Self-directed Use Research Articles

Timeframe for lymphedema therapy for head and neck cancer survivors.

e13535 Background: More than 90% of head and neck cancer (HNC) survivors experience secondary head and neck lymphedema. Prompt identification and treatment are essential given the progressive nature of lymphedema and potential complications. Usual care includes complete decongestive therapy performed by a lymphedema therapist followed by lifelong home self-care. The ability to participate in lymphedema therapy (LT) is deleteriously impacted by numerous barriers. We are conducting a phase 3 multisite randomized trial involving HNC survivors with treatment-naïve lymphedema which compares usual lymphedema care to the use of an advanced pneumatic compression device (APCD). For patients treated on the usual care arm, data pertaining to LT delivery was collected prospectively. Herein we report the preliminary analysis from this dataset. Methods: Eligible patients were age ≥18 years, had pathologically confirmed HNC, completed curative intent cancer therapy with no evidence of active cancer, were diagnosed with internal or external head and neck lymphedema with at least one core lymphedema associated symptom and had not previously received treatment for lymphedema. Participants were randomized to either usual care with complete decongestive therapy directed by a lymphedema therapist followed by home self-care or daily self-directed use of APCD. Anatomic measurements and patient reported outcome measures were obtained at 2-, 4- and 6-month endpoints. The intervention phase lasted 6 months and therapy records were received for analysis. Key outcome measures included the time from referral to LT evaluation consultation, time from LT evaluation to treatment session and time from referral to treatment session. Results: At the time of this analysis, 87 participants randomized to usual care arm were eligible for inclusion in this assessment. Of the 87 patients, we were unable to document completion of LT consultation or therapy for 39 patients. Among the 48 participants who were referred for LT and received therapy, 72% were male and 28% were female, with 91% identifying as white, 7% as black, and 2% as other. The average age was 62. The mean time from referral by a health care provider to initial lymphedema consultation was 19.6 (σ 18.1) days. Of note, there was a wide-ranging timeframe from referral to LT treatment, varying from 0 to 93 days. The mean time from consultation to treatment was 1.7 days (σ 5.1) and referral to treatment was 21.3 (σ 17.8). Conclusions: A key finding of this study is the high rate (45%) of those referred for LT were not documented to complete a therapy consultation or to receive therapy. Of those patients who receive therapy, consultation and treatment were delay significantly in a high percentage of patients. These finding highlight the need for additional investigation into barriers to timely implementation of LT for head and neck cancer survivors. Guidelines and standards of care should be developed to guide practitioners. Clinical trial information: NCT04797390 .

Precision computerised cognitive behavioural therapy (cCBT) for adolescents with depression: a pilot and feasibility randomised controlled trial protocol for SPARX-UK

BackgroundA serious game called SPARX (Smart, Positive, Active, Realistic, X-factor thoughts), originally developed in New Zealand and incorporating cognitive behavioural therapy (CBT) principles, has been shown to help reduce symptoms of depression and anxiety in adolescents with mild to moderate depression in studies undertaken in Australasia. However, SPARX has never been trialled in the United Kingdom (UK), and there have been issues relating to low engagement when it has been used in a real-world context.AimsTo conduct the first pilot and feasibility randomised controlled trial (RCT) in England to explore the use of SPARX in different settings. The trial will explore whether SPARX supported by an e-coach (assistant psychologists) improves adherence and engagement compared with self-directed (i.e. self-help) use. The trial results will be used to inform the optimal mode of delivery (SPARX supported vs. SPARX self-directed), to calculate an appropriate sample size for a full RCT, and to decide which setting is most suitable.MethodsFollowing consultation with young people to ensure study suitability/appropriateness, a total of 120 adolescents (11–19 years) will be recruited for this three-arm study. Adolescents recruited for the study across England will be randomised to receive either SPARX with human support (from an e-coach), self-directed SPARX, or a waitlist control group. Assessments will be conducted online at baseline, week 4, and 8–10-week post-randomisation. The assessments will include measures which capture demographic, depression (Patient Health Questionnaire modified for adolescents [PHQ-A]) and anxiety (Revised Child Anxiety and Depression Scale [RCADS]) symptomatology, and health-related quality-of-life data (EQ-5D-Y and proxy version). Analyses will be primarily descriptive. Qualitative interviews will be undertaken with a proportion of the participants and clinical staff as part of a process evaluation, and the qualitative data gathered will be thematically analysed. Finally, feasibility data will be collected on recruitment details, overall study uptake and engagement with SPARX, participant retention, and youth-reported acceptability of the intervention.DiscussionThe findings will inform the design of a future definitive RCT of SPARX in the UK. If the subsequent definitive RCT demonstrates that SPARX is effective, then an online serious game utilising CBT principles ultimately has the potential to improve the provision of care within the UK’s health services if delivered en masse.Trial registrationISRCTN: ISRCTN15124804. Registered on 16 January 2023, https://www.isrctn.com/ISRCTN15124804.

Impact of self-directed exercise intervention in a minority rich, hematopoietic stem cell transplant (HSCT) inpatient population at high risk for sarcopenia and falls.

390 Background: Extended hospitalizations in the adult HSCT population increase patients’ risk for deconditioning and sarcopenia. Sarcopenia negatively impacts overall survival in adult HSCT patients (Armenian et al, 2019) and is strongly associated with falls among older adults (Yeung et al, 2019; Marques A & Queirós C., 2018; Wheatley et al, 2021). Methods: In a safety net, minority rich, academic medical center in suburban NYC, stationary pedals were placed inside patient rooms in a 31-bedded inpatient HSCT unit starting Q4 2020. Intentional, inpatient room placement prevented additional risk of infectious exposures to COVID-19 in late 2020-2021, allowed for safe access to pedals from a seated position in chairs inside patient rooms, and provided insight into self-directed exercise participation. Attending MDs, PAs and RNs encourage HSCT patients to utilize stationary pedals up to 3 times daily, while usage remains self-directed. Direct observation of patient pedal usage and patient-verbalized interest in participation reflects positive acceptance and consistent usage since implementation. Results: 2019-2023 Midas Event Reporting data was reviewed by the author. Total numbers of Weak/Impaired Gait patient falls decreased in the post-implementation period: 19 falls at baseline versus 13 falls in 2021, 11 falls in 2022, and 3 falls in Q1 2023. Pre-intervention 2019 data indicates 63.3% of falls are among Weak/Impaired Gait patients. (2020 falls data is not included due to unit closures during the COVID-19 pandemic). Post-intervention 2021-2023 data reveals a mean of 51.2% of falls are in Weak/Impaired Gait patients, indicating a 12.1% decline in falls in the post-intervention period of 2.25 years. Conclusions: Sarcopenia and inpatient falls impact patient outcomes (i.e., injuries, extended hospitalizations, and survival) and are financially burdensome. Each inpatient fall, whether injurious or not, costs hospitals approximately 35,000 (Dykes et al, 2023). Reductions in numbers of inpatient falls at this institution are potentially associated with the following hospital cost savings: 210K in 2021, 280K in 2022 and a projected 245K in 2023. Reduction in sarcopenia during extended hospitalizations, when reviewed alongside the financial impact of inpatient falls, supports the ongoing implementation of self-directed exercises in this population. Next steps include self-directed use of resistance bands, chair-based and bed-based stretches, and utilizing self-tracking devices to record exercise duration. (Full references available upon request).

A study on factors influencing Chinese undergraduate EFL learners' self-directed use of mobile English learning resources.

This study aimed to examine the factors that potentially impact the self-directed use of mobile English learning resources (MELR). The participants were 206 Chinese undergraduate EFL learners at Yangzhou University in Mainland China. Applying and modifying the Unified Theory of Acceptance and Use of Technology (UTAUT), this study involved six constructs, including students' performance expectancy, effort expectancy, social influence, facilitating conditions, perceived playfulness, and behavioral intention to use MELR. The structural equation modeling (SEM) technique was adopted to analyze the data collected from the questionnaire. The findings showed that facilitating conditions acted as the most significant predictor of behavioral intention to adopt MELR, followed by effort expectancy, perceived playfulness, and performance expectancy. However, social influence did not have significant effects on students' use of MELR. Pedagogical implications for teachers and students were also presented in the end.

Adaptation and outcomes of a lay-guided mental health self-care model: Results of six trials

ObjectiveTo synthesize results of six controlled trials of self-care interventions for depression and/or anxiety, focusing on five trials in which lay guidance was compared to self-directed use of the same self-care tools. MethodsThe trials were conducted in Canada in different target populations. Self-care tools were adapted to each population. Guidance was provided in 3–15 calls over a period of 6–26 weeks. Depression and/or anxiety were assessed at follow-up (6–26 weeks). Pooled analyses used a meta-analytic approach. Engagement with the self-care tools was compared using the standardized difference or Cohen's d effect size. ResultsIn studies with homogeneous outcomes (three for depression, four for anxiety), the pooled effect sizes of guidance vs. self-directed use of the self-care tools were 0.36 (95% CI 0.10, 0.62, N = 235) for depression and 0.21 (95% CI -0.03, 0.44, N = 285) for anxiety. Guidance consistently led to greater engagement with the tools. ConclusionsThe intervention model is a potentially sustainable and accessible alternative to professionally guided self-care for people with mild-moderate depression. Factors which may have limited implementation success include: co-interventions, reduced number of guide calls (3 vs 6 or more), and delivery to dyads (patient-caregiver).

Technology-Enabled Intervention to Enhance Mindfulness, Safety, and Health Promotion Among Corrections Professionals: Protocol for a Prospective Quasi-Experimental Trial.

Correction professionals are a highly stressed workforce with heightened risks for depression, suicide, obesity, cardiovascular disease, and injury. These professionals, largely hidden from view, have received little study concerning means to improve their safety, health, and well-being. In other settings, mindfulness has resulted in lowered stress, along with other benefits. We hypothesized that a program that promoted mindfulness combined with more typical health and safety components could uniquely benefit corrections professionals. This project will assess a novel scalable, self-administered program to enhance the mindfulness, safety, and health of a vulnerable worker group. In partnership with the Oregon Department of Corrections, we are conducting a prospective quasi-experimental trial of a safety, health, and mindfulness program among 100 corrections professionals from 2 institutions. Survey and physiologic data will be collected at enrollment, upon weekly program completion (3 months), and at 9 months after enrollment. Primary outcome behaviors promoted by the program are being mindful, healthier eating, more physical activity, and greater restorative sleep. Secondary downstream benefits are anticipated in stress level, mood, positive feelings about the organization, vascular health, and cellular aging, along with job performance, injuries, and economic costs. Participants will meet in-person or in a Zoom-type meeting as 3- to 5-member coworker groups during their usual work hours for 30-minute sessions once a week for 12 weeks. The program uses self-guided web-based learning modules that include brief mindfulness practice, and it is accessible by smartphone, tablet, or laptop. Daily mindfulness practice is encouraged between sessions, which is facilitated by the study website and group format. The modules' structure emphasizes prerequisite knowledge, peer support, skill practice, self-monitoring, and enhancing self-efficacy for change. The program continues through self-directed use of the Headspace app following the 12 weekly sessions. Participants are being enrolled, and the intervention is ready to launch. Although mindfulness training has gained traction for worker well-being, its usual format requires a skilled trainer, an initial retreat, and weekly 2-hour meetings for several weeks. The content is limited to mindfulness without safety or health promotion aspects. The need for skilled trainers and time commitment limits the scalability of the usual mindfulness interventions. The planned program is an innovative combination of technology, e-learning, and a group format to add mindfulness to a safety and health curriculum. If acceptable and effective, the format would facilitate its widespread use. ClinicalTrials.gov NCT05608889; https://classic.clinicaltrials.gov/ct2/show/NCT05608889. PRR1-10.2196/45535.

Using an electronic safety netting tool designed to improve safety with respect to cancer referral in primary care: a qualitative service evaluation using rapid appraisal methods

BackgroundThis evaluation assesses the impact of an electronic safety netting software (E-SN) package, C the Signs, in primary care services across five boroughs in North East London (NEL).AimThis study evaluates...

Motivation in self-directed use of technology for English learning among high, average, and low achievers

Adopting a multi-theoretical perspective, this study examined how various motivational factors from three dominant motivational theories of volitional behaviors related to undergraduates' self-directed technology use for English learning, and how the relationships varied among high, average, and low achievers. Confirmatory factor analysis results supported a holistic model of nine motivational factors that drive these learners' self-directed technology use for English learning. The study found that motivational factors from different motivational perspectives drove different aspects of self-regulation with technology. Specifically, constructs from the theory of planned behaviors were essential to drive resource and metacognitive management; goal orientation constructs were the salient motivators of learners' use of technology for emotion management to maintain vigor for learning; and constructs from all three theoretical perspectives were critical to drive learners’ use of technology for goal setting and social regulation. Moreover, the motivational drive for self-directed technology use for English learning varied for learners of different proficiency levels. The findings suggest different motivational factors need to be attended to when encouraging and supporting the use of technology for the regulation of different aspects of English learning and among learners of different language proficiencies.

Internet sourcing and unsafe use of controlled drugs (opioids, sedatives and GABA drugs) in the UK: An in depth case study of consumer dynamics during COVID-19

The Internet offers increased availability and accessibility of medicinal pharmaceuticals including those containing opioids, sedatives and gamma-aminobutyric acid (GABA) drugs through both legal and illegal routes. Sourcing concerns have been further heightened due to the current severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic which reduced face-to-face access for non-COVID-19 related health conditions and to drug treatment services. This study is the second of a two stage study comprising interviews with three key stakeholders who were policy makers, health care professionals or police, and three individuals who sourced medicinal products online (ISOs). An in-depth case study approach was adopted. Thematic analysis of in-depth case narratives revealed the following key themes; Motivations, initiation, and making the move online; Process of sourcing online; Supply issues and COVID-19; Perception of control; Quality of medications; and Public health recommendations. Motivations for purchasing online are complex and methods to divert and control the supply of medicinal pharmaceuticals are equally complex and difficult to navigate. Novel routes to access now include Telegram, a cross-platform messaging service with enhance encryption and privacy. Whilst stakeholders and ISOs had similar views on the prevalence and ease of access to medication, there were also some substantial differences primarily in terms of perceptions of risk. This study highlights the need for enhanced pharmacovigilance of non-regulated online vendors and the imperatives of continued health messaging around the potential self-directed use of these controlled drugs and the dangers of using websites purporting to be regulated pharmacies.

Protocol for a randomised controlled trial evaluating the effectiveness of a CBT-based smartphone application for improving mental health outcomes in adolescents: the MobiliseMe study

BackgroundDepression is a leading cause of disability in adolescents, however few receive evidence-based treatment. Despite having the potential to overcome barriers to treatment uptake and adherence, there are very few CBT-based smartphone apps for adolescents. To address this gap, we developed ClearlyMe®, a self-guided CBT smartphone app for adolescent depression and anxiety. ClearlyMe® consists of 37 brief lessons containing core CBT elements, accessed either individually or as part of a ‘collection’. Here, we describe the protocol for a randomised controlled trial aiming to evaluate the effect of ClearlyMe® on depressive symptoms and secondary outcomes, including engagement, anxiety and wellbeing, when delivered with and without guided support compared to an attention matched control.MethodsWe aim to recruit 489 adolescents aged 12-17 years with mild to moderately-severe depressive symptoms. Participants will be screened for inclusion, complete the baseline assessment and are then randomly allocated to receive ClearlyMe® (self-directed use), ClearlyMe® with guided SMS support (guided use) or digital psychoeducation (attention-matched control). Depressive symptoms and secondary outcomes will be assessed at 6-weeks (primary endpoint) and 4-months post-baseline (secondary endpoint). Engagement, conceptualised as uptake, adherence and completion, will also be assessed 6-weeks post-baseline. Mixed-effects linear modelling will be used to conduct intention-to-treat analyses to determine whether reductions in depressive symptoms and secondary outcomes are greater for conditions receiving ClearlyMe® relative to control at 6-weeks and 4-months post-baseline and greater for intervention adherers relative to non-adherers. To minimise risk, participants will be encouraged to use the Get Help section of the app and can also opt to receive a call from the team clinical psychologist at baseline, and at the 6-week and 4-month post-baseline assessments when reporting suicidal ideation.DiscussionThis is the first clinical trial examining a CBT smartphone app specifically designed for adolescent depression. It will provide empirical evidence on the effects of ClearlyMe® on depressive symptoms when used with and without guided support.Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12622000131752).Universal trial numberU1111-1271-8519.

The benefits, challenges and impacts of accessing social media group support for breastfeeding: A systematic review.

Breastfeeding support is a key component in meeting the public health responsibility of increasing breastfeeding rates, with access to individualised, convenient and linked support across services central to improved outcomes. With the rise of new technology and the COVID‐19 pandemic, social media (SM) support for breastfeeding has become increasingly popular and it is important to understand how and why mothers access such support, and from whom, to optimise services and to meet mothers’ needs. Increasing research is building on women's use and experience of SM for breastfeeding, although there is a paucity of UK data. This systematic review aimed to understand the impacts of SM support for breastfeeding, including benefits and challenges, to establish the evidence for wider provision within maternity services. The search was limited to studies published in English and focused on the self‐directed use of social media groups for breastfeeding (defined as platforms that facilitate group support via interactivity, allowing for user‐generated content and subsequent responses). Of 327 papers retrieved, 13 studies were included for review. The six themes identified were: breastfeeding context, including factors impacting women's decision making; the relational impact of belonging to an online community; increased self‐efficacy; critiques of SM; the nature and types of support commonly sought and received; and breastfeeding duration as an outcome. The findings confirm that mothers value SM groups for community support, which normalises breastfeeding and provides the support they attribute to improved outcomes, and highlight that UK research focused on provision linked to wider services is needed.

The Relationship between Gross Anatomy Performance and the Learning and Study Strategies Inventory (LASSI) Among Physician Assistant Students

BackgroundSelf‐regulated learning (SRL) is defined as the processes that one carries out to accomplish goals through self‐directed use of specific strategies. In essence, it involves how someone becomes the master of their own learning processes and comprises behaviors of skill, will, and self‐regulation. Evidence supports that high levels of SRL are correlated with better grades and higher academic achievement. Tools exist to measure SRL in higher education, with the Learning and Study Strategies Inventory (LASSI) being one such tool (Weinstein et al., 2016). It is a 60‐item inventory that measures 10 subscales including motivation, anxiety, test strategies, time management, and selecting main ideas.ObjectiveThis study aims to address whether there is a correlation between LASSI subscales and gross anatomy performance in a sample of physician assistant (PA) students. While growing numbers of medical and dental programs utilize the LASSI to examine SRL, its use in allied health student populations has not been explored extensively. I hypothesized that there is a positive relationship with anatomy performance and LASSI scales such as motivation, test taking skills, and use of academic resources and a negative relationship with anxiety.MethodsFirst year students enrolled in a physician assistant program were invited to participate in the study during the second semester of their first year, following the completion of a four‐credit gross anatomy course and other basic science coursework taken during the first semester of the first year. The timing of LASSI administration was chosen as it was thought to more accurately reflect their SRL as a PA student, as opposed to administration upon program entry when it would measure their SRL prior to graduate school. It was a programmatic requirement to complete the LASSI, however participation and use of educational records in the study was voluntary, with written consent given. Spearman correlation was used to evaluate the association between the LASSI subscales and the average grade of four sets of exams (written and practical), as well as final grade. Analyses were performed using SPSS Version 27 and significance level was set at p<0.05.ResultsA total of 49 students completed the LASSI and 5 students opted out of the study, rendering an 89.8% response rate (n=44). Two LASSI subscales had significant positive correlations with anatomy performance 1) test strategies: exam 1 (r=.618, p<0.01), exam 2 (r=.451, p<0.01), exam 3 (r=.343, p<0.05), exam 4 (r=.325, p<0.01), and final anatomy grade (r=.502, p<0.01) and 2) selecting main ideas: exam 1 (r=.374, p<0.05).Conclusion and ImplicationsThe hypothesis that anatomy performance would be negatively correlated with anxiety and positively correlated with test strategies and other LASSI subscales was partially supported. This preliminary study reveals that only two LASSI subscales had significant positive correlations with anatomy performance: test strategies and selecting main ideas. Anxiety did not have a significant correlation with anatomy performance. It is unsurprising that a relationship exists between test‐taking strategies and anatomy grades, and the strength of this relationship decreased as students progressed through the semester. This research suggests that explicit instruction of test taking skills, SRL, and metacognitive awareness early in the curriculum may improve anatomy performance.

Evaluating knowledge and utilization of community health resources to promote autonomous decision-making among people experiencing homelessness in New Orleans

ABSTRACT People experiencing homelessness encounter barriers to self-directed community health resource use that may limit autonomous decision-making. Tailored educational material is needed to increase knowledge, promote well-informed resource access, and improve community health system navigability. This study aimed to 1) assess homeless individuals' baseline knowledge and utilization of community health resources and 2) evaluate use of a pocket-sized resource guide. Participants (N = 103) were recruited at a no-cost medical clinic in New Orleans to complete pre- and post-surveys assessing knowledge and utilization of community health resources listed on the guide. Over a third (38.8%) of participants indicated having low knowledge of resources at baseline. Utilization of resources varied substantially, ranging from a majority (66.7%) to a select few (6.9%) participants reporting attendance at sites. Among participants who completed the follow-up survey, self-rated knowledge of resources significantly increased (p = 0.029); however, the number of resources used in the past month slightly declined. These results may speak to participants who used the resource guides having an improved ability to selectively access resources for their specific needs. Interventions to improve health resource knowledge can, thus, aid more efficient and autonomous decision-making and are needed to improve community health system accessibility for populations experiencing homelessness.

What is “safety”?: Lethal means counseling as a cross-cultural communication

ABSTRACT U.S. suicide rates have risen every year over the past two decades with self-directed firearm use as the method accounting for the highest proportion of deaths. This pattern is particularly pronounced among veterans and members of the U.S. Armed Forces. The numerical burden of firearm-related suicide accompanied by characteristics of self-directed firearm injury have motivated the development of lethal means safety initiatives focused on firearms. Simultaneously, research has sought to characterize patterns of firearm ownership and use among veterans as well as optimal strategies for clinicians to deliver suicide prevention messages to firearm owners. Increasingly, findings from research have been understood as cultural factors that warrant greater attention to improve the quality of lethal means counseling. Here, we review and interpret selected research on cultural aspects of firearm ownership and suggest that cultural differences between health care practitioners and firearm owners may result in health care practitioners delivering clinical interventions that are broadly divergent from perspectives within the cultural frameworks of firearm owners. We follow by organizing these cultural factors into existing frameworks of cultural competency training as a basis for developing curriculum for health care practitioners to improve clinical care.

Web-Based Problem-solving Training With and Without Peer Support in Veterans With Unmet Mental Health Needs: Pilot Study of Feasibility, User Acceptability, and Participant Engagement.

BackgroundeHealth tools have the potential to meet the mental health needs of individuals who experience barriers to accessing in-person treatment. However, most users have less than optimal engagement with eHealth tools. Coaching from peer specialists may increase their engagement with eHealth.ObjectiveThis pilot study aims to test the feasibility and acceptability of a novel, completely automated web-based system to recruit, screen, enroll, assess, randomize, and then deliver an intervention to a national sample of military veterans with unmet mental health needs; investigate whether phone-based peer support increases the use of web-based problem-solving training compared with self-directed use; and generate hypotheses about potential mechanisms of action for problem-solving and peer support for future full-scale research.MethodsVeterans (N=81) with unmet mental health needs were recruited via social media advertising and enrolled and randomized to the self-directed use of a web-based problem-solving training called Moving Forward (28/81, 35%), peer-supported Moving Forward (27/81, 33%), or waitlist control (26/81, 32%). The objective use of Moving Forward was measured with the number of log-ins. Participants completed pre- and poststudy measures of mental health symptoms and problem-solving confidence. Satisfaction was also assessed post treatment.ResultsAutomated recruitment, enrollment, and initial assessment methods were feasible and resulted in a diverse sample of veterans with unmet mental health needs from 38 states. Automated follow-up methods resulted in 46% (37/81) of participants completing follow-up assessments. Peer support was delivered with high fidelity and was associated with favorable participant satisfaction. Participants randomized to receive peer support had significantly more Moving Forward log-ins than those of self-directed Moving Forward participants, and those who received peer support had a greater decrease in depression. Problem-solving confidence was associated with greater Moving Forward use and improvements in mental health symptoms among participants both with and without peer support.ConclusionsEnrolling and assessing individuals in eHealth studies without human contact is feasible; however, different methods or designs are necessary to achieve acceptable participant engagement and follow-up rates. Peer support shows potential for increasing engagement in web-based interventions and reducing symptoms. Future research should investigate when and for whom peer support for eHealth is helpful. Problem-solving confidence should be further investigated as a mechanism of action for web-based problem-solving training.Trial RegistrationClinicalTrials.gov NCT03555435; http://clinicaltrials.gov/ct2/show/NCT03555435

A case study of using Alexa for out-of-class, self-directed Japanese language learning

Intelligent personal assistants, otherwise known as virtual assistants, are artificial intelligence-powered conversational agents that utilize machine learning to understand and appropriately respond to user requests. In recent years, research interest on the use of this emerging technology for foreign language learning has increased. Several studies have examined the use of intelligent personal assistants for English as a foreign language learning. However, no study has studied intelligent personal assistants in the context of a non-English foreign language. Thus, this case study addressed this gap in the research by investigating the out-of-class, self-directed use of the intelligent personal assistant, Alexa, among six Japanese as a second language learners. The primary aim of the study was to better understand the experiences and perceptions of these learners when interacting with Alexa in the target language. According to an analysis of the participants’ usage history, it was found that the intelligent personal assistant could understand over 80% of the learners’ commands. When faced with a communication difficulty, the learners most often resorted to an abandonment of the previously misunderstood command, with rephrase and repeat strategies being used far less frequently. Concerning the learners’ opinions towards Alexa for autonomous foreign language learning, views were mostly positive. Namely, they believed interaction with Alexa was fun and supported their Japanese development. These results demonstrate that intelligent personal assistants have the potential to be a useful technology for self-directed foreign language learning for languages besides English.

Korean College Students’ Self-Directed Use of Machine Translator in an English Writing Class during the Digital Era: Is This a Crisis or a Chance?

The purpose of this research was to investigate how EFL college learners self-directed their English writing using MT in an English writing class. Specifically, this study focused on 1) What types of errors are identified the most frequently in the students’ writings?, 2) How those errors have been changed through the students’ self-directed revision process?, and 3) In what ways does this activity influence students’ perceptions toward English writing? The participants were six university students who took a 3-credit English writing class, and completed their writings using MT throughout the semester. The students’ written outcomes, in-depth interviews with them and results of writing tests were analyzed. The findings of data analysis indicated that first, the highest frequency of errors was seen in lexical errors at the rate of 65.5%, followed by morphological errors at the rate of 19.7%. Second, there has been a significant decrease in the overall types of errors between the first (35.0%) and second (20.9%) drafts, from the no-use of MT to the use of MT. Lastly, it can be said that the MT-assisted writing practice which took place during a short period of time had positive influence on students’ perceptions toward English writing. Implications for online classes in the Corona era are presented.

Self-directed Use of Digital Devices for Out-of-class English Learning

Twenty-first-century teaching and learning provide online resources accessible to foster learning experience across time and spaces in an informal context. Hence, enhancing learners’ voluntary adoption of digital devices is crucial to augment the promising assistance of technology for English language learning. This study sheds some light on English for Specific Purposes (ESP) learners’ voluntary digital devices for out-of-class language learning. A total of 267 Indonesian ESP learners participated in this study through a survey and semi-structured interview to examine how they were involved in informal digital learning of English beyond the classroom. The results showed that the learners used digital devices for both intentional learning to strengthen coursework and incidental learning to expand access to the target language. It was also found that the learners frequently employed digital devices for personalized aspects of the language rather than authenticity and connectivity. As for the digital device selection, the learners mostly preferred mobile phones to computers and tablets to carry out out-of-class English language activities. These results provide fruitful insights for educators on supporting ESP learners to engage in informal digital learning of English and achieve possible synchronicity between teachers' designed digital activities and learners' actual learning practices.

Becoming a process drama practitioner: An exploratory study of higher education language teachers in Japan

Research in language learning indicates that process drama (PD), an educational approach where students and teachers work in and out of role to explore themes and issues, can be well suited to the Japanese higher education (HE) context. Despite the benefits highlighted in the literature, PD remains a niche approach to language teaching and learning, with a limited number of practitioners in Japan. This study seeks to uncover language teachers’ experiences of becoming Process Drama Practitioners (PDPs) and using and sharing PD as an English language teaching approach in Japanese HE. Data were collected via in-depth interviews with six experienced PDPs. The findings indicate that prior positive experiences with drama was an encouraging factor of the adoption and self-directed initial use of PD in their teaching practices. Positive student outcomes and feedback were primary motivators for continued use of PD. Experiences of sharing PD led to a perceived need to distinguish PD from theatre-based approaches and establish connections to familiar approaches to language teaching.

The effect of initial support on fitness center use in new fitness center members. A randomized controlled trial

This provider and participant blinded parallel-group randomized controlled trial aimed to investigate if initial support given to new members via telephone and e-mail, compared to self-directed use, had an effect on booking with a fitness trainer, number of visits to the center, and membership duration. Participants included 356 new members, 174 randomized to the intervention group, and 182 to the control group. The intervention group received support to use the fitness center facilities through two phone calls and one e-mail over the first eight weeks of their membership. The control group got usual practice, which is self-directed use.Participants in the intervention group were more likely to book at least one session with a fitness trainer during the first six months (odds ratio 1.6, 95% confidence interval (CI) 1.0–2.5). However, the intervention did not influence the number of visits (mean difference after four years −11.7 days, 95% CI −34.8 to 11.3) or time to membership termination during the follow-up period (hazard ratio 1.1, 95% CI 0.8–1.3).In conclusion, initial support to use the fitness center facilities given to new fitness center members via telephone and e-mail increased the proportion of bookings with a fitness trainer during the first months of the membership, but it did not have an effect on the number of visits or membership termination during four years.