Behavioral Intervention Technologies Research Articles

Using the Intervention Mapping and Behavioral Intervention Technology Frameworks: Development of an mHealth Intervention for Physical Activity and Sedentary Behavior Change.

Few interventions to promote physical activity (PA) adapt dynamically to changes in individuals' behavior. Interventions targeting determinants of behavior are linked with increased effectiveness and should reflect changes in behavior over time. This article describes the application of two frameworks to assist the development of an adaptive evidence-based smartphone-delivered intervention aimed at influencing PA and sedentary behaviors (SB). Intervention mapping was used to identify the determinants influencing uptake of PA and optimal behavior change techniques (BCTs). Behavioral intervention technology was used to translate and operationalize the BCTs and its modes of delivery. The intervention was based on the integrated behavior change model, focused on nine determinants, consisted of 33 BCTs, and included three main components: (1) automated capture of daily PA and SB via an existing smartphone application, (2) classification of the individual into an activity profile according to their PA and SB, and (3) behavior change content delivery in a dynamic fashion via a proof-of-concept application. This article illustrates how two complementary frameworks can be used to guide the development of a mobile health behavior change program. This approach can guide the development of future mHealth programs.

Using technology to enhance and expand interventions for couples and families: Conceptual and methodological considerations.

Technological advances provide tremendous opportunities for couple and family interventions to overcome logistical, financial, and stigma-related barriers to treatment access. Given technology's ability to facilitate, augment, or at times even substitute for face-to-face interventions, it is important to consider the appropriate role of different technologies in treatment and how that may vary across specific instances of technology use. To that end, this article reviews the potential contributions of telemental health (aka, telehealth; e.g., videoconferencing to remotely deliver real-time services) and asynchronous behavioral intervention technologies (BITs; e.g., apps, web-based programs) for couple and family interventions. Design considerations-such as software and hardware requirements and recommendations, characteristics of intended users, ways to maximize engagement, and tips for integrating therapists/coaches-are included for both types of technology-based intervention. We also present suggestions for the most effective recruitment and evaluation strategies for technology-based couple and family interventions. Finally, we present legal and ethical issues that are especially pertinent when integrating technology into couple and family interventions. (PsycINFO Database Record

Health behavior models for informing digital technology interventions for individuals with mental illness.

Theoretical models offer valuable insights for designing effective and sustainable behavioral health interventions, yet the application of theory for informing digital technology interventions for people with mental illness has received limited attention. We offer a perspective on the importance of applying behavior theories and models to developing digital technology interventions for addressing mental and physical health concerns among people with mental illness. In this commentary, we summarize prominent theories of human behavior, highlight key theoretical constructs, and identify opportunities to inform digital health interventions for people with mental illness. We consider limitations with existing theories and models, and examine recent theoretical advances that can specifically guide development of digital technology interventions. Established behavioral frameworks including health belief model, theory of planned behavior, transtheoretical model, and social cognitive theory consist of important and overlapping constructs that can inform digital health interventions for people with mental illness. As digital technologies continue to evolve and enable longitudinal data collection, real-time behavior monitoring, and adaptive features tailored to users' changing needs over time, there are new opportunities to broaden our understanding of health behaviors and mechanisms of behavior change. Recent advances include dynamic models of behavior, persuasive system design, the behavioral intervention technology model, and behavioral models for just-in-time adaptive interventions. Behavior theories offer advantages for guiding use of digital technologies. Future researchers must explore how theoretical models can effectively advance efforts to develop, evaluate, and disseminate digital health interventions targeting individuals with mental illness. (PsycINFO Database Record

The Evolution of Personalized Behavioral Intervention Technology: Will It Change How We Measure or Deliver Rehabilitation?

Telehealth access, mobile communication, instrumented devices, and wearable sensing technologies can be configured by internet connectivity to hover like an invisible personal drone, curating continuous data about physical activity, mental state, and physiology, even body and environmental chemistry, during everyday life.1,2 The figurative drone can gather ground truth via direct observation of disabled persons after a stroke during their daily activities or rehabilitation practice, then transmit measurements of interest to clinicians and researchers with high accuracy in real time. The technology can be configured to ask about and record in-the-moment self-reports about mood, pain, social interaction, activity, and other personal events. After stroke, it can enable patients to receive rehabilitation in their homes and communities when little or no therapy would otherwise be available. Telerehabilitation includes tools for standard telemedicine in which personalized health care is delivered at a distance by, for example, videoconferencing. Mobile health (mHealth) supports these remote interactions between patients and clinicians with smartphone-based text messaging, video streaming, e-mail, health-related apps, and other wireless technologies, such as wearable motion and heart rate sensors. Instrumented exercise and practice devices with radio connectivity to the internet can also stream a record of training and progress. The conceptual bases for such applications to outpatient rehabilitation and clinical trials are subsumed under the motor learning theory that dominates stroke rehabilitation practices. That is, an adequate dose of repetitive practice at relevant tasks that are increasingly challenging and optimized by behavioral reinforcement, along with exercise for strengthening and conditioning, will best support training-induced neuroplasticity and potentially improve outcomes.3 Usual outpatient rehabilitation tends not to offer feedback and relies on informal or ordinal measures of progress. Feedback from multidimensional mHealth monitoring technologies may better motivate and guide compliance, training intensity, and progression when therapists incorporate sensor-derived ground truth about …

Ecological momentary interventions for depression and anxiety.

Ecological momentary interventions (EMIs) are becoming more popular and more powerful resources for the treatment and prevention of depression and anxiety due to advances in technological capacity and analytic sophistication. Previous work has demonstrated that EMIs can be effective at reducing symptoms of depression and anxiety as well as related outcomes of stress and at increasing positive psychological functioning. In this review, we highlight the differences between EMIs and other forms of treatment due to the nature of EMIs to be deeply integrated into the fabric of people's day-to-day lives. EMIs require unique considerations in their design, deployment, and evaluation. Furthermore, given that EMIs have been advanced by changes in technologies and that the use of behavioral intervention technologies for mental health has been increasing, we discuss how technologies and analytics might usher in a new era of EMIs. Future EMIs might reduce user burden and increase intervention personalization and sophistication by leveraging digital sensors and advances in natural language processing and machine learning. Thus, although current EMIs are effective, the EMIs of the future might be more engaging, responsive, and adaptable to different people and different contexts.

Mobile Application to Promote Adherence to Oral Chemotherapy and Symptom Management: A Protocol for Design and Development.

BackgroundOral chemotherapy is increasingly used in place of traditional intravenous chemotherapy to treat patients with cancer. While oral chemotherapy includes benefits such as ease of administration, convenience, and minimization of invasive infusions, patients receive less oversight, support, and symptom monitoring from clinicians. Additionally, adherence is a well-documented challenge for patients with cancer prescribed oral chemotherapy regimens. With the ever-growing presence of smartphones and potential for efficacious behavioral intervention technology, we created a mobile health intervention for medication and symptom management.ObjectiveThe objective of this study was to develop and evaluate the usability and acceptability of a smartphone app to support adherence to oral chemotherapy and symptom management in patients with cancer.MethodsWe used a 5-step development model to create a comprehensive mobile app with theoretically informed content. The research and technical development team worked together to develop and iteratively test the app. In addition to the research team, key stakeholders including patients and family members, oncology clinicians, health care representatives, and practice administrators contributed to the content refinement of the intervention. Patient and family members also participated in alpha and beta testing of the final prototype to assess usability and acceptability before we began the randomized controlled trial.ResultsWe incorporated app components based on the stakeholder feedback we received in focus groups and alpha and beta testing. App components included medication reminders, self-reporting of medication adherence and symptoms, an education library including nutritional information, Fitbit integration, social networking resources, and individually tailored symptom management feedback. We are conducting a randomized controlled trial to determine the effectiveness of the app in improving adherence to oral chemotherapy, quality of life, and burden of symptoms and side effects. At every stage in this trial, we are engaging stakeholders to solicit feedback on our progress and next steps.ConclusionsTo our knowledge, we are the first to describe the development of an app designed for people taking oral chemotherapy. The app addresses many concerns with oral chemotherapy, such as medication adherence and symptom management. Soliciting feedback from stakeholders with broad perspectives and expertise ensured that the app was acceptable and potentially beneficial for patients, caregivers, and clinicians. In our development process, we instantiated 7 of the 8 best practices proposed in a recent review of mobile health app development. Our process demonstrated the importance of effective communication between research groups and technical teams, as well as meticulous planning of technical specifications before development begins. Future efforts should consider incorporating other proven strategies in software, such as gamification, to bolster the impact of mobile health apps. Forthcoming results from our randomized controlled trial will provide key data on the effectiveness of this app in improving medication adherence and symptom management.Trial RegistrationClinicalTrials.gov NCT02157519; https://clinicaltrials.gov/ct2/show/NCT02157519 (Archived by WebCite at http://www.webcitation.org/6prj3xfKA)

Integrating human support into behavioral intervention technologies: The efficiency model of support.

Integrating human support into behavioral intervention technologies: The efficiency model of support.

Integrating Human Support Into Behavioral Intervention Technologies: The Efficiency Model of Support

A growing number of interventions use websites, mobile applications, and wearable devices to deliver and enhance mental health treatments. These technologies are used more often and are more effective when provided along with human support. Integrating human support, however, requires developed models for providing this support. This article presents the Efficiency Model of Support, a new model for understanding the provision of human support in the context of behavioral intervention technologies. The Efficiency Model of Support defines the ratio of benefit accrued from an intervention to resources devoted to it as a critical consideration in support provision. The Efficiency Model of Support serves to consolidate the current findings and guide future research and practice with regard to human support and technology.

Supplemental Material for Integrating Human Support Into Behavioral Intervention Technologies: The Efficiency Model of Support

Supplemental Material for Integrating Human Support Into Behavioral Intervention Technologies: The Efficiency Model of Support

Design and evaluation of a peer network to support adherence to a web-based intervention for adolescents

BackgroundDepression during adolescence is common but can be prevented. Behavioral intervention technologies (BITs) designed to prevent depression in adolescence, especially standalone web-based interventions, have shown mixed outcomes, likely due to poor intervention adherence. BIT research involving adults has shown that the presence of coaches or peers promotes intervention use. Developmentally, adolescence is a time when peer-based social relationships take precedence. This study examines whether peer-networked support may promote adherence to BITs in this age group. ObjectiveAdopting the framework of the Supportive Accountability model, which defines the types of human support and interactions required to maintain engagement and persistence with BITs, this paper presents a feasibility study of a peer-networked online intervention for depression prevention among adolescents. We described the development of the peer network, the evaluation of participant use of the peer networking features, and qualitative user feedback to inform continued BIT development. MethodTwo groups of adolescents (N=13) participated in 10-week programs of the peer networked based online intervention. Adolescents had access to didactic lessons, CBT based mood management tools, and peer networking features. The peer networking features are integrated into the site by making use expectations explicit, allow network members to monitor the activities of others, and to supportively hold each other accountable for meeting use expectations. The study collected qualitative feedback from participants as well as usage of site features and tools. ResultsParticipants logged in an average of 12.8 sessions over an average of 10.4 unique days during the 10-week program. On average, 66% of all use sessions occurred within the first 3weeks of use. The number of “exchange comments”, that is, comments posted that were part of an exchange between two or more participants, was significantly positively correlated with mean time spent on site (r=0.62, p=0.032), use of the Activity Tracker (r=0.70, p=0.012) and Didactic Lesson (r=0.73, p=0.007). Qualitative interviews revealed that adolescents generally liked and were motivated by the peer networking features during the first weeks of the intervention when general site use by group members was high. However, the decrease of site use by group members during the subsequent weeks negatively affected participants' desire to log on or engage with group members. ConclusionsThis pilot study highlights the potential that a BIT designed to harness the connection among a peer network, thereby promoting supportive accountability, may improve adolescent adherence to BITs for depression prevention.

"Kind and Grateful": A Context-Sensitive Smartphone App Utilizing Inspirational Content to Promote Gratitude.

BackgroundPrevious research has shown that gratitude positively influences psychological wellbeing and physical health. Grateful people are reported to feel more optimistic and happy, to better mitigate aversive experiences, and to have stronger interpersonal bonds. Gratitude interventions have been shown to result in improved sleep, more frequent exercise and stronger cardiovascular and immune systems. These findings call for the development of technologies that would inspire gratitude. This paper presents a novel system designed toward this end.MethodsWe leverage pervasive technologies to naturally embed inspiration to express gratitude in everyday life. Novel to this work, mobile sensor data is utilized to infer optimal moments for stimulating contextually relevant thankfulness and appreciation. Sporadic mood measurements are inventively obtained through the smartphone lock screen, investigating their interplay with grateful expressions. Both momentary thankful emotion and dispositional gratitude are measured. To evaluate our system, we ran two rounds of randomized control trials (RCT), including a pilot study (N = 15, 2 weeks) and a main study (N = 27, 5 weeks). Studies’ participants were provided with a newly developed smartphone app through which they were asked to express gratitude; the app displayed inspirational content to only the intervention group, while measuring contextual cues for all users.ResultsIn both rounds of the RCT, the intervention was associated with improved thankful behavior. Significant increase was observed in multiple facets of practicing gratitude in the intervention groups. The average frequency of practicing thankfulness increased by more than 120 %, comparing the baseline weeks with the intervention weeks of the main study. In contrast, the control group of the same study exhibited a decrease of 90 % in the frequency of thankful expressions. In the course of the study’s 5 weeks, increases in dispositional gratitude and in psychological wellbeing were also apparent. Analyzing the relation between mood and gratitude expressions, our data suggest that practicing gratitude increases the probability of going up in terms of emotional valence and down in terms of emotional arousal. The influences of inspirational content and contextual cues on promoting thankful behavior were also analyzed: We present data suggesting that the more successful times for eliciting expressions of gratitude tend to be shortly after a social experience, shortly after location change, and shortly after physical activity.ConclusionsThe results support our intervention as an impactful method to promote grateful affect and behavior. Moreover, they provide insights into design and evaluation of general behavioral intervention technologies.

Using Behavioral Intervention Technologies to Help Low-Income and Latino Smokers Quit: Protocol of a Randomized Controlled Trial.

BackgroundThe Institute for International Internet Interventions for Health at Palo Alto University proposes to develop digital tools specifically to help low-income English- and Spanish-speaking smokers to quit. Individuals from lower-income countries and those with lower social status quit at lower rates than those from high-income countries and those with higher social status.ObjectiveWe plan to launch a project designed to test whether a mobile-based digital intervention designed with systematic input from low-income English- and Spanish-speaking smokers from a public-sector health care system can significantly improve its acceptability, utilization, and effectiveness.MethodsUsing human-centered development methods, we will involve low-income patients in the design of a Web app/text messaging tool. We will also use their input to improve our recruitment and dissemination strategies. We will iteratively develop versions of the digital interventions informed by our human-centered approach. The project involves three specific aims: (1) human-centered development of an English/Spanish smoking cessation web app, (2) improvement of dissemination strategies, and (3) evaluation of resulting smoking cessation web app. We will develop iterative versions of a digital smoking cessation tool that is highly responsive to the needs and preferences of the users. Input from participants will identify effective ways of reaching and encouraging low-income English- and Spanish-speaking smokers to use the digital smoking cessation interventions to be developed. This information will support ongoing dissemination and implementation efforts beyond the grant period. We will evaluate the effectiveness of the successive versions of the resulting stop smoking Web app by an online randomized controlled trial. Increased effectiveness will be defined as increased utilization of the Web app and higher abstinence rates than those obtained by a baseline usual care Web app.ResultsRecruitment will begin January 2016, the study is intended to be completed by summer 2018, and the results should be available by fall 2019.ConclusionsThis study will provide useful knowledge in developing, testing, and disseminating mobile-based interventions for low-income smokers.ClinicalTrialClinicalTrials.gov NCT02666482; https://clinicaltrials.gov/ct2/show/NCT02666482 (Archived by WebCite at http://www.webcitation.org/6gtcwaT28)

Behavioral Intervention Technologies and Psychotherapy with Youth: A Review of the Literature

The dominant model of delivering psychological interventions is face-to-face (F2F) in oneto- one psychotherapy. Behavioral Intervention Technologies (BITs) may have the capacity to expand delivery models and/or increase the outcomes of therapy. This article is a systematic review of the available literature on BITs for children and adolescents with DSM-5 mental health diagnoses. All articles on EBSCOhost published between 1st January 2000 and 31st December 2014 referencing terms related to youth, BITs, and therapy were collected for analysis (n=7179). After inclusion/exclusion criteria were applied, 53 articles were included in the review, discussing BIT interventions for Anxiety, Depression, Obsessive-Compulsive Disorder, Attention-Deficit/Hyperactivity Disorder, Conduct Disorder, and Oppositional Defiant Disorder. The review found general support for BITs as interventions for child and adolescent disorders. Limitations of the current research and suggestions for future directions are discussed. Keywords: Adolescents, behavioral intervention technologies, children, interventions, psychotherapy, systematic review.

A review of design characteristics of cognitive behavioral therapy-informed behavioral intervention technologies for youth with depression and anxiety

ObjectiveCognitive behavioral therapy (CBT) has the strongest evidence base for the prevention and treatment of depression and anxiety in youth. Behavioral intervention technologies (BITs) provide an opportunity to overcome access barriers to traditional delivery of CBT. The present review evaluates the design characteristics of CBT-informed BITs for depression and anxiety designed for and tested with youth.MethodsA state-of-the-art review of three library databases (PubMed, Scopus, and Web of Science) was conducted to identify papers that evaluated the use of CBT-informed BITs for the prevention and/or treatment of depression and anxiety among youth. Narrative results of design characteristics were organized using the BIT model, which provides a framework for design and evaluation.Results219 unique results were retrieved through the search. After review, 14 papers (4 prevention and 10 treatment) met the selection criteria. A broad diversity occurred in reporting the design and methodology of CBT delivered to youth through BITs. Psychoeducation was overwhelmingly utilized as the primary change strategy throughout the interventions, with a heavy use of content delivery elements and linear workflows. The reporting of sample characteristics was minimal and varied.ConclusionsProviding psychoeducation via content delivery was the most utilized BIT change strategy in the interventions, likely limiting the use of multiple BIT elements or flexible workflows. While characterizations could be inferred from the current reports, the high level of variability in reporting is problematic. Generalizability becomes increasingly more difficult to carry out effectively without clear descriptions of the design for evaluated BITs.

Meta-analysis on cognitive behavioral treatment and behavioral intervention technologies for anxious youth: more than a BIT effective

Meta-analysis on cognitive behavioral treatment and behavioral intervention technologies for anxious youth: more than a BIT effective

Trials of Intervention Principles: Evaluation Methods for Evolving Behavioral Intervention Technologies.

In recent years, there has been increasing discussion of the limitations of traditional randomized controlled trial (RCT) methodologies for the evaluation of eHealth and mHealth interventions, and in particular, the requirement that these interventions be locked down during evaluation. Locking down these interventions locks in defects and eliminates the opportunities for quality improvement and adaptation to the changing technological environment, often leading to validation of tools that are outdated by the time that trial results are published. Furthermore, because behavioral intervention technologies change frequently during real-world deployment, even if a tested intervention were deployed in the real world, its shelf life would be limited. We argue that RCTs will have greater scientific and public health value if they focus on the evaluation of intervention principles (rather than a specific locked-down version of the intervention), allowing for ongoing quality improvement modifications to the behavioral intervention technology based on the core intervention principles, while continuously improving the functionality and maintaining technological currency. This paper is an initial proposal of a framework and methodology for the conduct of trials of intervention principles (TIPs) aimed at minimizing the risks of in-trial changes to intervention technologies and maximizing the potential for knowledge acquisition. The focus on evaluation of intervention principles using clinical and usage outcomes has the potential to provide more generalizable and durable information than trials focused on a single intervention technology.

Web-based interventions for ulcerative colitis and Crohn's disease: systematic review and future directions.

Behavioral intervention technologies (BITs), the application of psychological and behavioral interventions through the use of technology, provide the opportunity for clinicians to deliver care through a means that overcomes a number of treatment barriers. Web-based interventions are a subset of BITs developing as promising alternatives to face-to-face delivery of treatments and monitoring for patients with ulcerative colitis (UC) and Crohn’s disease (CD). A systematic review of literature resulted in five empirical studies of web-based interventions for UC and CD. Additionally, an informal search of a popular search engine yielded limited, currently available, web-based interventions for patients with UC and CD. Despite being an ideal population for the development and dissemination of online interventions, patients with UC and CD have far less treatment options compared to other behavioral health concerns. However, given the growing body of research involving web-based interventions for other conditions, researchers and clinicians targeting UC and CD management and treatment have the benefit of being able to utilize the BIT model, an existing conceptual framework for the development of web-based interventions for both conditions. The BIT model is presented and applied to the treatment of UC and CD, as well as a technology development program, Purple, and usability guidelines to guide clinical researchers in the future development, evaluation, and dissemination of BITs for patients with UC and CD.

Purple: a modular system for developing and deploying behavioral intervention technologies.

The creation, deployment, and evaluation of Web-based and mobile-based applications for health, mental health, and wellness within research settings has tended to be siloed, with each research group developing their own systems and features. This has led to technological features and products that are not sharable across research teams, thereby limiting collaboration, reducing the speed of dissemination, and raising the bar for entry into this area of research. This paper provides an overview of Purple, an extensible, modular, and repurposable system created for the development of Web-based and mobile-based applications for health behavior change. Purple contains features required to construct applications and to manage and evaluate research trials using these applications. Core functionality of Purple includes elements that support user management, content authorship, content delivery, and data management. We discuss the history and development of the Purple system guided by the rationale of producing a system that allows greater collaboration and understanding across research teams interested in investigating similar questions and using similar methods. Purple provides a useful tool to meet the needs of stakeholders involved in the creation, provision, and usage of eHealth and mHealth applications. Housed in a non-profit, academic institution, Purple also offers the potential to facilitate the diffusion of knowledge across the research community and improve our capacity to deliver useful and usable applications that support the behavior change of end users.

Behavioral intervention technologies for positive psychology: Introduction to the special issue

"Behavioral intervention technologies for positive psychology: Introduction to the special issue." The Journal of Positive Psychology, 9(6), pp. 475–476

Positive impact by design: The Wales Centre for Behaviour Change

The Wales Centre for Behaviour Change is a research project that aims to integrate positive psychology with emerging technologies and behavioral science to promote prosperity and well-being. The behavioral focus emphasizes choice architectures and environmental triggers in their influence on positive change. This paper describes the background for this project, as well the theory and design of the center and its work. We review behavioral intervention technologies that the center is employing, or plans to employ, to augment the decision-making capabilities of its target audience. Technologies can be positioned in the behavioral stream to reduce complexity and distraction and in so doing help individuals make optimal decisions.