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Bricker J, Miao Z, Mull K, Santiago-Torres M, Vock DM. Can a Single Variable Predict Early Dropout From Digital Health Interventions? Comparison of Predictive Models From Two Large Randomized Trials. J Med Internet Res 2023; 25:e43629. [PMID: 36662550 PMCID: PMC9898835 DOI: 10.2196/43629] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/22/2022] [Accepted: 12/31/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A single generalizable metric that accurately predicts early dropout from digital health interventions has the potential to readily inform intervention targets and treatment augmentations that could boost retention and intervention outcomes. We recently identified a type of early dropout from digital health interventions for smoking cessation, specifically, users who logged in during the first week of the intervention and had little to no activity thereafter. These users also had a substantially lower smoking cessation rate with our iCanQuit smoking cessation app compared with users who used the app for longer periods. OBJECTIVE This study aimed to explore whether log-in count data, using standard statistical methods, can precisely predict whether an individual will become an iCanQuit early dropout while validating the approach using other statistical methods and randomized trial data from 3 other digital interventions for smoking cessation (combined randomized N=4529). METHODS Standard logistic regression models were used to predict early dropouts for individuals receiving the iCanQuit smoking cessation intervention app, the National Cancer Institute QuitGuide smoking cessation intervention app, the WebQuit.org smoking cessation intervention website, and the Smokefree.gov smoking cessation intervention website. The main predictors were the number of times a participant logged in per day during the first 7 days following randomization. The area under the curve (AUC) assessed the performance of the logistic regression models, which were compared with decision trees, support vector machine, and neural network models. We also examined whether 13 baseline variables that included a variety of demographics (eg, race and ethnicity, gender, and age) and smoking characteristics (eg, use of e-cigarettes and confidence in being smoke free) might improve this prediction. RESULTS The AUC for each logistic regression model using only the first 7 days of log-in count variables was 0.94 (95% CI 0.90-0.97) for iCanQuit, 0.88 (95% CI 0.83-0.93) for QuitGuide, 0.85 (95% CI 0.80-0.88) for WebQuit.org, and 0.60 (95% CI 0.54-0.66) for Smokefree.gov. Replacing logistic regression models with more complex decision trees, support vector machines, or neural network models did not significantly increase the AUC, nor did including additional baseline variables as predictors. The sensitivity and specificity were generally good, and they were excellent for iCanQuit (ie, 0.91 and 0.85, respectively, at the 0.5 classification threshold). CONCLUSIONS Logistic regression models using only the first 7 days of log-in count data were generally good at predicting early dropouts. These models performed well when using simple, automated, and readily available log-in count data, whereas including self-reported baseline variables did not improve the prediction. The results will inform the early identification of people at risk of early dropout from digital health interventions with the goal of intervening further by providing them with augmented treatments to increase their retention and, ultimately, their intervention outcomes.
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Affiliation(s)
- Jonathan Bricker
- Division of Public Health Sciences, Fred Hutch Cancer Center, Seattle, WA, United States
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Zhen Miao
- Department of Statistics, University of Washington, Seattle, WA, United States
| | - Kristin Mull
- Division of Public Health Sciences, Fred Hutch Cancer Center, Seattle, WA, United States
| | | | - David M Vock
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, United States
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Black EW, Ferdig RE, Fleetwood A, Thompson LA. Hospital homebound students and K-12 online schooling. PLoS One 2022; 17:e0264841. [PMID: 35324944 PMCID: PMC8947101 DOI: 10.1371/journal.pone.0264841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/17/2022] [Indexed: 12/03/2022] Open
Abstract
The flexibility afforded by online education may provide opportunities for learners with disability who require absence from traditional learning environments. This study sought to describe how a subset of learners with disability, those with hospital-homebound designation, perform in K-12 online classes, particularly as compared to non-hospital homebound counterparts. A cross-sectional analysis was performed of all Florida Virtual School course enrollments from August 1, 2012 to July 31, 2018. Researchers analyzed 2,534 course enrollments associated with K-12 students who, at the time of their course enrollment, had hospital-homebound designation, and a comparison group of 5,470,591 enrollments from K-12 students without hospital-homebound status. Data analysis showed three important outcomes. First, hospital-homebound designated student academic performance was equivalent to their non-hospital homebound counterparts. Second, however, hospital-homebound course enrollments were 26% more likely to result in a withdrawal prior to grade generation. Third, these withdrawals were potentially mitigated when H/H designated students were enrolled in five or more classes or in classes with five or more students. The results of this study provided evidence that when they can remain enrolled, hospital-homebound learners experience equivalent academic outcomes in online learning environments. These findings suggest that healthcare professionals should be made aware of the potentially equivalent outcomes for their patients. Moreover, virtual schools should seek to identify and create supports for these students.
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Affiliation(s)
- Erik W. Black
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida, United States of America
- School of Teaching and Learning, College of Education, University of Florida, Gainesville, Florida, United States of America
- * E-mail:
| | - Richard E. Ferdig
- School of Teaching, Learning and Curriculum Studies, College of Education, Health, Human Services, Kent State University, Kent, Ohio, United States of America
- Research Center for Educational Technology, Kent State University, Kent, Ohio, United States of America
| | - April Fleetwood
- Office of Analysis, Assessment, and Accountability, Florida Virtual School, Orlando, Florida, United States of America
| | - Lindsay A. Thompson
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida, United States of America
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, United States of America
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Spitzer MWH, Gutsfeld R, Wirzberger M, Moeller K. Evaluating students' engagement with an online learning environment during and after COVID-19 related school closures: A survival analysis approach. Trends Neurosci Educ 2021; 25:100168. [PMID: 34844697 PMCID: PMC8599139 DOI: 10.1016/j.tine.2021.100168] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/14/2021] [Accepted: 11/14/2021] [Indexed: 11/07/2022]
Abstract
Background Due to the COVID-19 pandemic schools all over the world were closed and thereby students had to be instructed from distance. Consequently, the use of online learning environments for online distance learning increased massively. However, the perseverance of using online learning environments during and after school closures remains to be investigated. Method We examined German students’ (n ≈ 300,000 students; ≈ 18 million computed problem sets) engagement in an online learning environment for mathematics by means of survival analysis. Results We observed that the total number of students who registered increased considerably during and after school closures compared to the previous three years. Importantly, however, the proportion of students engaged also decreased more rapidly over time. Conclusion The application of survival analysis provided valuable insights into students’ engagement in online learning - or conversely students’ increased dropout rates - over time. Its application to educational settings allows to address a broader range of questions on students’ engagement in online learning environments in the future.
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Affiliation(s)
| | | | - Maria Wirzberger
- University of Stuttgart, Stuttgart 70174, Germany; Max Planck Institute for Intelligent Systems, Tuebingen, Germany; LEAD Graduate School and Research Network, University of Tuebingen, Germany
| | - Korbinian Moeller
- LEAD Graduate School and Research Network, University of Tuebingen, Germany; Centre for Mathematical Cognition, School of Science, Loughborough University, Loughborough, United Kingdom; Leibniz-Institut fuer Wissensmedien, Tuebingen, Germany; Individual Development and Adaptive Education for Children at Risk Center, Frankfurt, Germany
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Hübner S, Haijen E, Kaelen M, Carhart-Harris RL, Kettner H. Turn on, Tune in, and Drop out: Predictors of Attrition in a Prospective Observational Cohort Study on Psychedelic Use. J Med Internet Res 2021; 23:e25973. [PMID: 34319246 PMCID: PMC8367105 DOI: 10.2196/25973] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/19/2021] [Accepted: 05/04/2021] [Indexed: 01/16/2023] Open
Abstract
Background The resurgence of research and public interest in the positive psychological effects of psychedelics, together with advancements in digital data collection techniques, have brought forth a new type of research design, which involves prospectively gathering large-scale naturalistic data from psychedelic users; that is, before and after the use of a psychedelic compound. A methodological limitation of such studies is their high attrition rate, particularly owing to participants who stop responding after initial study enrollment. Importantly, study dropout can introduce systematic biases that may affect the interpretability of results. Objective Based on a previously collected sample (baseline n=654), here we investigated potential determinants of study attrition in web-based prospective studies on psychedelic use. Methods Logistic regression models were used to examine demographic, psychological trait and state, and psychedelic-specific predictors of dropout. Predictors were assessed 1 week before, 1 day after, and 2 weeks after psychedelic use, with attrition being defined as noncompletion of the key endpoint 4 weeks post experience. Results Predictors of attrition were found among demographic variables including age (β=0.024; P=.007) and educational levels, as well as personality traits, specifically conscientiousness (β=–0.079; P=.02) and extraversion (β=0.082; P=.01). Contrary to prior hypotheses, neither baseline attitudes toward psychedelics nor the intensity of acute challenging experiences were predictive of dropout. Conclusions The baseline predictors of attrition identified here are consistent with those reported in longitudinal studies in other scientific disciplines, suggesting their transdisciplinary relevance. Moreover, the lack of an association between attrition and psychedelic advocacy or negative drug experiences in our sample contextualizes concerns about problematic biases in these and related data.
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Affiliation(s)
- Sebastian Hübner
- Centre for Psychedelic Research, Imperial College London, London, United Kingdom
| | - Eline Haijen
- Centre for Psychedelic Research, Imperial College London, London, United Kingdom
| | - Mendel Kaelen
- Centre for Psychedelic Research, Imperial College London, London, United Kingdom
| | | | - Hannes Kettner
- Centre for Psychedelic Research, Imperial College London, London, United Kingdom
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Buis L. Implementation: The Next Giant Hurdle to Clinical Transformation With Digital Health. J Med Internet Res 2019; 21:e16259. [PMID: 31746763 PMCID: PMC6893559 DOI: 10.2196/16259] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/22/2019] [Accepted: 11/11/2019] [Indexed: 01/09/2023] Open
Abstract
Clinical implementation of digital health is a major hurdle to overcome in the coming years. Considering the role of the Journal of Medical Internet Research in the past 20 years and looking toward the journal’s future, this viewpoint acknowledges the vision of medicine and the role that digital health plays in that vision. It also highlights barriers to implementation of digital health as an obstacle to achieving that vision. In particular, this paper focuses on how digital health research must start looking toward implementation as an area of inquiry and the role that the Journal of Medical Internet Research and its' sister journals from JMIR Publications can play in this process.
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Affiliation(s)
- Lorraine Buis
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
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Pedersen DH, Mansourvar M, Sortsø C, Schmidt T. Predicting Dropouts From an Electronic Health Platform for Lifestyle Interventions: Analysis of Methods and Predictors. J Med Internet Res 2019; 21:e13617. [PMID: 31486409 PMCID: PMC6753691 DOI: 10.2196/13617] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/24/2019] [Accepted: 07/07/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The increasing prevalence and economic impact of chronic diseases challenge health care systems globally. Digital solutions can potentially improve efficiency and quality of care, but these initiatives struggle with nonusage attrition. Machine learning methods have been proven to predict dropouts in other settings but lack implementation in health care. OBJECTIVE This study aimed to gain insight into the causes of attrition for patients in an electronic health (eHealth) intervention for chronic lifestyle diseases and evaluate if attrition can be predicted and consequently prevented. We aimed to build predictive models that can identify patients in a digital lifestyle intervention at high risk of dropout by analyzing several predictor variables applied in different models and to further assess the possibilities and impact of implementing such models into an eHealth platform. METHODS Data from 2684 patients using an eHealth platform were iteratively analyzed using logistic regression, decision trees, and random forest models. The dataset was split into a 79.99% (2147/2684) training and cross-validation set and a 20.0% (537/2684) holdout test set. Trends in activity patterns were analyzed to assess engagement over time. Development and implementation were performed iteratively with health coaches. RESULTS Patients in the test dataset were classified as dropouts with an 89% precision using a random forest model and 11 predictor variables. The most significant predictors were the provider of the intervention, 2 weeks inactivity, and the number of advices received from the health coach. Engagement in the platform dropped significantly leading up to the time of dropout. CONCLUSIONS Dropouts from eHealth lifestyle interventions can be predicted using various data mining methods. This can support health coaches in preventing attrition by receiving proactive warnings. The best performing predictive model was found to be the random forest.
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Affiliation(s)
| | - Marjan Mansourvar
- Centre of Health Informatics and Technology, The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | | | - Thomas Schmidt
- Centre of Health Informatics and Technology, The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
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Ek A, Delisle Nyström C, Chirita-Emandi A, Tur JA, Nordin K, Bouzas C, Argelich E, Martínez JA, Frost G, Garcia-Perez I, Saez M, Paul C, Löf M, Nowicka P. A randomized controlled trial for overweight and obesity in preschoolers: the More and Less Europe study - an intervention within the STOP project. BMC Public Health 2019; 19:945. [PMID: 31307412 PMCID: PMC6631737 DOI: 10.1186/s12889-019-7161-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/13/2019] [Indexed: 12/15/2022] Open
Abstract
Background Childhood overweight and obesity is a serious public health issue with an increase being observed in preschool-aged children. Treating childhood obesity is difficult and few countries use standardized treatments. Therefore, there is a need to find effective approaches that are feasible for both health care providers and families. Thus, the overall aim of this study is to assess the acceptance and effectiveness of a parent support program (the More and Less, ML) for the management of overweight and obesity followed by a mobile health (mHealth) program (the MINISTOP application) in a socially diverse population of families. Methods/design A two-arm, parallel design randomized controlled trial in 300 2-to 6-year-old children with overweight and obesity from Romania, Spain and Sweden (n = 100 from each). Following baseline assessments children are randomized into the intervention or control group in a 1:1 ratio. The intervention, the ML program, consists of 10-weekly group sessions which focus on evidence-based parenting practices, followed by the previously validated MINISTOP application for 6-months to support healthy eating and physical activity behaviors. The primary outcome is change in body mass index (BMI) z-score after 9-months and secondary outcomes include: waist circumference, eating behavior (Child Eating Behavior Questionnaire), parenting behavior (Comprehensive Feeding Practices Questionnaire), physical activity (ActiGraph wGT3x-BT), dietary patterns (based on metabolic markers from urine and 24 h dietary recalls), epigenetic and gut hormones (fasting blood samples), and the overall acceptance of the overweight and obesity management in young children (semi-structured interviews). Outcomes are measured at baseline and after: 10-weeks (only BMI z-score, waist circumference), 9-months (all outcomes), 15- and 21-months (all outcomes except physical activity, dietary patterns, epigenetics and gut hormones) post-baseline. Discussion This study will evaluate a parent support program for weight management in young children in three European countries. To boost the effect of the ML program the families will be supported by an app for 6-months. If the program is found to be effective, it has the potential to be implemented into routine care to reduce overweight and obesity in young children and the app could prove to be a viable option for sustained effects of the care provided. Trial registration ClinicalTrials.gov NCT03800823; 11 Jan 2019.
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Affiliation(s)
- Anna Ek
- Division of Pediatrics, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
| | | | - Adela Chirita-Emandi
- Genetics Department, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania.,"Louis Turcanu" Clinical Emergency Hospital for Children, Timisoara, Romania
| | - Josep A Tur
- Research Group on Community Nutrition & Oxidative Stress, University of the Balearic Islands, Palma de Mallorca, Spain.,CIBER of Physiology of Obesity and Nutrition (CIBEROBN), Instituto Carlos III, Madrid, Spain
| | - Karin Nordin
- Division of Pediatrics, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Cristina Bouzas
- Research Group on Community Nutrition & Oxidative Stress, University of the Balearic Islands, Palma de Mallorca, Spain.,CIBER of Physiology of Obesity and Nutrition (CIBEROBN), Instituto Carlos III, Madrid, Spain
| | - Emma Argelich
- Research Group on Community Nutrition & Oxidative Stress, University of the Balearic Islands, Palma de Mallorca, Spain.,CIBER of Physiology of Obesity and Nutrition (CIBEROBN), Instituto Carlos III, Madrid, Spain
| | - J Alfredo Martínez
- CIBER of Physiology of Obesity and Nutrition (CIBEROBN), Instituto Carlos III, Madrid, Spain.,Department of Nutrition, Food Science, and Physiology, Centre for Nutrition Research, University of Navarra, Pamplona, Spain.,IMDEA Food Precision Nutrition, Madrid, Spain
| | - Gary Frost
- Section for Nutrition Research, Department of Medicine, Imperial College London, Hammersmith Campus, London, UK
| | - Isabel Garcia-Perez
- Division of Systems and Digestive Medicine, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, South Kensington Campus, London, UK
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Campus de Montilivi, Girona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Instituto Carlos III, Madrid, Spain
| | - Corina Paul
- Pediatrics Department, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania.,2nd Pediatrics Clinic, Clinical Emergency County Hospital Timisoara, Timisoara, Romania
| | - Marie Löf
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Paulina Nowicka
- Division of Pediatrics, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Food Studies, Nutrition, and Dietetics, Uppsala University, Uppsala, Sweden
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