Feedback Messages Research Articles

ERevis(ing): Students’ revision of text evidence use in an automated writing evaluation system

Abstract We investigate students’ implementation of the feedback messages they received in an automated writing evaluation system (eRevise) that aims to improve students’ use of text evidence in their writing. Seven 5th and 6th-grade teachers implemented eRevise (n = 143 students). Qualitative analysis of students’ essays across first and second drafts suggests that the majority of students made changes to their essays that were in line with the feedback they received, though few of these changes resulted in substantive improvement in essay quality. Twenty percent of students did not attempt to implement the feedback; these students generally made small changes to wording or mechanics. In response to the feedback to add more evidence, students whose essays did not improve or showed only slight improvement frequently added in evidence that was not text based or repeated evidence already present in the first draft. When prompted to explain how the evidence they included connected to their claim, many students paraphrased the evidence, added a short conclusion, or explained generally how the evidence supports claims (not how this was instantiated in their writing). Implications for teaching argument writing and for designing AWE systems that support students to successfully revise their essays are discussed.

The SMARTER Trial: Design of a trial testing tailored mHealth feedback to impact self-monitoring of diet, physical activity, and weight

BackgroundSelf-monitoring food intake and physical activity (PA) is positively related to weight loss and the addition of feedback (FB) messages has been shown to reinforce behavior change. Moreover, the more immediate the delivery of reinforcing FB messages, the more likely they will promote the desired behaviors. PurposeDescribe design and rationale of SMARTER, a National Institute of Heart, Lung, and Blood (NHLBI)-sponsored randomized, controlled trial, which compares the differential efficacy of two weight loss treatments among 530 adults, ages 18 and older. MethodsSingle-site, 2-group design trial with subjects randomized 1:1 to either: 1) self-monitoring (SM), where participants self-monitor diet, PA, and weight using a commercial smartphone application (app); or 2) SM + FB, where participants self-monitor and receive real-time, tailored feedback (FB) as pop-up messages up to 3 times/day for 12 months. Daily FB messages address diet and PA behaviors and a weekly FB message addresses self-weighing. We hypothesize that subjects assigned to SM + FB will show greater weight loss at 6 and 12 months and greater sustained engagement in the program than the SM group, measured by adherence to the study's lifestyle and SM protocol. We will explore temporal relationships of the frequency, timing, and type of FB delivered and subsequent lifestyle behaviors through examination of serially collected real-time SM (diet, PA, weight) data over 12 months. ConclusionsIf efficacious, this fully scalable intervention could be efficiently translated and disseminated to reach large numbers of individuals through commercial apps at lower cost than existing in-person weight loss programs.

Using Persuasive Systems Design Model to Evaluate "Cuida tu Ánimo": An Internet-Based Pilot Program for Prevention and Early Intervention of Adolescent Depression.

Background: “Cuida tu Ánimo” (CTA [Take Care of Your Mood]) is an internet-based program for prevention and early intervention of adolescent depression implemented in Chile and Colombia. In the pilot application of the program, participants interacted with the program through a website that provided psychoeducational information, chat, and telephone appointments as well as monitoring and feedback messages. To date, most similar programs were not developed taking design features into consideration. The persuasive systems design (PSD) model is a comprehensive framework developed to aid in the design and evaluation of systems capable of influencing users' attitudes or behaviors. The purpose of this study was to evaluate the persuasiveness of CTA pilot program using the PSD model.Methods: The methodology used was expert evaluation, where specialists evaluate the program against a list of design principles.Results: Although the PSD model was not used to design the program, system features proposed by PSD were present, mainly “Dialogue support” features. Persuasion context analysis was not carried out by the developers. No aspects of the program could be related to “Primary task support” features because the developers did not define a primary task.Discussion: Key aspects of the PSD model could be incorporated in the CTA program to enhance system persuasiveness and improve adherence.

Reputation transferability across contexts: Maintaining cooperation among anonymous cryptomarket actors when moving between markets

BackgroundBuyers and sellers of illegal drugs in cryptomarkets have been found to overcome trust issues created by anonymity and the lack of legal protection with the help of reputation systems. Cryptomarkets rarely operate for longer than a year before closing or getting shut down due to external shocks, such as law enforcement operations. This results in large flows of users migrating between market platforms. An important question in order to better understand why cryptomarkets recover quickly after external shocks is: to what extent can reputation be carried over between different markets? This problem is non-trivial given the anonymity of cryptomarket users and the fact that reputation is tied to a user's online identity. Here we analyze conditions under which sellers choose to migrate with the same identity and whether reputation history from previous cryptomarkets yields benefits in new contexts. MethodsWe analyze sellers’ migration in three cryptomarkets (Abraxas, Agora and AlphaBay) and follow their reputation history by linking user accounts between marketplaces using the Grams database. We use longitudinal multi-level regression models to compare market success of migrant and non-migrant sellers. In total, the data contains more than 7,500 seller account and 2.5 million buyers’ reputational feedback messages over a period of 3 years. FindingsIt is predominantly the successful sellers with a large number of sales and high reputation who choose to migrate and maintain their identity using cryptographic methods after market closures. We find that reputation history from previous markets creates a competitive advantage to migrant sellers compared to market entrants. ConclusionReputation transferability embeds cryptomarket users beyond a single market platform, which incentivizes cooperative behavior. The results also suggest that reputation transferability might contribute to a quick recovery of online drug trade after shutdowns and accumulation of market share in the hands of a small fraction of successful sellers.

Feedback and Mobile Instant Messaging: Using WhatsApp as a Feedback Tool in EFL

Feedback and Mobile Instant Messaging: Using WhatsApp as a Feedback Tool in EFL

Participant engagement with a text message delivered intervention for weight loss and maintenance of weight loss in the postpartum period

AbstractIntroduction: Postpartum weight management is difficult for many mothers due to the demands of parenthood. Women have highlighted a need for support but experience barriers to engaging with lifestyle interventions hence more adaptable approaches are required. This work examined participants’ engagement with a 12-month, theory-based, automated, text message (SMS) delivered, intervention supporting postpartum weight management.Methods: SMS content was informed by: 1) the ‘Health Action Process Approach’ (HAPA)1; 2) behaviour change techniques associated with effectiveness in weight management interventions2; 3) women's accounts of postpartum weight-related experiences; and 4) personal and public involvement. A two-arm pilot RCT recruited women within two years postpartum, with a BMI ≥ 25 kg/m2, through community sources and social media. Women were randomised via a secure remote system to receive the intervention or an active control delivering child development messages. Participants received 353 messages during the 12 month intervention. Two-way messages were used to assess engagement: 50 messages prompted women to respond with their weight; 36 interactive messages requested participants’ to respond ‘Yes/No’ to a question which then triggered a feedback message. Participant engagement with two-way messages was calculated as a percentage of replies sent by women and was categorised as ‘high’ or ‘low’ according to the median number of replies sent. Weight was measured at 0, 3, 6, 9 and 12 months.Results: 51 of 100 women recruited were randomised to receive the intervention. In months 0–6, (47%) and (95%) of participants responded to the weight messages and the ‘Yes/No’ messages respectively. In months 7–12, the responses were (77%) and (86%) respectively. Participants who were high engagers with weight messages had greater mean weight loss compared with low engagers at all time points: at 12 months high engagers (n = 18) lost -2.66 kg and had a reduction in waist circumference at 12 months of -8.9 cm, compared to changes in low engagers (n = 18) of -0.84 kg and -3.6 cm. Likewise, high engagers with ‘Yes/No’ messages had greater mean weight loss compared with low engagers at all time points: at 12 months high engagers (n = 16) lost -2.87 kg and had a reduction in waist circumference of -9.4 cm, compared to changes in low engagers (n = 20) of -0.86 kg and -3.6 cm.Discussion: The use of two-way text messages was a useful way to encourage engagement with this SMS-delivered intervention. Higher engagement resulted in more weight loss compared to low engagement.

An energy-cyber-physical system for personalized normative messaging interventions: Identification and classification of behavioral reference groups

Within residences, normative messaging interventions have encouraged households to engage in various pro-environmental behaviors. In norm-based intervention campaigns, it is hypothesized that more personally relevant reference groups increase norm adherence, thus improving the effectiveness of normative messaging interventions. Advanced energy grid infrastructure, such as smart meters and cloud computing, enables the creation of highly personalized behavioral reference groups in a non-invasive manner by dynamically classifying households into highly similar user groups based on usage patterns. Unfortunately, it remains unclear how readily available data on household energy use and housing characteristics affect the classification performance of dynamic behavioral reference groups. Therefore, this research evaluates the classification performance of dynamic behavioral reference groups using readily available data. An energy-cyber-physical system for personalized normative messaging interventions is trained and tested using one-year of energy use data from 2248 households in Holland, Michigan. Dynamic behavioral reference group classification proved very accurate, 94.7–95.9% for weekly feedback and 89.9–93.1% for monthly feedback using only readily available data. In addition, using more historical energy use data contributes to enhancing classification accuracy. Lastly, high classification performance for each behavioral reference group is achieved at 97.6% of precision, recall and F1-score. With the proposed system, it is possible to dynamically assign highly personalized behavioral reference groups to households every billing cycle even if behavioral patterns are subject to change. Thus, interveners will be able to deploy personalized normative feedback messages on a large scale.

Warm elaborated feedback. Exploring its benefits on post-feedback behaviour

This study provides evidence on the impact of including warm messages in elaborated feedback. These messages are aimed at the motivational process that can be mobilised by feedback and that which can condition its reception and the way students face the task (post-feedback behaviour). In a task where secondary school students had to learn a new strategy for improving their reading skills in a computer-based environment, we compared the use of elaborated feedback with the use of elaborated feedback enhanced with motivational messages (warm elaborated feedback) and a control condition (without feedback). The results showed that students receiving warm elaborated feedback revisited the text more often than those receiving only the elaborated feedback, and that both groups revisited the text more than the control group. This finding suggests that controlling the motivational aspects in feedback messages may increase the effectiveness of elaborated feedback.

An Investigation of High School Students’ Errors in Introductory Programming: A Data-Driven Approach

This study implemented a data-driven approach to identify Chinese high school students’ common errors in a Java-based introductory programming course using the data in an automated assessment tool called the Mulberry. Students’ error-related behaviors were also analyzed, and their relationships to success in introductory programming were investigated. This study identified 15 common compilation errors and 6 common test errors. The results showed that these common errors accounted for a large proportion of all errors, so identifying the common errors is important to help students succeed in introductory programming courses. Based on these common errors, five underlying student difficulties were identified and are discussed. In addition, after analyzing existing measures of students’ error-related behaviors, we developed a measure called improvement rate to quantify students’ success in fixing errors. The results of our study suggest that students’ competence of improving code is important to their success in introductory programming. We recommend researchers design and develop automated assessment tools that provide feedback messages for common student errors and instructors who explicitly teach knowledge and skills of improving code in class.

Assessment of the Efficacy, Safety, and Effectiveness of Weight Control and Obesity Management Mobile Health Interventions: Systematic Review.

BackgroundThe use of apps to tackle overweight and obesity by tracking physical and dietary patterns and providing recommendations and motivation strategies to achieve personalized goals has increased over recent years. However, evidence of the efficacy, effectiveness, and safety of these apps is severely lacking.ObjectiveThe aim of this study was to identify efficacy, safety, and effectiveness criteria used to assess weight control, overweight, and obesity management in mobile health (mHealth) interventions through a systematic review.MethodsPubMed, PsycINFO, Scopus, UK Trial Database, ClinicalTrials.gov, and the Cochrane Library were surveyed up to May 2018. All types of clinical studies were considered. A total of 2 independent reviewers assessed quality using Scottish Intercollegiate Guidelines Network (SIGN) criteria. Ratings were used to provide an overall score for each study (low, moderate, or high). Data were synthesized in evidence tables.ResultsFrom 233 potentially relevant publications, only 28 studies were included. Of these, 13 (46%) were randomized control trials, 11 were single-arm studies (39%), 3 were nonrandomized controlled trials (11%), and 1 study was a cluster randomized trial (4%). The studies were classified as low (15), high (7), and moderate (6) quality according to SIGN criteria. All studies focused on efficacy, with only 1 trial mentioning safety and another 1 effectiveness. In 11 studies, the apps were used as stand-alone interventions, the others were multicomponent studies that included other tools for support such as sensors or websites. The main management tool included in the apps was feedback messaging (24), followed by goal-setting mechanisms (20) and self-monitoring (19). The majority of studies took weight or body mass index loss as the main outcome (22) followed by changes in physical activity (14) and diet (12). Regarding outputs, usability, adherence, and engagement (17) were the most reported, followed by satisfaction (7) and acceptability (4).ConclusionsThere is a remarkable heterogeneity among these studies and the majority have methodological limitations that leave considerable room for improvement. Further research is required to identify all relevant criteria for assessing the efficacy of mHealth interventions in the management of overweight and obesity.Trial RegistrationPROSPERO CRD42017056761; https://tinyurl.com/y2zhxtjx

Exploring group interactions in synchronous mobile computer-supported learning activities

This paper presents the results of a study of synchronous mobile computer-supported collaborative learning (mCSCL) that emphasized levels of pre-structuring in the context of primary school participants who need more guidance to benefit from the collaborative work. The male and female participants, who were, on average, 8-year-old primary school students, used Internet-connected mobile devices to work synchronously in small groups on mathematics tasks. The study examined two mCSCL interaction modes. In the first mode, each group member is assigned a role, and should have completed one part of the task before the group members negotiated their solutions. In the second mode, all group members completed parts of the task individually, and then negotiated their solutions to progress through the activity. The two interaction modes were compared in terms of student task completion attempts and incorrect completion attempts. The study results are of medium to large effect size and indicated that for tasks of lower difficulty, task distribution using roles led to statistically significantly more incorrect task completion attempts compared to the design without roles. For tasks of greater difficulty, there were more incorrect task completion attempts in groups with no explicit distribution of work compared to the groups with roles. The design of synchronous mCSCL technology emphasizes the importance of state preservation mechanisms, synchronization mechanisms, and immediate feedback messages. Practical implications of this study are that teachers must actively consider the type of mCSCL design they choose when preparing their mobile collaborative lessons, and choose an adequate design for the planned task difficulty level.

Feedback messaging, thermal comfort and usage of office-based personal comfort systems

Psychological processes are involved in human thermal comfort evaluation, and play a role in people's judgement of their thermal environment. Could these processes be beneficially managed in some way? This paper reports what is believed to be the first investigation of whether messaging, in the form of energy feedback and social normative information, can affect human subjective thermal comfort-related evaluations. Work was conducted in a controlled environmental room, the context being that of a multi-occupant office with messaging being delivered to individuals via a computer screen on each desk. Investigations were conducted for a range of warm office conditions (24.5 °C, 27 °C, 29.5 °C, as might be encountered in summertime). Experimental sessions of two hours’ duration were undertaken for: no messaging; messaging appearing at the second hour; messaging present at first hour then removed at second hour. A total of 62 subjects (23 female and 39 male) took part, with all (except one) of the thermal conditions that involved messaging being experienced by 9 participants.The appearance of energy feedback and social normative messaging was found to have a statistically-significant effect on reported thermal sensations, reported thermal comfort and reported intended desk fan usage, these being observed at the higher end of the temperature range, but had no effect on other subjective evaluations. Presence, then removal, of messaging showed no significant effects, as did an effective ‘control group’ comparison. Whilst effects were observed on certain subjective thermal evaluations at the higher temperatures, these were at the 95% confidence level, and it is recommended that a larger scale study be undertaken to confirm, or otherwise, these observations.The study offers a method that can be followed for future investigations under controlled conditions, and serves to design further, larger-scale, experiments, to investigate actual usage of personal comfort systems and the role of messaging in this context. Implications of any ‘intervention-type’ influences (of which ‘messaging’ could be an example) on subjective evaluations, if confirmed, may open a new way to help manage human thermal comfort and energy use in offices or similar environments, but this will require further careful consideration, particularly from the perspective of human health and well-being, prior to any deployment in practice.

Attitudes and Response to a Smartphone-Based Digital Pill Intervention to Enhance PrEP Adherence Among Men Who Have Sex With Men With Stimulant Use

Background Digital pills contain a radiofrequency emitter and gelatin capsule that over-encapsulate a study medication. The radiofrequency emitter, activated by the chloride ion gradient in the stomach, transmits a signal to a wearable Reader device following ingestion. The Reader relays ingestion data to a smartphone app and cloud-based server, allowing for real-time verification of ingestion events and adherence measurement. Digitized pre-exposure prophylaxis (PrEP) may improve outcomes in populations with suboptimal adherence related to substance use. Stimulant use is particularly prevalent among men who have sex with men (MSM) and is associated with increased HIV risk behavior and transmission. We conducted seven focus groups with MSM who use stimulants (N=16) to inform the development of PrEPsteps, a novel smartphone-based adherence intervention respondent to data from digitized PrEP and designed to augment adherence. Objective To inform the specification of the design, content, and delivery of the smartphone-based PrEPsteps adherence system via focus groups with HIV-negative MSM who use stimulants. Methods Seven focus groups were conducted with HIV-negative MSM reporting stimulant use (eg, cocaine, methamphetamine) in the past six months. Participants self-reported medical history, substance use and sexual activity. Focus groups explored responses to digital pill technology, willingness and barriers to use, content and timing of adherence messaging, and three intervention components: (1) abbreviated cognitive behavioral therapy (CBT) adherence counseling (LifeSteps); (2) contingent reinforcement/corrective feedback; and (3) substance use-related Screening, Brief Intervention and Referral to Treatment (SBIRT). Focus groups were transcribed and analyzed using applied thematic analysis. Results Sixteen individuals participated in focus groups. All were male; age ranged from 24 to 63 (mean 39.9, SD 14.1) and most self-identified as gay (N=13). Participants were primarily non-Hispanic or Latino (N=12); 10 identified as white, two as black, and four as multiracial. Most had at least a college degree (N=14). Twelve participants were taking PrEP, 5 of whom reported missed doses in the past two weeks. Number of sexual partners in the past three months ranged from 1 to 200 (M=28.1; SD=50.9). Fifteen participants reported using stimulants during the last 30 days. Participants viewed digital pills as a tool to enhance PrEP adherence and accountability. They expressed a willingness to use the digital pill and identified physicians, family members, and partners as people with whom they would share adherence data. The Reader was viewed as the most difficult technological component to use, although participants also described the device as itself an adherence reminder. Participants identified customizability as a valuable aspect of the technology; message and reminder content, structure, and scheduling were all considered customizable. With regard to the intervention, participants were accepting of and willing to interact with corrective feedback messages linked to a brief CBT LifeSteps booster session. Conclusions PrEPsteps, a smartphone-based adherence intervention, was viewed as acceptable by HIV-negative MSM who use stimulants. Individuals perceived corrective feedback notifications to be the most helpful component of the system, and expressed a strong preference for customizability across the intervention.

ERevise: Using Natural Language Processing to Provide Formative Feedback on Text Evidence Usage in Student Writing

Writing a good essay typically involves students revising an initial paper draft after receiving feedback. We present eRevise, a web-based writing and revising environment that uses natural language processing features generated for rubricbased essay scoring to trigger formative feedback messages regarding students’ use of evidence in response-to-text writing. By helping students understand the criteria for using text evidence during writing, eRevise empowers students to better revise their paper drafts. In a pilot deployment of eRevise in 7 classrooms spanning grades 5 and 6, the quality of text evidence usage in writing improved after students received formative feedback then engaged in paper revision.

A joint optimization method of coding and transmission for conversational HD video service

Multipath transmission is considered to be a promising approach for supporting data delivery of conversational high-definition (HD) video service as it is able to aggregate more transmission resources, increase the reliability of data transmission, and thereby improve the user experience of service. However, most research achievements of multipath video transmission have mainly concentrated on the efficiency of video delivery while less attention has been paid to the dynamic video bit rate adjustment which is also important to improving the quality of such video service. To take full advantage of multipath video transmission, this paper presents a joint optimization method for conversational HD video service, taking into account the linkage between video coding and transmission. In the aspect of the video coding, a region rate based perceptual coding scheme is applied by the combination usage of the characteristics of such video service, which aims to adapt the output bit rate to match the dynamic network conditions. The scheme allocates different coding frequency or rate for different regions in a video frame according to their perceptual importance dynamically, and then skips some unimportant regions and encodes the key regions. Moreover, a multipath load distribution method is adopted to optimize the transmission process which schedules the coded frames over multiple paths by employing the capacity-limited water filling (CLWF) algorithm, to meet the stringent delay requirements of conversational HD video service. Furthermore, the transmission quality of each path is assessed and the coding parameters are adjusted periodically according to the data transmission status and feedback messages. Experiments are carried out with a simulation in OMNeT++ and the results demonstrate that the proposed method performs much better than the existing schemes in terms of data transmission and playback quality.

Using Targeted Feedback to Address Common Student Misconceptions in Introductory Programming: A Data-Driven Approach

With the expansion of computer science (CS) education, CS teachers in K-12 schools should be cognizant of student misconceptions and be prepared to help students establish accurate understanding of computer science and programming. Digital tools, such as automated assessment systems, can be useful and supportive in teaching CS courses. This two-stage design-based research (DBR) study investigated the effects of targeted feedback in an automated assessment system for addressing common misconceptions of high school students in a Java-based introductory programming course. Based on students’ common errors and underlying misconceptions, targeted feedback messages were designed and provided for students. The quantitative analysis found that with targeted feedback students were more likely to correct the errors in their code. The qualitative analysis of students’ solutions revealed that when improving the code, students receiving feedback made fewer intermediate incorrect solutions. In other words, the targeted feedback messages may help to promote conceptual change and facilitate learning. Although the findings of this exploratory study showed evidence of the power of digital tools, more research is needed to make technology benefit more CS teachers.

Abstract 2428: New school health care: Utilizing technology in the treatment and support of women with breast cancer in the ambulatory setting

Abstract Background Adjuvant endocrine therapies (AETs) (e.g. tamoxifen and aromatase inhibitors (AIs) are almost always prescribed to early stage breast cancer (BrCa) patients as AETs have been shown to reduce risk of recurrence and mortality for women with hormone receptor-positive early stage breast cancer. Despite proven efficacy and patient education efforts, AET adherence is suboptimal. Most patients report symptom burden as the most common cause for non-adherence. We conducted focus groups among this patient population to aid in the refinement of a communication app for patients to report symptoms to their healthcare team and receive tailored feedback messages. The app aims to improve AET adherence, symptom management, and quality of life. Method Four focus groups (N=28), stratified by race (Black and White) and patient length of time on AET ( < 6 months AET use or > 6 months AET use), were conducted in Memphis, Tennessee. The focus groups were audiotaped, transcribed, and analyzed to identify key themes. Results Participants indicated they would be open to utilizing technology throughout their cancer treatment. The app was viewed as a conduit in the exchange of information between the patient and their healthcare team. Even patients who typically did not use or “like” technology thought the messages and symptom management information would be beneficial. Reporting symptoms through the app and then receiving a phone call from their healthcare team to respond to those symptoms was viewed as the most beneficial component to the patients. One participant stated how she could see the benefit of the symptom reporting feature when first initiating AET therapy: “There were times when I wanted to go tell my doctor, “STOP THIS MEDICINE RIGHT NOW, find me something else to do, find something else besides this because this stuff is not working for me.” In regards to the tailored feedback messaging through the app, participant stated, “I like the one that says, ‘Take meds regularly is an effective way to prevent cancer from coming back,’ because for me that is the only reason why I take it SOME days just to make sure that it doesn’t come back because I HATE the stuff.” Conclusions Early stage hormone receptor positive breast cancer patients may benefit from utilizing technology in the management of their care. The use of a communication app with tailored feedback messaging has the potential to increase medication adherence, improve symptom management and quality of life, improve the provider- patient relationship, and ultimately reduce mortality. As healthcare shifts toward focusing on patient-centered care and preparing patients to manage their care at home, apps like the one examined in the current study may play a vital role in helping these and other patient populations. Citation Format: Tameka N. Jones, Andrew J. Paladino, Gregory A. Vidal, Rebecca Krukowski, J. Carolyn Graff, Ryan Blue, Ilana Graetz, Lee Schwartzberg, Mehmet Kocak, Janeane Anderson. New school health care: Utilizing technology in the treatment and support of women with breast cancer in the ambulatory setting [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2428.

On the performance of OPC UA and MQTT for data exchange between industrial plants and cloud servers

The Internet of Things (IoT) is a key technology in the development of Industry 4.0. An increasing number of new industrial devices are expected to communicate with each other by means of local (edge) and cloud computing servers. In this article, two well-known protocols used for IoT and Industrial IoT (IIoT) are compared in terms of their performance when they are used to send/receive data to/from cloud servers. Due to their wide diffusion and suitability, the considered protocols are open platform communication-unified architecture publisher-subscriber (OPC UA PubSub) (purposely developed and maintained by industrial consortia) and message queuing telemetry transport (MQTT), the most well-known message protocol originally developed by IBM. The performance comparison is carried out considering the overall quantity of the data transferred (user payload plus overhead) and the roundtrip time required to send in data and receive a feedback message in return. The experimental results include the evaluation of several cloud computing server and application scenarios, highlighting how each protocol is particularly suitable for certain situations. Finally, conclusions about the best choice for data exchange between devices are given.

The Feasibility of a Using a Smart Button Mobile Health System to Self-Track Medication Adherence and Deliver Tailored Short Message Service Text Message Feedback.

BackgroundAs many as 50% of people experience medication nonadherence, yet studies for detecting nonadherence and delivering real-time interventions to improve adherence are lacking. Mobile health (mHealth) technologies show promise to track and support medication adherence.ObjectiveThe study aimed to evaluate the feasibility and acceptability of using an mHealth system for medication adherence tracking and intervention delivery. The mHealth system comprises a smart button device to self-track medication taking, a companion smartphone app, a computer algorithm used to determine adherence and then deliver a standard or tailored SMS (short message service) text message on the basis of timing of medication taking. Standard SMS text messages indicated that the smartphone app registered the button press, whereas tailored SMS text messages encouraged habit formation and systems thinking on the basis of the timing the medications were taken.MethodsA convenience sample of 5 adults with chronic kidney disease (CKD), who were prescribed antihypertensive medication, participated in a 52-day longitudinal study. The study was conducted in 3 phases, with a standard SMS text message sent in phases 1 (study days 1-14) and 3 (study days 46-52) and tailored SMS text messages sent during phase 2 (study days 15-45) in response to participant medication self-tracking. Medication adherence was measured using: (1) the smart button and (2) electronic medication monitoring caps. Concordance between these 2 methods was evaluated using percentage of measurements made on the same day and occurring within ±5 min of one another. Acceptability was evaluated using qualitative feedback from participants.ResultsA total of 5 patients with CKD, stages 1-4, were enrolled in the study, with the majority being men (60%), white (80%), and Hispanic/Latino (40%) of middle age (52.6 years, SD 22.49; range 20-70). The mHealth system was successfully initiated in the clinic setting for all enrolled participants. Of the expected 260 data points, 36.5% (n=95) were recorded with the smart button and 76.2% (n=198) with electronic monitoring. Concordant events (n=94), in which events were recorded with both the smart button and electronic monitoring, occurred 47% of the time and 58% of these events occurred within ±5 min of one another. Participant comments suggested SMS text messages were encouraging.ConclusionsIt was feasible to recruit participants in the clinic setting for an mHealth study, and our system was successfully initiated for all enrolled participants. The smart button is an innovative way to self-report adherence data, including date and timing of medication taking, which were not previously available from measures that rely on recall of adherence. Although the selected smart button had poor concordance with electronic monitoring caps, participants were willing to use it to self-track medication adherence, and they found the mHealth system acceptable to use in most cases.

Use of financial incentives and text message feedback to increase healthy food purchases in a grocery store cash back program: a randomized controlled trial

BackgroundThe HealthyFood (HF) program offers members up to 25% cash back monthly on healthy food purchases. In this randomized controlled trial, we tested the efficacy of financial incentives combined with text messages in increasing healthy food purchases among HF members.MethodsMembers receiving the lowest (10%) cash back level were randomized to one of six arms: Arm 1 (Usual Care): 10% cash back, no weekly text, standard monthly text; Arm 2: 10% cash back, generic weekly text, standard monthly text; Arm 3: 10% cash back, personalized weekly text, standard monthly text; Arm 4: 25% cash back, personalized weekly text, standard monthly text; Arm 5: 10 + 15%NET cash back, personalized weekly text, standard monthly text; and, Arm 6: 10 + 15%NET cash back, personalized weekly text, unbundled monthly text. In the 10 + 15%NET cash back, the cash back amount was the baseline 10% plus 15% of the net difference between healthy and unhealthy spending. The generic text included information on HF and healthy eating, while the personalized text had individualized feedback on purchases. The standard monthly text contained the cash back amount. The unbundled monthly text included the amount lost due to unhealthy purchases. The primary outcome was the average monthly percent healthy food spending. Secondary outcomes were the percent unhealthy food spending, and the percent healthy and unhealthy food items.ResultsOf the members contacted, 20 opted out, and 2841 met all inclusion criteria. There were no between-arm differences in the examined outcomes. The largest mean (standard deviation) difference in percent healthy spending was between Arm 1 (24.8% [11%]) and Arm 2 (26.8% [13%]), and the largest mean difference in percent unhealthy spending was also between Arm 1 (24.4% [20%]) and Arm 2 (21.7% [17%]), but no differences were statistically significant after correction for multiple comparisons.ConclusionsNone of the tested financial incentive structures or text strategies differentially affected food purchasing. Notably, more than doubling the cash back amount and introducing a financial disincentive for unhealthy purchases did not affect purchasing. These findings speak to the difficulty of changing shopping habits and to the need for innovative strategies to shift complex health behaviors.Trial registrationNCT02486588 Increasing Engagement with a Healthy Food Benefit. The trial was prospectively registered on July 1, 2015.