, University of Glasgow, Glasgow, United Kingdom
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Bang M, Jang CW, Kim HS, Park JH, Cho HE. Mobile applications for cognitive training: Content analysis and quality review. Internet Interv 2023; 33:100632. [PMID: 37312799 PMCID: PMC10258500 DOI: 10.1016/j.invent.2023.100632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 03/31/2023] [Accepted: 05/25/2023] [Indexed: 06/15/2023] Open
Abstract
Background As the number of individuals suffering from cognitive diseases continues to rise, dealing with the diminished cognitive function that comes with age has become a serious public health concern. While the use of mobile applications (apps) as digital treatments for cognitive training shows promise, the analysis of their content and quality remains unclear. Objective The aim of this study was to systematically search and assess cognitive training apps using the multidimensional mobile app rating scale (MARS) to rate objective quality and identify critical points. Methods A search was conducted on the Google Play Store and Apple App Store in February 2022 using the terms "cognitive training" and "cognitive rehabilitation." The cognitive domains provided by each app were analyzed, and the frequency and percentage according to the apps were obtained. The MARS, a mHealth app quality rating tool including multidimensional measures, was used to analyze the quality of the apps. The relationship between the MARS score, the number of reviews, and 5-star ratings were examined. Results Of the 53 apps, 52 (98 %) included memory function, 48 (91 %) included attention function, 24 (45 %) included executive function, and 19 (36 %) included visuospatial function. The mean (SD) scores of MARS, 5-star ratings, and reviews of 53 apps were 3.09 (0.61), 4.33 (0.30), and 62,415.43 (121,578.77). From the between-section comparison, engagement (mean 2.97, SD 0.68) obtained lower scores than functionality (mean 3.18, SD 0.62), aesthetics (mean 3.13, SD 0.72), and information (mean 3.11, SD 0.54). The mean quality score and reviews showed a statistically significant association (r = 0.447 and P = .001*). As the number of domains increased, the mean quality score showed a statistically significant increasing trend (P = .002*). Conclusions Most apps provided training for the memory and attention domains, but few apps included executive function or visuospatial domains. The quality of the apps improved significantly when more domains were provided, and was positively associated with the number of reviews received. These results could be useful for the future development of mobile apps for cognitive training.
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Affiliation(s)
- Myeonghwan Bang
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
- Department of Integrative Medicine, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Chan Woong Jang
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyoung Seop Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Jung Hyun Park
- Department of Integrative Medicine, Yonsei University Graduate School, Seoul, Republic of Korea
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Medical Device Engineering and Management, Yonsei University Graduate School, Seoul, Korea
| | - Han Eol Cho
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
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Killian MO, Schelbe L, Lustria MLA, Watkivs M, Gupta D. Engaging Adolescent Heart Transplant Recipients Through In-App Messaging During Mobile Health Intervention. Prog Transplant 2023; 33:229-235. [PMID: 37491864 DOI: 10.1177/15269248231189862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Introduction: Adolescents heart transplant recipients experience difficulty with adherence to immunosuppressive medication leading to increased risk of organ rejection, hospitalization, and mortality. Few interventions have been successful to promote medication adherence in adolescent heart transplant patients as most fail to engage the patient in the behavioral change process and support patient-provider communication. The purpose of this study was to explore the nature and degree of in-app communication between adolescent heart transplant recipients and nursing staff during an asynchronous mobile video directly observed therapy intervention. Methods: A content analysis of 894 in-app messages exchanged between 10 adolescent patients and nurses during a 12-week mobile-based intervention was conducted. Two authors used an inductive, iterative process to guide a thematic analysis of the asynchronous in-app messages with high interrater reliability ranging from 81.5% to 100%. Findings: In-app messages fell under 3 broad content categories: (1) interpersonal support and rapport-building, (2) medically related questions and information, or (3) functional information about the intervention and the mHealth app. Results demonstrated the degree to which interpersonal engagement occurred during the intervention, the nature of these exchanges, and their relationship to medication adherence. Conclusions: The study provided insights into the feasibility and benefits of 2-way communication features of the directly observed therapy intervention in promoting engagement and in improving medication adherence among adolescent heart transplant patients. Continued research and clinical focus on patient engagement and impactful aspects of interpersonal communication could aid in the translation of this intervention into standard clinical care at pediatric transplant centers.
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Affiliation(s)
- Michael O Killian
- College of Social Work, Florida State University, Tallahassee, FL, USA
- College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Lisa Schelbe
- College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Mia Liza A Lustria
- College of Medicine, Florida State University, Tallahassee, FL, USA
- School of Information, College of Communication and Information, Florida State University, Tallahassee, FL, USA
- College of Social Sciences and Public Policy, Florida State University, Tallahassee, FL, USA
| | - Madison Watkivs
- Interdisciplinary Medical Sciences, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Dipankar Gupta
- UF Shands Children's Hospital, UF Health Congenital Heart Center, University of Florida, Gainesville, FL, USA
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McCall MP, Anton MT, Highlander A, Loiselle R, Forehand R, Khavjou O, Jones DJ. Technology-Enhanced Behavioral Parent Training: The Relationship Between Technology Use and Efficiency of Service Delivery. Behav Modif 2023; 47:1094-1114. [PMID: 37086169 PMCID: PMC10403959 DOI: 10.1177/01454455231165937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
Behavior disorders (BDs) are common and, without treatment, can have long-term impacts on child and family health. Behavioral Parent Training (BPT) is the standard of care intervention for early-onset BDs; however, structural socioeconomic barriers hinder treatment outcomes for low-income families. While digital technologies have been proposed as a mechanism to improve engagement in BPT, research exploring the relationship between technology use and outcomes is lacking. Thus, this study with 34 low-income families examined the impact of parents' use of adjunctive mobile app components on treatment efficiency in one technology-enhanced (TE-) BPT program, Helping the Noncompliant Child (HNC). While parent use of the TE-HNC app and its impact on the efficiency of service delivery varied across specific components, increased app use significantly reduced the number of weeks required for families to achieve skill mastery. Implications for the design and development of behavior intervention technologies in general, as well as for BPT in particular, are discussed.
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Affiliation(s)
| | | | | | - Raelyn Loiselle
- The University of North Carolina at Chapel Hill, USA
- NYU Langone Health, New York City, NY, USA
| | | | - Olga Khavjou
- RTI International Research Institute, Triangle Park, NC, USA
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Larson D, Henning J, Burgermaster M. Smartphone Applications (Apps) for Nutrition Education: A Qualitative Analysis of Outpatient Dietitian Perspectives. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:596-603. [PMID: 37354197 DOI: 10.1016/j.jneb.2023.05.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 04/28/2023] [Accepted: 05/15/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE To explore how outpatient dietitians select and use applications (apps) to support nutrition education. METHODS Qualitative analysis of 20 dietitians who participated in semistructured interviews investigating their app use and recommendation processes. Transcripts were analyzed using thematic analysis. RESULTS Four themes described how dietitians perceive apps for nutrition education: (1) nutrition education goals focus on long-term lifestyle behavior change while protecting patients' relationship with food, (2) attitudes toward tracking apps influence app selection, (3) dietitians differentiate among patients who will benefit from tracking vs information apps, and (4) barriers to optimal app use result in adaptations by dietitians. CONCLUSIONS AND IMPLICATIONS Barriers exist to optimal app use for nutrition education. However, accessible app design, app selection guides, and research expounding the effects of apps and their use by dietitians may improve how practitioners incorporate apps into nutrition education.
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Affiliation(s)
- Dagny Larson
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX
| | - Jacqueline Henning
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX
| | - Marissa Burgermaster
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX; Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX.
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Metz G, Roosjen H, Zweers W, Crutzen R. Evaluating use of web-based interventions: an example of a Dutch sexual health intervention. Health Promot Int 2023; 38:daab190. [PMID: 37596929 PMCID: PMC10439511 DOI: 10.1093/heapro/daab190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2023] Open
Abstract
With the current increase in web-based interventions, the question of how to measure, and consequently improve engagement in such interventions is gaining more importance. Modern day web analytics tools make it easy to monitor use of web-based interventions. However, in this article, we propose that it would be more meaningful to first examine how the developers envisioned the use of the intervention to establish behavior change (i.e. intended use), before looking into how the intervention is ultimately used with web analytics (i.e. actual use). Such an approach responds to the regularly expressed concern that behavioral interventions are often poorly described, leading to less meaningful evaluations as it is not clear what exactly is being evaluated. Using a page on chlamydia prevention (104 557 pageviews in 2020) from a Dutch sexual health intervention (Sense), we demonstrate the value of acyclic behavior change diagrams (ABCDs) as a method to visualize intended use of an intervention. ABCDs show at a glance how behavior change principles are applied in an intervention and target determinants of behavior. Based on this ABCD, we investigate actual use of the intervention, using web analytics tool Matomo. Despite being intended to stimulate STI-testing, only 14% of the 35 347 transfers from this page led to the STI-testing page and a high bounce rate (79%) and relatively high exit rate were reported (69%). Recommendations to further interpret the data are given. This real-life example demonstrates the potential of combining ABCDs and Matomo as methods to gain insight into use of web-based interventions.
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Affiliation(s)
- Gido Metz
- Department of Health Promotion, Maastricht University/CAPHRI, The Netherlands
| | | | | | - Rik Crutzen
- Department of Health Promotion, Maastricht University/CAPHRI, The Netherlands
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Kekkonen M, Korkiakangas E, Laitinen J, Oinas-Kukkonen H. Factors Reducing the Use of a Persuasive mHealth App and How to Mitigate Them: Thematic Analysis. JMIR Hum Factors 2023; 10:e40579. [PMID: 37358883 DOI: 10.2196/40579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 03/12/2023] [Accepted: 05/02/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Studies on which persuasive features may work for different users in health contexts are rare. The participants in this study were microentrepreneurs. We built a persuasive mobile app to help them to recover from work. Representatives of this target group tend to be very busy due to work, which was reflected in their use of the app during the randomized controlled trial intervention. Microentrepreneurs also often have dual roles; they are professionals in their line of work as well as entrepreneurs managing their own business, which may add to their workload. OBJECTIVE This study aimed to present users' views on the factors that hinder their use of the mobile health app that we developed and how these factors could be mitigated. METHODS We interviewed 59 users and conducted both data-driven and theory-driven analyses on the interviews. RESULTS Factors reducing app use could be divided into 3 categories: use context (problem domain-related issues, eg, the lack of time due to work), user context (user-related issues, eg, concurrent use of other apps), and technology context (technology-related issues, eg, bugs and usability). Due to the nature of the participants' entrepreneurship, which often interferes with personal life, it became clear that designs targeting similar target groups should avoid steep learning curves and should be easy (quick) to use. CONCLUSIONS Personalized tunneling-guiding the user through a system via personalized solutions-could help similar target groups with similar issues better engage with and keep using health apps because of the easy learning curve. When developing health apps for interventions, background theories should not be interpreted too strictly. Applying theory in practice may require rethinking approaches for adaptation as technology has evolved rapidly and continues to evolve. TRIAL REGISTRATION ClinicalTrials.gov NCT03648593; https://clinicaltrials.gov/ct2/show/NCT03648593.
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Affiliation(s)
- Markku Kekkonen
- Oulu Advanced Research on Service and Information Systems, Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
| | | | | | - Harri Oinas-Kukkonen
- Oulu Advanced Research on Service and Information Systems, Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
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Ding X, Wuerth K, Sakakibara B, Schmidt J, Parde N, Holsti L, Barbic S. Understanding Mobile Health and Youth Mental Health: Scoping Review. JMIR Mhealth Uhealth 2023; 11:e44951. [PMID: 37220197 PMCID: PMC10278734 DOI: 10.2196/44951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/30/2023] [Accepted: 05/16/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND A total of 75% of people with mental health disorders have an onset of illness between the ages of 12 and 24 years. Many in this age group report substantial obstacles to receiving quality youth-centered mental health care services. With the rapid development of technology and the recent COVID-19 pandemic, mobile health (mHealth) has presented new opportunities for youth mental health research, practice, and policy. OBJECTIVE The research objectives were to (1) synthesize the current evidence supporting mHealth interventions for youths who experience mental health challenges and (2) identify current gaps in the mHealth field related to youth's access to mental health services and health outcomes. METHODS Guided by the methods of Arksey and O'Malley, we conducted a scoping review of peer-reviewed studies that used mHealth tools to improve youth mental health (January 2016-February 2022). We searched MEDLINE, PubMed, PsycINFO, and Embase databases using the following key terms: (1) mHealth; (2) youth and young adults; and (3) mental health. The current gaps were analyzed using content analysis. RESULTS The search produced 4270 records, of which 151 met inclusion criteria. Included articles highlight the comprehensive aspects of youth mHealth intervention resource allocation for targeted conditions, mHealth delivery methods, measurement tools, evaluation of mHealth intervention, and youth engagement. The median age for participants in all studies is 17 (IQR 14-21) years. Only 3 (2%) studies involved participants who reported their sex or gender outside of the binary option. Many studies (68/151, 45%) were published after the onset of the COVID-19 outbreak. Study types and designs varied, with 60 (40%) identified as randomized controlled trials. Notably, 143 out of 151 (95%) studies came from developed countries, suggesting an evidence shortfall on the feasibility of implementing mHealth services in lower-resourced settings. Additionally, the results highlight concerns related to inadequate resources devoted to self-harm and substance uses, weak study design, expert engagement, and the variety of outcome measures selected to capture impact or changes over time. There is also a lack of standardized regulations and guidelines for researching mHealth technologies for youths and the use of non-youth-centered approaches to implementing results. CONCLUSIONS This study may be used to inform future work as well as the development of youth-centered mHealth tools that can be implemented and sustained over time for diverse types of youths. Implementation science research that prioritizes youths' engagement is needed to advance the current understanding of mHealth implementation. Moreover, core outcome sets may support a youth-centered measurement strategy to capture outcomes in a systematic way that prioritizes equity, diversity, inclusion, and robust measurement science. Finally, this study suggests that future practice and policy research are needed to ensure the risk of mHealth is minimized and that this innovative health care service is meeting the emerging needs of youths over time.
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Affiliation(s)
- Xiaoxu Ding
- Faculty of Medicine, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
- Faculty of Graduate Studies, Rehabilitation Science, University of British Columbia, Vancouver, BC, Canada
| | - Kelli Wuerth
- Foundry, Providence Health Care, Vancouver, BC, Canada
| | - Brodie Sakakibara
- Faculty of Medicine, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
- Faculty of Graduate Studies, Rehabilitation Science, University of British Columbia, Vancouver, BC, Canada
- Faculty of Medicine, Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada
| | - Julia Schmidt
- Faculty of Medicine, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
- Faculty of Graduate Studies, Rehabilitation Science, University of British Columbia, Vancouver, BC, Canada
| | - Natalie Parde
- Department of Computer Science, University of Illinois Chicago, Chicago, IL, United States
- Natural Language Processing Laboratory, University of Illinois Chicago, Chicago, IL, United States
| | - Liisa Holsti
- Faculty of Medicine, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
- Faculty of Graduate Studies, Rehabilitation Science, University of British Columbia, Vancouver, BC, Canada
| | - Skye Barbic
- Faculty of Medicine, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
- Faculty of Graduate Studies, Rehabilitation Science, University of British Columbia, Vancouver, BC, Canada
- Foundry, Providence Health Care, Vancouver, BC, Canada
- Centre for Health Evaluation & Outcome Sciences, Vancouver, BC, Canada
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Tobin MM, Jones TL, Ho YSH, Short CE. Using photovoice to explore young women's experiences of behaviour change techniques in physical activity mobile apps. Int J Behav Nutr Phys Act 2023; 20:43. [PMID: 37055760 PMCID: PMC10101820 DOI: 10.1186/s12966-023-01447-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 04/04/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Research shows that inactive young women are attracted to using mobile phone applications (apps) to increase physical activity. Apps can promote physical activity by delivering a range of behaviour change techniques to influence determinants of user behaviour. Previous qualitative research has examined user experiences with techniques in physical activity apps, however there is little research specifically among young women. This study aimed to explore young women's experiences using commercial physical activity apps to change their behaviour. METHODS Young women were recruited online to use a randomly assigned app for two weeks to achieve a personal goal. Using photovoice, a qualitative participatory research method, participants generated insights about their experiences through photographs and semi-structured interviews. Thematic analysis was conducted on photograph and interview data. RESULTS Thirty-two female participants, aged 18-24 years, completed the study. Behaviour change techniques tended to cluster around four key themes: logging and monitoring physical activity; reminders and prompts; workout videos and written instructions; and social features. Social support also strongly influenced participants' experiences. CONCLUSIONS Results suggest that behaviour change techniques influenced physical activity in line with social cognitive models, and these models are useful to understand how apps can target user behaviour for young women. The findings identified factors important for young women that seemed to moderate their experiences, such as social norms about women's appearance, which should be further explored within the context of behaviour change models and app design.
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Affiliation(s)
- Mollie M Tobin
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Tamara L Jones
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia.
| | - Yui Sum Haylie Ho
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Camille E Short
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia
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Jiang X, Chen J, Yuan X, Lin Y, Chen Y, Li S, Jiang Q, Yu H, Du Q, Peng J. Feasibility of an Individualized mHealth Nutrition (iNutrition) Intervention for Post-Discharged Gastric Cancer Patients Following Gastrectomy: A Randomized Controlled Pilot Trial. Nutrients 2023; 15:nu15081883. [PMID: 37111102 PMCID: PMC10144256 DOI: 10.3390/nu15081883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
(1) Background: A major challenge for post-discharged gastric cancer patients following gastrectomy is the impact of the anatomy change on decreased oral intake, nutritional status, and, ultimately, quality of life. The purpose of this study is to examine the feasibility and preliminary effects of an individualized mHealth nutrition (iNutrition) intervention in post-discharged gastric cancer patients following gastrectomy. (2) Methods: A mixed-method feasibility study with a parallel randomized controlled design was conducted. Patients were randomly assigned to either the iNutrition intervention group (n = 12) or the control group (n = 12). Participants completed measures at baseline (T0), four (T1), and twelve weeks (T2) post-randomization. (3) Results: Recruitment (33%) and retention (87.5%) rates along with high adherence and acceptability supported the feasibility of the iNutrition intervention for post-discharged gastric cancer patients following gastrectomy, echoed by the qualitative findings. The iNutrition intervention significantly improved participants' nutritional behavior (p = 0.005), energy intake (p = 0.038), compliance with energy requirements (p = 0.006), and compliance with protein requirements (p = 0.008). (4) Conclusions: The iNutrition intervention is feasible and potentially benefits post-discharged gastric cancer patients following gastrectomy. A larger trial is required to establish the efficacy of this approach. Trial Registration: 19 October 2022 Chinese Clinical Trial Registry, ChiCTR2200064807.
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Affiliation(s)
- Xiaohan Jiang
- School of Nursing, Sun Yat-sen University, Guangzhou 510006, China
| | - Jiamin Chen
- Department of Gastric Surgery, Department of General Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510006, China
- Department of Clinical Nutrition, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510006, China
| | - Xiuhong Yuan
- Department of Gastric Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510006, China
| | - Yijia Lin
- Department of Gastric Surgery, Department of General Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510006, China
| | - Yingliang Chen
- Department of Gastric Surgery, Department of General Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510006, China
| | - Sijia Li
- Department of Gastric Surgery, Department of General Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510006, China
| | - Qiuxiang Jiang
- Department of Gastric Surgery, Department of General Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510006, China
| | - Hong Yu
- Department of Gastric Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510006, China
| | - Qianqian Du
- School of Nursing, Sun Yat-sen University, Guangzhou 510006, China
| | - Junsheng Peng
- School of Nursing, Sun Yat-sen University, Guangzhou 510006, China
- Department of Gastric Surgery, Department of General Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510006, China
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46
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Laws RA, Cheng H, Rossiter C, Kuswara K, Markides BR, Size D, Corcoran P, Ong K, Denney‐Wilson E. Perinatal support for breastfeeding using mHealth: A mixed methods feasibility study of the My Baby Now app. MATERNAL & CHILD NUTRITION 2023; 19:e13482. [PMID: 36725007 PMCID: PMC10019053 DOI: 10.1111/mcn.13482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/20/2022] [Accepted: 01/13/2023] [Indexed: 02/03/2023]
Abstract
Despite the well-known benefits of breastfeeding, breastfeeding rates remain suboptimal, particularly for women with lower socioeconomic position. Although popular, breastfeeding apps are often poor quality; their impact on breastfeeding knowledge, attitudes, confidence and intentions is unknown. A mixed method pre-post feasibility study was conducted to: 1) explore the feasibility of the My Baby Now app in providing perinatal breastfeeding support; 2) examine the impact on breastfeeding knowledge, attitudes, confidence and intentions; 3) to examine any differences in acceptability and impact of the app according to maternal education. The My Baby Now app was offered to pregnant women 20-30 weeks gestation. Breastfeeding knowledge and intentions were collected at baseline (T1) and 36-38 weeks gestation (T2); attitudes and confidence were collected at baseline, T2 and T3 (8-12 weeks post-partum). App engagement was measured via app analytics. Qualitative interviews were conducted with a purposeful sample following T3. Of 266 participants recruited, 169 (64%) completed T2 and 157 (59%) completed T3. Mothers without university education rated the app to be higher quality, more useful and impactful than mothers with university education. From T1-T2, breastfeeding knowledge (59.6% vs. 66.5%, p < 0.001) and exclusive breastfeeding intentions (76.6% vs. 80.9%, p < 0.001) increased. Breastfeeding attitudes and confidence scores also increased significantly across T1-T2 and T1-T3. App engagement during pregnancy predicted changes in breastfeeding attitudes from T1-T2 among participants without university education. App engagement did not predict changes in breastfeeding knowledge, confidence or intentions. Future randomised controlled studies should examine the effectiveness of mHealth interventions on breastfeeding outcomes.
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Affiliation(s)
- Rachel A. Laws
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition ScienceDeakin UniversityGeelongAustralia
| | - Heilok Cheng
- Susan Wakil School of Nursing and MidwiferyThe University of SydneyCamperdownAustralia
| | - Chris Rossiter
- Susan Wakil School of Nursing and MidwiferyThe University of SydneyCamperdownAustralia
| | - Konsita Kuswara
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition ScienceDeakin UniversityGeelongAustralia
| | - Brittany R. Markides
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition ScienceDeakin UniversityGeelongAustralia
| | - Donna Size
- Sydney Institute for Women, Children and their Families, Sydney Local Health DistrictSydneyAustralia
| | - Patricia Corcoran
- Sydney Institute for Women, Children and their Families, Sydney Local Health DistrictSydneyAustralia
- Canterbury Hospital Maternity Unit, Sydney Local Health DistrictSydneyAustralia
| | - Kok‐Leong Ong
- Department of Information Systems and Business Analytics, AISSCRMIT UniversityMelbourneAustralia
| | - Elizabeth Denney‐Wilson
- Susan Wakil School of Nursing and MidwiferyThe University of SydneyCamperdownAustralia
- Sydney Institute for Women, Children and their Families, Sydney Local Health DistrictSydneyAustralia
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Weingarden H, Garriga Calleja R, Greenberg JL, Snorrason I, Matic A, Quist R, Harrison O, Hoeppner SS, Wilhelm S. Characterizing observed and effective behavioral engagement with smartphone cognitive behavioral therapy for body dysmorphic disorder: A methods roadmap and use case. Internet Interv 2023; 32:100615. [PMID: 36969390 PMCID: PMC10031461 DOI: 10.1016/j.invent.2023.100615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
Smartphone psychotherapies are growing in popularity, yet little is understood about (1) how people prefer to engage with psychotherapy apps, or (2) which engagement patterns constitute effective engagement. The present study uses secondary data from a 12-week randomized waitlist-controlled trial of smartphone-delivered cognitive behavioral therapy (CBT) for body dysmorphic disorder (BDD) (N = 77) to address these aims. Additionally, using the present study as a use-case, we seek to provide a roadmap for how researchers may improve upon methodological limitations of existing smartphone psychotherapy engagement research. We measured behavioral engagement via 19 objective variables derived from phone analytics data, which we reduced via factor analysis into two factors: 1) use volume and frequency, and 2) session duration. Cluster analysis based on engagement factors yielded three engager types, which mapped onto "deep" users, "samplers," and "light" users. The clusters did not differ significantly in improvement in BDD severity across treatment, although deep users improved more than light users at a marginally significant level. Results suggest that varying patterns of preferred engagement may be efficacious. Moreover, the study's methods provide an example of how researchers can measure and study behavioral engagement comprehensively and objectively. Trial Registration: ClinicalTrials.gov Identifier: NCT04034693.
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Affiliation(s)
- Hilary Weingarden
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | | | - Jennifer L. Greenberg
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Ivar Snorrason
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | | | - Rachel Quist
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | | | - Susanne S. Hoeppner
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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48
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Bijkerk LE, Oenema A, Geschwind N, Spigt M. Measuring Engagement with Mental Health and Behavior Change Interventions: an Integrative Review of Methods and Instruments. Int J Behav Med 2023; 30:155-166. [PMID: 35578099 PMCID: PMC10036274 DOI: 10.1007/s12529-022-10086-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Engagement is a complex construct consisting of behavioral, cognitive, and affective dimensions, making engagement a difficult construct to measure. This integrative review aims to (1) present a multidisciplinary overview of measurement methods that are currently used to measure engagement with adult mental health and behavior change interventions, delivered in-person, blended, or digitally, and (2) provide a set of recommendations and considerations for researchers wishing to study engagement. METHODS We used an integrative approach and identified original studies and reviews on engagement with mental health or behavior change interventions that were delivered in-person, digitally, or blended. RESULTS Forty articles were analyzed in this review. Common methods to assess engagement were through objective usage data, questionnaire-based data, and qualitative data, with objective usage data being used most frequently. Based on the synthesis of engagement measures, we advise researchers to (1) predefine the operationalization of engagement for their specific research context, (2) measure behavioral, cognitive, and affective dimensions of engagement in all cases, and (3) measure engagement over time. CONCLUSIONS Current literature shows a bias towards behavioral measures of engagement in research, as most studies measured engagement exclusively through objective usage data, without including cognitive and affective measures of engagement. We hope that our recommendations will help to reduce this bias and to steer engagement research towards an integrated approach.
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Affiliation(s)
- Laura Esther Bijkerk
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
| | - Anke Oenema
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Nicole Geschwind
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Mark Spigt
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- General Practice Research Unit, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
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49
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Jeong S, Aymerich-Franch L, Arias K, Alghowinem S, Lapedriza A, Picard R, Park HW, Breazeal C. Deploying a robotic positive psychology coach to improve college students' psychological well-being. USER MODELING AND USER-ADAPTED INTERACTION 2023; 33:571-615. [PMID: 38737788 PMCID: PMC11086679 DOI: 10.1007/s11257-022-09337-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/22/2022] [Indexed: 05/14/2024]
Abstract
Despite the increase in awareness and support for mental health, college students' mental health is reported to decline every year in many countries. Several interactive technologies for mental health have been proposed and are aiming to make therapeutic service more accessible, but most of them only provide one-way passive contents for their users, such as psycho-education, health monitoring, and clinical assessment. We present a robotic coach that not only delivers interactive positive psychology interventions but also provides other useful skills to build rapport with college students. Results from our on-campus housing deployment feasibility study showed that the robotic intervention showed significant association with increases in students' psychological well-being, mood, and motivation to change. We further found that students' personality traits were associated with the intervention outcomes as well as their working alliance with the robot and their satisfaction with the interventions. Also, students' working alliance with the robot was shown to be associated with their pre-to-post change in motivation for better well-being. Analyses on students' behavioral cues showed that several verbal and nonverbal behaviors were associated with the change in self-reported intervention outcomes. The qualitative analyses on the post-study interview suggest that the robotic coach's companionship made a positive impression on students, but also revealed areas for improvement in the design of the robotic coach. Results from our feasibility study give insight into how learning users' traits and recognizing behavioral cues can help an AI agent provide personalized intervention experiences for better mental health outcomes.
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Affiliation(s)
| | | | | | - Sharifa Alghowinem
- MIT Media Lab, Cambridge, MA, USA
- Computer and Information Sciences College at Prince Sultan University, Riyadh, Saudi Arabia
| | - Agata Lapedriza
- MIT Media Lab, Cambridge, MA, USA
- Estudis d’Informàtica, Multimèdia i Telecomunicacióat Universitat Oberta de Catalunya, Barcelona, Spain
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50
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Maspero S, Ebert C, Moser S, Zink A, Sichert P, Schielein M, Weis J, Ziehfreund S. The Potential of Instagram to Reduce Stigmatization of People with Psoriasis: A Randomized Controlled Pilot Study. Acta Derm Venereol 2023; 103:adv3513. [PMID: 36967544 PMCID: PMC10074282 DOI: 10.2340/actadv.v103.3513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/21/2022] [Indexed: 03/29/2023] Open
Abstract
Psoriasis is a stigmatized skin disease. This randomized controlled trial aimed to evaluate an Instagram based stigma-reduction intervention targeting daily Instagram users aged 18 to 49 years without psoriasis. After stratification for baseline characteristics (t0), stigmatization of psoriasis was assessed using a questionnaire and a photo-rating task immediately before (t1) and after (t2) the intervention and two weeks post-intervention (t3). Data from 54 participants, recruited in a university setting and via Instagram, were analysed. For 10 min between t1 and t2, the intervention group (n = 26) and the control group (n = 28) scrolled through two different Instagram accounts. Psoriasis-sensitizing content was displayed to the intervention group while beauty-glorifying posts were shown to the control group. Results indicated significantly less Disease-related Misconceptions in the intervention group in comparison to the control group at t2 (U = 145.50, Z = -3.79, p < 0.001) and at t3 (U = 177.00, Z = -3.25, p = 0.003). Moreover, the intervention group showed a significant reduction over time in Stereotype Endorsement (F(2, 50) = 13.40, p < 0.001, partial η² = 0.35) and Disease-related Misconceptions (χ2(2) = 12.64, p = 0.002). These findings suggest that addressing psoriasis on Instagram has the potential to effectively reduce the related stigmatization. Further studies are necessary to assess the impact of social media on stigmatization concerning psoriasis in more depth.
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Affiliation(s)
- Simona Maspero
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Christopher Ebert
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Selina Moser
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Alexander Zink
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
| | - Pablo Sichert
- Department of Informatics, Technical University of Munich, Munich, Germany
| | - Maximilian Schielein
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
| | - Johanna Weis
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany.
| | - Stefanie Ziehfreund
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany; Technical University of Munich, Institute of General Practice and Health Services Research, School of Medi-cine, Munich, Germany.
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