Behavioral Intervention Technologies Research Articles

Assessing the Feasibility and Acceptability of Smart Speakers in Behavioral Intervention Research With Older Adults: Mixed Methods Study.

Smart speakers, such as Amazon's Echo and Google's Nest Home, combine natural language processing with a conversational interface to carry out everyday tasks, like playing music and finding information. Easy to use, they are embraced by older adults, including those with limited physical function, vision, or computer literacy. While smart speakers are increasingly used for research purposes (eg, implementing interventions and automatically recording selected research data), information on the advantages and disadvantages of using these devices for studies related to health promotion programs is limited. This study evaluates the feasibility and acceptability of using smart speakers to deliver a physical activity (PA) program designed to help older adults enhance their physical well-being. Community-dwelling older adults (n=18) were asked to use a custom smart speaker app to participate in an evidence-based, low-impact PA program for 10 weeks. Collected data, including measures of technology acceptance, interviews, field notes, and device logs, were analyzed using a concurrent mixed analysis approach. Technology acceptance measures were evaluated using time series ANOVAs to examine acceptability, appropriateness, feasibility, and intention to adopt smart speaker technology. Device logs provided evidence of interaction with and adoption of the device and the intervention. Interviews and field notes were thematically coded to triangulate the quantitative measures and further expand on factors relating to intervention fidelity. Smart speakers were found to be acceptable for administering a PA program, as participants reported that the devices were highly usable (mean 5.02, SE 0.38) and had strong intentions to continue their use (mean 5.90, SE 0.39). Factors such as the voice-user interface and engagement with the device on everyday tasks were identified as meaningful to acceptability. The feasibility of the devices for research activity, however, was mixed. Despite the participants rating the smart speakers as easy to use (mean 5.55, SE 1.16), functional and technical factors, such as Wi-Fi connectivity and appropriate command phrasing, required the provision of additional support resources to participants and potentially impaired intervention fidelity. Smart speakers present an acceptable and appropriate behavioral intervention technology for PA programs directed at older adults but entail additional requirements for resource planning, technical support, and troubleshooting to ensure their feasibility for the research context and for fidelity of the intervention.

Can robots do therapy?: Examining the efficacy of a CBT bot in comparison with other behavioral intervention technologies in alleviating mental health symptoms

Artificial intelligence therapy bots are gaining traction in the psychotherapy marketplace. Yet, the only existing study examining the efficacy of a therapy bot lacks any meaningful controls for comparison in claiming its effectiveness to treat depression. The current study aims to examine the efficacy of Woebot against three control conditions, including ELIZA, a basic (non-“smart”) conversational bot, a journaling app, and a passive psychoeducation control group. In a sample of 65 young adults, a repeated measures ANOVA failed to detect differences in symptom reduction between active and passive groups. In follow-up analyses using paired samples t-tests, ELIZA users experienced mental health improvements with the largest effect sizes across all mental health outcomes, followed by daily journaling, then Woebot, and finally psychoeducation. Findings reveal that Woebot does not offer benefit above and beyond other self-help behavioral intervention technologies. They underscore that using a no-treatment control group study design to market clinical services should no longer be acceptable nor serve as an acceptable precursor to marketing a chatbot as functionally equivalent to psychotherapy. Doing so creates unnecessary risk for consumers of psychotherapy and undermines the clinical value of robotic therapeutics that could prove effective at addressing mental health problems through rigorous research.

Enhancing Mental Health and Medication Adherence Among Men Who Have Sex With Men Recently Diagnosed With HIV With a Dialectical Behavior Therapy-Informed Intervention Incorporating mHealth, Online Skills Training, and Phone Coaching: Development Study Using Human-Centered Design Approach.

Mental health problems are common among men who have sex with men (MSM) living with HIV and may negatively affect medication adherence. Psychosocial interventions designed to address these urgent needs are scarce in China. Incorporating behavioral health theories into intervention development strengthens the effectiveness of these interventions. The absence of a robust theoretical basis for interventions may also present challenges to identify active intervention ingredients. This study aims to systematically describe the development of a mobile health-based intervention for MSM recently diagnosed with HIV in China, including the theoretical basis for the content and the considerations for its technological delivery. We used intervention mapping (IM) to guide overall intervention development, a behavioral intervention technology model for technological delivery design, and a human-centered design and cultural adaptation model for intervention tailoring throughout all steps of IM. The dialectical behavior therapy (DBT)-informed intervention, Turning to Sunshine, comprised 3 components: app-based individual skills learning, group-based skills training, and on-demand phone coaching. The theoretical basis for the intervention content is based on the DBT model of emotions, which fits our conceptualization of the intervention user's mental health needs. The intervention aims to help MSM recently diagnosed with HIV (1) survive moments of high emotional intensity and strong action urges, (2) change emotional expression to regulate emotions, and (3) reduce emotional vulnerability, as well as (4) augment community resources for mental health services. Technological delivery considerations included rationale of the medium, complexity, and esthetics of information delivery; data logs; data visualization; notifications; and passive data collection. This study laid out the steps for the development of a DBT-informed mobile health intervention that integrated app-based individual learning, group-based skills training, and phone coaching. This intervention, Turning to Sunshine, aims to improve mental health outcomes for MSM newly diagnosed with HIV in China. The IM framework informed by human-centered design principles and cultural adaptation considerations offered a systematic approach to develop the current intervention and tailor it to the target intervention users. The behavioral intervention technology model facilitated the translation of behavioral intervention strategies into technological delivery components. The systematic development and reporting of the current intervention can serve as a guide for similar intervention studies. The content of the current intervention could be adapted for a broader population with similar emotional struggles to improve their mental health outcomes.

Cultural Responsivity in Technology-Enabled Services: Integrating Culture Into Technology and Service Components.

Technology-enabled services (TESs) are clinical interventions that combine technological and human components to provide health services. TESs for mental health are efficacious in the treatment of anxiety and depression and are currently being offered as frontline treatments around the world. It is hoped that these interventions will be able to reach diverse populations across a range of identities and ultimately decrease disparities in mental health treatment. However, this hope is largely unrealized. TESs include both technology and human service components, and we argue that cultural responsivity must be considered in each of these components to help address existing treatment disparities. To date, there is limited guidance on how to consider cultural responsivity within these interventions, including specific targets for the development, tailoring, or design of the technologies and services within TESs. In response, we propose a framework that provides specific recommendations for targets based on existing models, both at the technological component level (informed by the Behavioral Intervention Technology Model) and the human support level (informed by the Efficiency Model of Support). We hope that integrating culturally responsive considerations into these existing models will facilitate increased attention to cultural responsivity within TESs to ensure they are ethical and responsive for everyone.

Postmarket Surveillance for Effective Regulation of Digital Mental Health Treatments.

Postmarket Surveillance for Effective Regulation of Digital Mental Health Treatments.

Exploring the barriers and facilitators for supporting adolescents with knee pains adherence to mobile health apps: A think-aloud study.

Mobile health (mHealth) applications have the potential to support adolescents' self-management of knee pain. However, ensuring adherence remains a barrier when designing mHealth concepts for adolescents. This study aimed to explore barriers and facilitators for adhering to mHealth interventions to inform design principles. Think-aloud tests were conducted with 12 adolescents (aged 12.5 years median) with knee pain, using a low-fidelity prototype. The prototype was informed by the authors previous work, rapid prototyping sessions with seven health professionals, and synthesis via the Behavioral Intervention Technology Model. The think-aloud tests were video recorded and analyzed thematically to identify design principles. The analysis based on user testing with adolescents with knee pain identified three themes: "user experience and feedback," "contextual challenges," and "new features" and nine subthemes. Adolescents were able to use mHealth behavioral features such as self-tracking, goal setting, education, and data visualization to capture and reflect on their knee pain developments, which facilitated use. However, adolescents struggle with timing interventions, breaking down management behaviors, and biases towards interventions were identified as internal threats to adherence. Competing activities, parental meddling, and privacy concerns were external adherence barriers. Twelve design principles were identified for integrating these insights into mHealth designs. Participants' motivations for adherence were influenced by internal and external factors. While adolescents were able to use mHealth behavioral features to capture and reflect on knee pain developments, understanding how to accommodate adolescents' cognitive abilities, competing activities, and need for independence is quintessential to enhance adherence in everyday contexts.

Pilot RCT Examining Satisfaction and Disability Outcomes of a Technology-Supported Self-Management Intervention in Post-Stroke Individuals

<h3>Research Objectives</h3> To evaluate the participant satisfaction and the preliminary efficacy of a technology-supported self-management intervention to improve post-stroke disability outcomes. <h3>Design</h3> 12-week, two-arm randomized controlled trial. <h3>Setting</h3> Community. <h3>Participants</h3> Twenty-four participants (intervention = 11; control = 13) with mild to moderate stroke (mean age = 59.4 years [SD = 11.7], male = 58%, black = 38%). <h3>Interventions</h3> Intervention group received the interactive Self-Management Augmented Rehabilitation Technologies (iSMART). It is an adjunctive behavioral intervention technology composed of skills training, coaching, and text messaging for improved self-management of chronic conditions and participation strategies. Control group received stroke education materials and phone calls over the 12-week. <h3>Main Outcome Measures</h3> Satisfaction was measured by the Client Satisfaction Questionnaire (CSQ), and the Healing Encounters & Attitudes Lists – Health Care Environment (HEAL-HCE), Patient-Provider Connection (HEAL-PPC) and Treatment Expectancy (HEAL-TEX). Disability outcomes were measured by the Patient Health Questionnaire-9 (PHQ-9), Stroke Impact Scale (SIS), Activity Card Sort (ACS), and Reintegration to Normal Living Index (RNL). <h3>Results</h3> Two iSMART participants withdrew from the study. The iSMART group reported greater satisfaction than the control group (CSQ: d = 0.387; HEAL-HCE: d = 0.454; HEAL-PPC: d = 0.374; HEAL – TEX: d = 0.328). The iSMART group exhibited moderate but the control group exhibited small effects on SIS's mobility (iSMART: d = 0.521, control: d = 0.069), hand function (d = 0.699, d = 0.222), and recovery (d = 0.545, d = 0.171), and RNL (d = 0.652, d = 0.272) scores. Both groups exhibited small effects on other scores. <h3>Conclusions</h3> The iSMART participants reported higher participant satisfaction and greater treatment effects than the control participants, suggesting that the iSMART may hold promise for post-stroke self-management. <h3>Author(s) Disclosures</h3> None disclosed.

A Technology-Augmented Intervention to Promote Self-Management Self-Efficacy among Persons with Stroke: A Pilot Feasibility Study

<h3>Research Objectives</h3> To determine the feasibility and the initial effect of a technology-augmented intervention to improve self-management self-efficacy in persons with stroke. <h3>Design</h3> A three-month randomized feasibility study. <h3>Setting</h3> Community. <h3>Participants</h3> Twenty-four individuals (42% female, 38% black, 54% married, 71% mild severity, 83% Ischemic stroke) with chronic stroke (control arm = 13, intervention arm = 11) were recruited. <h3>Interventions</h3> Participants in the intervention group received the iSMART (interactive Self-Management Augmented Rehabilitation Technologies). The iSMART is an adjunctive behavioral intervention technology composed of skills training, coaching, and text messaging for improved self-management of chronic conditions and the use of participation strategies in persons after stroke. Participants in the control group received stroke-specific educational materials and phone calls without iSMART content. <h3>Main Outcome Measures</h3> Acceptability of Intervention Measure, Intervention Appropriateness Measure, Feasibility of Intervention Measure, PROMIS Self-Efficacy for Managing Chronic Conditions, and Participation Strategies Self-Efficacy Scale. <h3>Results</h3> Two iSMART participants withdrew from the study, resulting in an overall retention rate of 82%. Participants responded to 78% of all messages received. The iSMART group had higher feasibility (d = .449), acceptability (d = .505), and appropriateness (d = .540) than the control group. The iSMART group showed moderate to large effects (d = .494 to .870) in improving self-efficacy in managing emotions, symptoms, daily activities, and treatments and medications. The iSMART also showed moderate effects (d = .554 to .673) in improving self-efficacy in using participation strategies for home, community, and work activities. The control group demonstrated small effects in these outcomes. <h3>Conclusions</h3> The iSMART is a feasible and effective intervention to improve the self-efficacy of persons with stroke for managing chronic conditions and using strategies to support participation. <h3>Author(s) Disclosures</h3> None disclosed.

The Feasibility of a Family-Focused CBT Skills Self-Help App

Behavioral intervention technology (BIT) is one avenue for extending the reach of evidence-based pediatric mental health. We developed Anchors Away: Anxiety at Bay, a family-friendly stand-alone mobile health app for children ages 6 to 11 that delivers CBT strategies tailored to mental health struggles typical for youth. This study assessed the acceptability, appropriateness, feasibility, and fidelity following an iterative model of development that provided quantitative and qualitative data. We made changes based on feedback from pilot data and clinical expert stakeholders and conducted a randomized controlled trial (RCT). Findings largely supported the acceptability and feasibility of the app. 71.8% of those randomized to the app show some degree of engagement with the child-side of the app and 47.4% completed all game modules. Most participants (80%) reported that they would purchase the app and found it to be easy to use and helpful in meeting their child’s specific anxiety and emotion regulation challenges.

Cost-Utility of the eHealth Application ‘Oncokompas’, Supporting Incurably Ill Cancer Patients to Self-Manage Their Cancer-Related Symptoms: Results of a Randomized Controlled Trial

Evidence on the cost-effectiveness of eHealth in palliative care is scarce. Oncokompas, a fully automated behavioral intervention technology, aims to support self-management in cancer patients. This study aimed to assess the cost-utility of the eHealth application Oncokompas among incurably ill cancer patients, compared to care as usual. In this randomized controlled trial, patients were randomized into the intervention group (access to Oncokompas) or the waiting-list control group (access after three months). Healthcare costs, productivity losses, and health status were measured at baseline and three months. Intervention costs were also taken into account. Non-parametric bootstrapping with 5000 replications was used to obtain 95% confidence intervals around the incremental costs and quality-adjusted life years (QALYs). A probabilistic approach was used because of the skewness of cost data. Altogether, 138 patients completed the baseline questionnaire and were randomly assigned to the intervention group (69) or the control group (69). In the base case analysis, mean total costs and mean total effects were non-significantly lower in the intervention group (−€806 and −0.01 QALYs). The probability that the intervention was more effective and less costly was 4%, whereas the probability of being less effective and less costly was 74%. Among patients with incurable cancer, Oncokompas does not impact incremental costs and seems slightly less effective in terms of QALYs, compared to care as usual. Future research on the costs of eHealth in palliative cancer care is warranted to assess the generalizability of the findings of this study.

The Impact of Personalized Human Support on Engagement With Behavioral Intervention Technologies for Employee Mental Health: An Exploratory Retrospective Study.

Digital healthcare has grown in popularity in recent years as a scalable solution to address increasing rates of mental illness among employees, but its clinical potential is limited by low engagement and adherence, particularly in open access interventions. Personalized guidance, involving structuring an intervention and tailoring it to the user to increase accountability and social support, is one way to increase engagement with digital health programs. This exploratory retrospective study therefore sought to examine the impact of guidance in the form of personalized prompts from a lay-person (i.e., non-health professional) on user's (N = 88) engagement with a 16-week Behavioral Intervention Technology targeting employee mental health and delivered through a mobile application. Chi-squared tests and Mann-Whitney tests were used to examine differences in retention and engagement between individuals who received personalized prompts throughout their 4-month program and individuals for whom personalized prompts were introduced in the seventh week of their program. There were no significant differences between the groups in the number of weeks they remained active in the app (personalized messages group Mdn = 3.5, IQR = 3; control group Mdn = 2.5, IQR = 4.5; p = 0.472). In the first 3 weeks of the intervention program, the proportion of individuals who explored the educational modules feature and the messaging with health coaches feature was also not significantly associated with group (ps = 1.000). The number of modules completed and number of messages sent to health coaches in the first 3 weeks did not differ significantly between the two groups (ps ≥ 0.311). These results suggest that guidance from a non-health professional is limited in its ability to increase engagement with an open access Behavioral Intervention Technology for employees. Moreover, the findings suggest that the formation of a relationship between the individual and the agent providing the guidance may be necessary in order for personalized guidance to increase engagement.

Behavioral Intervention Technologies – Historical, Medical, Philosophical, and Ethical Perspectives

In this study, we will analyze, from philosophical, medical and bioethical points of view, the genetic ways in which the biological foundations of human behavior can be identified, as well as the technologies that can contribute to the modification of certain human behaviors, especially aggressive ones. Ideas about the inheritance of a certain behavior have been identified since Greek antiquity, but in the 20th century, along with sequencing and mapping of all genes of the members of our species, the possibility of identifying possible genes for learning and memory has emerged and therefore the ability to act on them through “behavioral genetics” could develop. In the dawn of the 21st century, researchers begin to consider that abnormal behaviors had a certain genetic mutation located on the “X” chromosome or on the “Y” chromosome and the concept of “genetics of intellectual disability” was introduced in the medical literature. After the identification of the genes or the constellation of genes that underlie the occurrence of psychiatric disorders, the researchers developed genetic engineering to be performed on certain groups of neuronal cells, but these activities lead to the question: how useful or dangerous these new genome editing technologies will be, especially in terms of conservation and perpetuation of the human species. We conclude that the chimera-type people, whose genetic structure is artificially constructed, would raise issues primarily about their identity, their integration into traditional societies, but also about the need for a new legislation. However, the future society will have, at some point, to accept the reality of genetic interventions, the purpose of which is to achieve much more radical transformations in human nature.

Early Development of a Virtual Coach for Healthy Coping Interventions in Type 2 Diabetes Mellitus: Validation Study.

BackgroundMobile health solutions aimed at monitoring tasks among people with diabetes mellitus (DM) have been broadly applied. However, virtual coaches (VCs), embedded or not in mobile health, are considered valuable means of improving patients’ health-related quality of life and ensuring adherence to self-care recommendations in diabetes management. Despite the growing need for effective, healthy coping digital interventions to support patients’ self-care and self-management, the design of psychological digital interventions that are acceptable, usable, and engaging for the target users still represents the main challenge, especially from a psychosocial perspective.ObjectiveThis study primarily aims to test VC interventions based on psychoeducational and counseling approaches to support and promote healthy coping behaviors in adults with DM. As a preliminary study, university students have participated in it and have played the standardized patients’ (SPs) role with the aim of improving the quality of the intervention protocol in terms of user acceptability, experience, and engagement. The accuracy of users’ role-playing is further analyzed.MethodsThis preliminary study is based on the Obesity-Related Behavioral Intervention Trial model, with a specific focus on its early phases. The healthy coping intervention protocol was initially designed together with a team of psychologists following the main guidelines and recommendations for psychoeducational interventions for healthy coping in the context of DM. The protocol was refined with the support of 3 experts in the design of behavioral intervention technologies for mental health and well-being, who role-played 3 SPs’ profiles receiving the virtual coaching intervention in a Wizard of Oz setting via WhatsApp. A refined version of the healthy coping protocol was then iteratively tested with a sample of 18 university students (mean age 23.61, SD 1.975 years) in a slightly different Wizard of Oz evaluation setting. Participants provided quantitative and qualitative postintervention feedback by reporting their experiences with the VC. Clustering techniques on the logged interactions and dialogs between the VC and users were collected and analyzed to identify additional refinements for future VC development.ResultsBoth quantitative and qualitative analyses showed that the digital healthy coping intervention was perceived as supportive, motivating, and able to trigger self-reflection on coping strategies. Analyses of the logged dialogs showed that most of the participants accurately played the SPs’ profile assigned, confirming the validity and usefulness of this testing approach in preliminary assessments of behavioral digital interventions and protocols.ConclusionsThis study outlined an original approach to the early development and iterative testing of digital healthy coping interventions for type 2 DM. Indeed, the intervention was well-accepted and proved its effectiveness in the definition and refinement of the initial protocol and of the user experience with a VC before directly involving real patients in its subsequent use and testing.

Digital Health Platform for Emotional and Self-Management Support of Caregivers of Children Receiving Growth Hormone Treatment.

In recent years there has been growing research on the combination of evidence-based behavioral change techniques with mobile-based recommender systems. In this paper, we have focused on understanding the psychological burdens experienced by caregivers of children undergoing growth hormone treatment (GHt) and the perceived barriers to and drivers of the adoption of a digital health solution. This is a mixed-methods formative research study looking into technical acceptance aspects of using digital health for the emotional support of parents of children undergoing GHt. After one month using the ADHERA CARING platform (Adhera Health, Inc., Palo Alto, CA), individual semi-structured interviews were conducted. ADHERA CARING provides tailored emotional and self-management support to caregivers of children undergoing GHt to improve adherence to treatment through positive education, personalized motivational messages, and emotional support. A preliminary thematic analysis and categorization were carried out, based on the Behavioral Intervention Technology (BIT) model. The majority of participants were female. All caregivers positively valued having the tool, especially at the beginning of treatment. Information provided in the educational module was useful and improved self-efficacy. Motivational messages contributed to commitment and reinforced the educational content, thus promoting continuity of treatment and potentially improving treatment efficacy. Most participants (n=10, 80%) accessed all educational units and completed all the 27 quiz questions. Regarding the motivational messages, the overall average rating was 4.55 out of 5.00. ADHERA CARING has the potential to help caregivers to understand the treatment journey. Nevertheless, users have identified that some types of educational content are more valuable at specific stages of the treatment journey, which suggests that personalization of educational content is required to adapt to different stages of the patient journey.

A gamified app on emotion recognition and anger management for pre-school children

Anger is a common reason for child mental-health referrals. Therefore, children need to develop emotion recognition and anger management skills from an early age. Gamified apps can deliver mental health interventions for children, but this research area is still in its infancy. A gamified, interactive storytelling mobile app, which was designed as a stress prevention intervention for young children was tested by 20 preprimary school children (4–6 years old) during a science festival. The study aimed to examine children’s understanding of three anger management techniques demonstrated through the app. The main data source of the study consisted of 20 individual audiotaped semi-structured children interviews. Interviews were transcribed verbatim and analyzed using a qualitative data analysis software. Findings showed that the story is comprehensible by preschool children. Eleven out of 20 children could recall at least one anger management technique but only seven (7/20) could identify or demonstrate a technique that can be applied in a stressful situation in real life. There is a need to embed additional scaffolding, prompts, or motivational rewards for children to engage with more than one anger management technique and to avoid misconceptions. Gamified apps can potentially be effective behavioral intervention technologies to deliver emotional education to young children affordably, accessibly, and engagingly.

Engaging Parents and Health Care Stakeholders to Inform Development of a Behavioral Intervention Technology to Promote Pediatric Behavioral Health: Mixed Methods Study.

BackgroundDespite effective psychosocial interventions, gaps in access to care persist for youth and families in need. Behavioral intervention technologies (BITs) that apply psychosocial intervention strategies using technological features represent a modality for targeted prevention that is promising for the transformation of primary care behavioral health by empowering parents to take charge of the behavioral health care of their children. To realize the potential of BITs for parents, research is needed to understand the status quo of parental self-help and parent-provider collaboration to address behavioral health challenges and unmet parental needs that could be addressed by BITs.ObjectiveThe aim of this study is to conduct foundational research with parents and health care stakeholders (HCS) to discover current practices and unmet needs related to common behavioral health challenges to inform the design, build, and testing of BITs to address these care gaps within a predominantly rural health system.MethodsWe conducted a convergent mixed-parallel study within a large, predominantly rural health system in which the BITs will be developed and implemented. We analyzed data from parent surveys (N=385) on current practices and preferences related to behavioral health topics to be addressed in BITs along with focus group data of 48 HCS in 9 clinics regarding internal and external contextual factors contributing to unmet parental needs and current practices. By comparing and relating the findings, we formed interpretations that will inform subsequent BIT development activities.ResultsParents frequently endorsed several behavioral health topics, and several topics were relatively more or less frequently endorsed based on the child’s age. The HCS suggested that BITs may connect families with evidence-based guidance sooner and indicated that a web-based platform aligns with how parents already seek behavioral health guidance. Areas of divergence between parents and HCS were related to internalizing problems and cross-cutting issues such as parenting stress, which may be more difficult for health care HCS to detect or address because of the time constraints of routine medical visits.ConclusionsThese findings provide a rich understanding of the complexity involved in meeting parents’ needs for behavioral health guidance in a primary care setting using BITs. User testing studies for BIT prototypes are needed to successfully design, build, and test effective BITs to empower parents to take charge of promoting the behavioral health of their children.

Meta-Analysis of Parent Training Programs Utilizing Behavior Intervention Technologies

Behavioral Parent Training (BPT) traditionally occurs in face-to-face (FTF BPT). Recently, Behavioral Intervention Technology (BIT) has been developed to deliver BPT in lieu of or as an adjunct to FTF BPT using websites, computer software, smartphone applications, podcasts, pre-recorded sessions, and teletherapy. The present meta-analysis reviews BIT BPT randomized control and comparison studies to determine the overall efficacy of BITs, if the level of human support significantly effects BIT BPT treatment outcomes, and which populations BIT BPT are effective for, by analyzing the following study variables: socioeconomic status, race, and clinical population. The analyses indicated that, overall, BIT BPT is an effective treatment (g = 0.62), and did not indicate a significant difference between levels of human support (χ2 (3) = 4.94, p = 0.18). Analysis did indicate a significant difference between studies that used waitlist or education control groups, compared to studies that used active treatment controls (χ2 (1) = 12.90, p = 0.00). The analyses did not indicate a significant difference between clinical population, low socioeconomic status, and racial minority studies. These findings provide preliminary evidence that BIT BPT is effective for treating child and adolescent externalizing behavior in a variety of populations.

Smartphone-Based Interventions to Reduce Sedentary Behavior and Promote Physical Activity Using Integrated Dynamic Models: Systematic Review.

BackgroundTraditional psychological theories are inadequate to fully leverage the potential of smartphones and improve the effectiveness of physical activity (PA) and sedentary behavior (SB) change interventions. Future interventions need to consider dynamic models taken from other disciplines, such as engineering (eg, control systems). The extent to which such dynamic models have been incorporated in the development of interventions for PA and SB remains unclear.ObjectiveThis review aims to quantify the number of studies that have used dynamic models to develop smartphone-based interventions to promote PA and reduce SB, describe their features, and evaluate their effectiveness where possible.MethodsDatabases including PubMed, PsycINFO, IEEE Xplore, Cochrane, and Scopus were searched from inception to May 15, 2019, using terms related to mobile health, dynamic models, SB, and PA. The included studies involved the following: PA or SB interventions involving human adults; either developed or evaluated integrated psychological theory with dynamic theories; used smartphones for the intervention delivery; the interventions were adaptive or just-in-time adaptive; included randomized controlled trials (RCTs), pilot RCTs, quasi-experimental, and pre-post study designs; and were published from 2000 onward. Outcomes included general characteristics, dynamic models, theory or construct integration, and measured SB and PA behaviors. Data were synthesized narratively. There was limited scope for meta-analysis because of the variability in the study results.ResultsA total of 1087 publications were screened, with 11 publications describing 8 studies included in the review. All studies targeted PA; 4 also included SB. Social cognitive theory was the major psychological theory upon which the studies were based. Behavioral intervention technology, control systems, computational agent model, exploit-explore strategy, behavioral analytic algorithm, and dynamic decision network were the dynamic models used in the included studies. The effectiveness of quasi-experimental studies involved reduced SB (1 study; P=.08), increased light PA (1 study; P=.002), walking steps (2 studies; P=.06 and P<.001), walking time (1 study; P=.02), moderate-to-vigorous PA (2 studies; P=.08 and P=.81), and nonwalking exercise time (1 study; P=.31). RCT studies showed increased walking steps (1 study; P=.003) and walking time (1 study; P=.06). To measure activity, 5 studies used built-in smartphone sensors (ie, accelerometers), 3 of which used the phone’s GPS, and 3 studies used wearable activity trackers.ConclusionsTo our knowledge, this is the first systematic review to report on smartphone-based studies to reduce SB and promote PA with a focus on integrated dynamic models. These findings highlight the scarcity of dynamic model–based smartphone studies to reduce SB or promote PA. The limited number of studies that incorporate these models shows promising findings. Future research is required to assess the effectiveness of dynamic models in promoting PA and reducing SB.Trial RegistrationInternational Prospective Register of Systematic Reviews (PROSPERO) CRD42020139350; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=139350.

Innovating Technology-Enhanced Interventions for Youth Suicide: Insights for Measuring Implementation Outcomes.

Technology is one medium to increase youth engagement, especially among underserved and minority groups, in suicide preventive interventions. Technology can be used to supplement or adjunct an in-person intervention, guide an in-person intervention, or be the stand-alone (automated) component of the intervention. This range in technological use is now called the continuum of behavioral intervention technologies (BITs). Overall, suicide intervention researchers do not use this terminology to categorize how the role of technology differs across technology-enhanced youth interventions. There is growing recognition that technology-enhanced interventions will not create substantial public health impact without an understanding of the individual (youth, families, and providers), mezzo (clinics and health systems of care), and contextual factors (society, culture, community) that are associated with their implementation. Implementation science is the study of methods to promote uptake of evidence-based practices and policies into the broader health care system. In this review, we incorporate work from implementation science and BIT implementation to illustrate how the study of technology-enhanced interventions for youth suicide can be advanced by specifying the role of technology and measuring implementation outcomes.

Mixed Results on the Efficacy of the CharacterMe Smartphone App to Improve Self-Control, Patience, and Emotional Regulation Competencies in Adolescents.

Unprecedented levels of access to adolescents' time and attention provide opportunities to convert traditional character and socioemotional competencies interventions into behavioral intervention technologies. However, these new tools must be evaluated rather than assuming previously validated activities will be efficacious when converted to a mobile platform. Thus, we sought to design and provide initial data on the effectiveness of the CharacterMe smartphone app to build self-control and patience, which are built on underlying social-emotional regulation competencies, in a sample of 618 adolescents (Mage = 16.07, Female = 56.6%). We also sought to examine whether framing the app activities as having a transcendent (spiritual connection or moral/prosocial) rather than instrumental purpose would increase engagement and change in self-control, patience, and emotion regulation. Finally, we tested the impact of framing activities as building strengths vs. fixing weaknesses. Results highlight the difficulty of translating psychological interventions to behavioral intervention technologies. Overall, the CharacterMe smartphone app was unsuccessful in increasing self-control, patience, or emotion regulation in adolescents, with analyses showing no significant mean changes over time. Framing conditions and user engagement were largely not significant predictors of change in self-control, patience, and emotion regulation.