Abstract
BackgroundImplementation intentions are mental representations of simple plans to translate goal intentions into behavior under specific conditions. Studies show implementation intentions can produce moderate to large improvements in behavioral goal achievement. Human associative memory mechanisms have been implicated in the processes by which implementation intentions produce effects. On the basis of the adaptive control of thought-rational (ACT-R) theory of cognition, we hypothesized that the strength of implementation intention effect could be manipulated in predictable ways using reminders delivered by a mobile health (mHealth) app.ObjectiveThe aim of this experiment was to manipulate the effects of implementation intentions on daily behavioral goal success in ways predicted by the ACT-R theory concerning mHealth reminder scheduling.MethodsAn incomplete factorial design was used in this mHealth study. All participants were asked to choose a healthy behavior goal associated with eat slowly, walking, or eating more vegetables and were asked to set implementation intentions. N=64 adult participants were in the study for 28 days. Participants were stratified by self-efficacy and assigned to one of two reminder conditions: reminders-presented versus reminders-absent. Self-efficacy and reminder conditions were crossed. Nested within the reminders-presented condition was a crossing of frequency of reminders sent (high, low) by distribution of reminders sent (distributed, massed). Participants in the low frequency condition got 7 reminders over 28 days; those in the high frequency condition were sent 14. Participants in the distributed conditions were sent reminders at uniform intervals. Participants in the massed distribution conditions were sent reminders in clusters.ResultsThere was a significant overall effect of reminders on achieving a daily behavioral goal (coefficient=2.018, standard error [SE]=0.572, odds ratio [OR]=7.52, 95% CI 0.9037-3.2594, P<.001). As predicted by ACT-R, using default theoretical parameters, there was an interaction of reminder frequency by distribution on daily goal success (coefficient=0.7994, SE=0.2215, OR=2.2242, 95% CI 0.3656-1.2341, P<.001). The total number of times a reminder was acknowledged as received by a participant had a marginal effect on daily goal success (coefficient=0.0694, SE=0.0410, OR=1.0717, 95% CI −0.01116 to 0.1505, P=.09), and the time since acknowledging receipt of a reminder was highly significant (coefficient=−0.0490, SE=0.0104, OR=0.9522, 95% CI −0.0700 to −0.2852], P<.001). A dual system ACT-R mathematical model was fit to individuals’ daily goal successes and reminder acknowledgments: a goal-striving system dependent on declarative memory plus a habit-forming system that acquires automatic procedures for performance of behavioral goals.ConclusionsComputational cognitive theory such as ACT-R can be used to make precise quantitative predictions concerning daily health behavior goal success in response to implementation intentions and the dosing schedules of reminders.
Highlights
BackgroundMobile health systems provide new opportunities to provide precise individualized just-in-time interventions to support behavior change [1]. mobile health (mHealth) provides a path for translating evidence-based interventions (EBIs) onto delivery systems that are replicable, scalable, and sustainable, with great economies of scale for health care delivery [2]. mHealth provides new opportunities to study and apply psychological theory in the ecology of everyday life, with a focus on meaningful health-related behavior [3,4].In this paper, we present an exploratory 28-day study in which an mHealth app delivered interventions to support people in pursuing self-selected healthy behavior change goals such as eating more vegetables, eating more slowly, and increased walking time per day
As predicted by adaptive control of thought-rational (ACT-R), using default theoretical parameters, there was an interaction of reminder frequency by distribution on daily goal success
The total number of times a reminder was acknowledged as received by a participant had a marginal effect on daily goal success, and the time since acknowledging receipt of a reminder was highly significant
Summary
BackgroundMobile health (mHealth) systems provide new opportunities to provide precise individualized just-in-time interventions to support behavior change [1]. mHealth provides a path for translating evidence-based interventions (EBIs) onto delivery systems that are replicable, scalable, and sustainable, with great economies of scale for health care delivery [2]. mHealth provides new opportunities to study and apply psychological theory in the ecology of everyday life, with a focus on meaningful health-related behavior [3,4].In this paper, we present an exploratory 28-day study in which an mHealth app delivered interventions to support people in pursuing self-selected healthy behavior change goals such as eating more vegetables, eating more slowly, and increased walking time per day. Mobile health (mHealth) systems provide new opportunities to provide precise individualized just-in-time interventions to support behavior change [1]. The adaptive control of thought-rational (ACT-R) theory of cognition [7] is used to develop an integrated mechanistic account of the role of implementation intentions in enhancing behavior change intentions and actions; how reminders have time-varying strengthening effects on the impact of implementation interventions; and how controlled, deliberative, goal-striving behavior becomes automatic and habitual. On the basis of the adaptive control of thought-rational (ACT-R) theory of cognition, we hypothesized that the strength of implementation intention effect could be manipulated in predictable ways using reminders delivered by a mobile health (mHealth) app
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