Self-monitoring Tools Research Articles

Longitudinal validation of a tool for asthma self-monitoring.

To establish longitudinal validation of a new tool, the Asthma Symptom Tracker (AST). AST combines weekly use of the Asthma Control Test with a color-coded graph for visual trending. Prospective cohort study of children age 2 to 18 years admitted for asthma. Parents or children (n = 210) completed baseline AST assessments during hospitalization, then over 6 months after discharge. Concurrent with the first 5 AST assessments, the Asthma Control Questionnaire (ACQ) was administered for comparison. Test-retest reliability (intraclass correlation) was moderate, with a small longitudinal variation of AST measurements within subjects during follow-ups. Internal consistency was strong at baseline (Cronbach's α 0.70) and during follow-ups (Cronbach's α 0.82-0.90). Criterion validity demonstrated a significant correlation between AST and ACQ scores at baseline (r = -0.80, P < .01) and during follow-ups (r = -0.64, -0.72, -0.63, and -0.69). The AST was responsive to change over time; an increased ACQ score by 1 point was associated with a decreased AST score by 2.65 points (P < .01) at baseline and 3.11 points (P < .01) during follow-ups. Discriminant validity demonstrated a strong association between decreased AST scores and increased oral corticosteroid use (odds ratio 1.13, 95% confidence interval, 1.10-1.16, P < .01) and increased unscheduled acute asthma visits (odds ratio 1.23, 95% confidence interval, 1.18-1.28, P < .01). The AST is reliable, valid, and responsive to change over time, and can facilitate ongoing monitoring of asthma control and proactive medical decision-making in children.

Longitudinal Validation of a Tool for Asthma Self-Monitoring

Longitudinal Validation of a Tool for Asthma Self-Monitoring

Development of a side-effect self-monitoring HOME notebook (HNB): Results from a single institution experience.

150 Background: Cancer treatments can be associated with distress and side effects. As therapies are often provided in ambulatory care settings, patients (Pts) have to manage related effects at home, without specialised real-time support. In some cases, Pts are also responsible of prescribed oral adiuvant therapy. In this study we present evaluation results of a self-monitoring and self-education tool to be included in clinical record. Methods: From Jan 2011 to Jan 2013, we enrolled 227 (114M, 113F) Pts new diagnosed with cancer, 204 entered the study, 23 refused. Pts received a note book (HNB) including 2 guidelines about alimentation and skin/mucous/sexuality, 1 daily diary. Pts were asked to complete diary recording side-effects and managing toxicities following the simple guidelines provided. Pts also had a self-administered questionnaire (SQ) to give opinion about tool. Two hundred and four diaries were given; 112 SQ collected. Start-up educational meetings were conducted to illustrate how to register symptoms on diary and monthly we monitored compliance by auditing. Results: SQ analysis shows the following. Average age was 65.14 (median 66); 55% were ≥65 yrs old; 50% received adiuvant treatment, 43% palliative. HNB was used by 33% Pts, 64% Pts and relatives, 3% relatives. 100% Pts say it’s very useful and 98% easy to understand/fill. Most usefull and consulted sections are: alimentation 42%, diary symptoms checklist 31%, skin/mucous/sexuality 25%. Alimentation 42% and diary 24% were the parts they would deepen. Most usefull suggestions about self-care were those on fatigue/decrease in appetite 54%, altered taste 27%, oral cavity inflammation 13%. Sixtynine Pts had nausea and find suggestions given on it useful; 111 rated informations on treatments helpful. Evaluations on study were excellent for 46% Pts, good for 50%, sufficient for 4%. Conclusions: Results confirm HNB efficacy and usefulness. It is easy to understand and fill and provides Pts with heplfull self-managed informations. It’s a precise and higly reliable assessment and monitoring tool at home both for Pts and oncologists. We are evaluating use of HNB as a tool for continuity of care and for phase IV trials.

Perspectives on wellness self-monitoring tools for older adults

PurposeOur purpose was to understand different stakeholder perceptions about the use of self-monitoring tools, specifically in the area of older adults’ personal wellness. In conjunction with the advent of personal health records, tracking personal health using self-monitoring technologies shows promising patient support opportunities. While clinicians’ tools for monitoring of older adults have been explored, we know little about how older adults may self-monitor their wellness and health and how their health care providers would perceive such use. MethodsWe conducted three focus groups with health care providers (n=10) and four focus groups with community-dwelling older adults (n=31). ResultsOlder adult participants’ found the concept of self-monitoring unfamiliar and this influenced a narrowed interest in the use of wellness self-monitoring tools. On the other hand, health care provider participants showed open attitudes toward wellness monitoring tools for older adults and brainstormed about various stakeholders’ use cases. The two participant groups showed diverging perceptions in terms of: perceived uses, stakeholder interests, information ownership and control, and sharing of wellness monitoring tools. ConclusionsOur paper provides implications and solutions for how older adults’ wellness self-monitoring tools can enhance patient-health care provider interaction, patient education, and improvement in overall wellness.

Implementing Health Information Technology in a Patient-Centered Manner: Patient Experiences With an Online Evidence-Based Lifestyle Intervention

The patient-centered care (PCC) model and the use of health information technology (HIT) are major initiatives for improving U.S. healthcare quality and delivery. A lack of published data on patient perceptions of Internet-based care makes patient-centered implementation of HIT challenging. To help ascertain patients' perceptions of an online intervention, patients completing a 1-year web-based lifestyle intervention were asked to complete a semistructured interview. We used qualitative methodology to determine frequency and types of interview responses. Overall satisfaction with program features was coded on a Likert-type scale. High levels of satisfaction were seen with the online lifestyle coaching (80%), self-monitoring tools (57%), and structured lesson features (54%). Moderated chat sessions and online resources were rarely used. Frequently identified helpful aspects were those that allowed for customized care and shared decision-making consistent with the tenets of PCC. Unhelpful program aspects were reported less often. Findings suggest that despite challenges for communicating effectively in an online forum, the personalized support, high-tech data management capabilities, and easily followed evidence-based curricula afforded by HIT may be a means of providing PCC and improving healthcare delivery and quality.

Survey of Sensor-Based Personal Wellness Management Systems

The cost of healthcare is expected to grow enormously in the coming years. To keep these costs limited, we need better technological tools for self-monitoring and independent aging and to put a stronger emphasis on wellness, defined as a balanced and healthy lifestyle that avoids diseases at every stage of life. In contrast to traditional medical science that examines patients in laboratories, wellness has so far been difficult to measure objectively. This situation is changing due to the availability of wearable and pervasive sensors, smartphones, and other body-worn devices that can track and infer users’ activities. Technological advances in this area are rapidly pushing forward. The range of methods as well as the health domains where sensors have been used for monitoring is proliferating. This has created a unique opportunity to understand wellness in an integrative and balanced framework. The goal of this survey is to summarize the latest innovations in sensor technology and present the state-of-the-art of personal wellness management systems with the purpose of shedding light on where this field is developing and where the future research opportunities lie.

Clicking Away: Repurposing Student Response Systems to Lessen Off-Task Behavior

Self-monitoring is a well-documented practice to assist educators with addressing students' behavioral challenges. However, little research has examined technology to support students' self-monitoring. Within this study, three elementary students were taught self-monitoring skills using student response systems to increase on-task behaviors in an inclusive setting. When prompted by the teacher, students identified as having an emotional disability or students at risk for behavioral challenges used a student response system to record if they were on or off task. A single-subject withdrawal design indicated the frequency of each student's off-task behavior decreased during use of the student response system. During the withdrawal and maintenance phases, frequency of the behavior returned to baseline levels. The technology supported improved student behavior when used, but students were unable to maintain the improved on-task behavior when they were not self-monitoring. Student and teacher perceptions of the student response system technology verified the off-task behavior data; students and teachers were positive about the use of the technology as a self-monitoring tool.

Web‐based self‐monitoring for weight loss among overweight/obese women at increased risk for breast cancer: the HELP pilot study

Excess weight and physical inactivity are modifiable risk factors for breast cancer. Training women to use self-help resources over the internet has potential for reducing intervention costs and enhancing maintenance. A total of 50 overweight/obese women at increased breast cancer risk were randomized to a 12-week intervention or a comparison group. Telephone-based sessions trained participants to use web-based self-monitoring tools to set goals and track diet and exercise. The comparison group received dietary information but no training. At baseline and 12 weeks, participants were weighed and wore an accelerometer. Participants were aged 60.9 ± 0.8 years with a BMI of 33.1 ± 0.6 kg/m(2). The intervention group lost 3.3 ± 4.0 kg, whereas the comparison group gained 0.9 ± 3.4 kg (p < 0.0001). Intervention participants who found the website helpful lost 5.6 ± 0.7 kg; those who did not lost 0.8 ± 0.9 kg (p < 0.001). Change in physical activity was +70 ± 140 min/week among those who found the website helpful, -6 ± 75 min/week among those who did not, and -34 ± 207 min/week in the comparison group (p < 0.01). A program to train women to use web-based weight loss tools achieved a substantial short-term weight loss among the majority of participants. Further follow-up is needed to assess weight loss maintenance over time.

A Social Media–Based Physical Activity Intervention: A Randomized Controlled Trial

Online social networks, such as Facebook™, have extensive reach, and they use technology that could enhance social support, an established determinant of physical activity. This combination of reach and functionality makes online social networks a promising intervention platform for increasing physical activity. To test the efficacy of a physical activity intervention that combined education, physical activity monitoring, and online social networking to increase social support for physical activity compared to an education-only control. RCT. Students (n=134) were randomized to two groups: education-only controls receiving access to a physical activity-focused website (n=67) and intervention participants receiving access to the same website with physical activity self-monitoring and enrollment in a Facebook group (n=67). Recruitment and data collection occurred in 2010 and 2011; data analyses were performed in 2011. Female undergraduate students at a large southeastern public university. Intervention participants were encouraged through e-mails, website instructions, and moderator communications to solicit and provide social support related to increasing physical activity through a physical activity-themed Facebook group. Participants received access to a dedicated website with educational materials and a physical activity self-monitoring tool. The primary outcome was perceived social support for physical activity; secondary outcomes included self-reported physical activity. Participants experienced increases in social support and physical activity over time but there were no differences in perceived social support or physical activity between groups over time. Facebook participants posted 259 times to the group. Two thirds (66%) of intervention participants completing a post-study survey indicated that they would recommend the program to friends. Use of an online social networking group plus self-monitoring did not produce greater perceptions of social support or physical activity as compared to education-only controls. Given their promising features and potential reach, efforts to further understand how online social networks can be used in health promotion should be pursued. This study is registered at clinicaltrials.govNCT01421758.

Feasibility and Acceptability of Using Pedometers as an Intervention Tool for Latinas

Due to high rates of inactivity and related chronic illnesses among Latinas, the current study examined the feasibility and acceptability of using pedometers as an intervention tool in this underserved population. Data were taken from a larger randomized, controlled trial2 and focused on the subsample of participants (N = 43) who were randomly assigned to receive a physical activity intervention with pedometers and instructions to log pedometer use daily and mail completed logs back to the research center each month for 6 months. Retention (90.7% at 6 months) and adherence to the pedometer protocol (68.89% returned ≥ 5 of the 6 monthly pedometer logs) were high. Overall, participants reported increased physical activity at 6 months and credited pedometer use for helping them achieve these gains (75.7%). Participants who completed a high proportion (≥ 5/6) of pedometer logs reported significantly greater increases in physical activity and related process variables (stages of change, self-efficacy, behavioral processes of change, social support from friends) than those who were less adherent (completed < 5 pedometer logs). Pedometers constitute a low-cost, useful tool for encouraging self-monitoring of physical activity behavior in this at-risk group.

Self-monitoring Using Mobile Phones in the Early Stages of Adolescent Depression: Randomized Controlled Trial

BackgroundThe stepped-care approach, where people with early symptoms of depression are stepped up from low-intensity interventions to higher-level interventions as needed, has the potential to assist many people with mild depressive symptoms. Self-monitoring techniques assist people to understand their mental health symptoms by increasing their emotional self-awareness (ESA) and can be easily distributed on mobile phones at low cost. Increasing ESA is an important first step in psychotherapy and has the potential to intervene before mild depressive symptoms progress to major depressive disorder. In this secondary analysis we examined a mobile phone self-monitoring tool used by young people experiencing mild or more depressive symptoms to investigate the relationships between self-monitoring, ESA, and depression.ObjectivesWe tested two main hypotheses: (1) people who monitored their mood, stress, and coping strategies would have increased ESA from pretest to 6-week follow-up compared with an attention comparison group, and (2) an increase in ESA would predict a decrease in depressive symptoms.MethodsWe recruited patients aged 14 to 24 years from rural and metropolitan general practices. Eligible participants were identified as having mild or more mental health concerns by their general practitioner. Participants were randomly assigned to either the intervention group (where mood, stress, and daily activities were monitored) or the attention comparison group (where only daily activities were monitored), and both groups self-monitored for 2 to 4 weeks. Randomization was carried out electronically via random seed generation, by an in-house computer programmer; therefore, general practitioners, participants, and researchers were blinded to group allocation at randomization. Participants completed pretest, posttest, and 6-week follow-up measures of the Depression Anxiety Stress Scale and the ESA Scale. We estimated a parallel process latent growth curve model (LGCM) using Mplus to test the indirect effect of the intervention on depressive symptoms via the mediator ESA, and calculated 95% bias-corrected bootstrapping confidence intervals (CIs).ResultsOf the 163 participants assessed for eligibility, 118 were randomly assigned and 114 were included in analyses (68 in the intervention group and 46 in the comparison group). A parallel process LGCM estimated the indirect effect of the intervention on depressive symptoms via ESA and was shown to be statistically significant based on the 95% bias-corrected bootstrapping CIs not containing zero (–6.366 to –0.029). The proportion of the maximum possible indirect effect estimated was κ2 =.54 (95% CI .426–.640).ConclusionsThis study supported the hypothesis that self-monitoring increases ESA, which in turn decreases depressive symptoms for young people with mild or more depressive symptoms. Mobile phone self-monitoring programs are ideally suited to first-step intervention programs for depression in the stepped-care approach, particularly when ESA is targeted as a mediating factor.Trial RegistrationClinicalTrials.gov NCT00794222; http://clinicaltrials.gov/ct2/show/NCT00794222 (Archived by WebCite at http://www.webcitation.org/65lldW34k)

Chronic hand eczema - self-management and prognosis: a study protocol for a randomised clinical trial

BackgroundHand eczema has a one-year prevalence of approximately 10 % in the general Danish population. Often the disease becomes chronic with numerous implications for the individual’s daily life, occupation and quality of life. However, no guidelines of self-management recommendations beyond the acute stage are given. Self-management of the disease is pivotal and involves self-monitoring of the condition, medication adherence, and preventive behaviour. Interventions best to support the individual in this ongoing process need to be developed.Methods/designThis paper describes the design of a randomised clinical trial to test a newly developed intervention of individual counselling versus conventional information. 300 patients consecutively referred to dermatologic treatment at two different settings are individually randomised to either the intervention programme, named ‘The Healthy Skin Clinic’ or to the control group. Block-wise randomisation according to setting and gender is carried out.The intervention offers a tool for self-monitoring; basic and specific individual counselling; the possibility of asynchronous communication with the intervention team; and an electronic patient dialogue forum. Primary outcome variable is objective assessment of the hand eczema severity performed at baseline prior to randomisation, and repeated at six months follow-up. Secondary outcome variables are dermatology related life quality and perceived global burden of disease.DiscussionThe trial aims at evaluating a newly developed guidance programme which is expected to support self-management of patients referred to dermatology treatment due to chronic hand eczema. The design of the protocol is pragmatic with blinding of neither participants nor the investigator. Thus, in the interpretation of the results, the investigator takes into account effects that may be attributed to actors of the interventions rather than the intervention per se as well of potential observer bias. Inclusion criterions are wide in order to increase transferability of the results.Trial registrationThe trial is registered in ClinicalTrials.Gov with registration number NCT01482663.

The Supervision Triangle: An Integrating Model

The supervision triangle is a new framework for enabling beginning and trainee supervisors to understand the process and to organize the content of their supervision. It can also be a self-monitoring tool for experienced supervisors and a teaching aid in supervisor training.

A Review of the Effectiveness of Physical Activity Interventions for Adult Males

Physical inactivity is one of the main modifiable risk factors for a range of noncommunicable diseases. Of particular interest are adult males, a hard-to-reach population group for health promotion interventions. The purpose of this review is to provide a critical evaluation of the published health-related physical activity interventions that have targeted adult males. A comprehensive search of MEDLINE, CINAHL®, ScienceDirect, Web of Science, PsycINFO, the Cochrane Library, and SPORTDiscus™ was conducted for intervention studies published in English, between January 1990 and August 2010. Studies including community-dwelling adult men (≥ 18 years), or including both males and females where data on male participants could be extracted and examined, were included in this review. Studies assessing changes in levels of physical activity, physical fitness or changes in biomarkers of disease risk relevant to physical activity (e.g. body weight, waist circumference, lipids, blood pressure) were the primary focus. A total of 14 studies focusing on physical activity only and nine combined physical activity and nutrition studies were also included in this review. Ten of the 14 physical activity only studies and four of the nine combined physical activity and nutrition studies demonstrated significant increases in physical activity outcomes. Face-to-face, group-based and print-based methods were most commonly employed in these interventions. Within each mode of delivery, a number of elements including regular feedback, access to self-monitoring tools, elements of social support, variety in activities and a degree of friendly competition, were revealed as positive inclusions for this population group. Males are generally under-represented in health-promotion interventions and should therefore be targeted specifically, and while results of the included studies are encouraging, there is a lack of intervention studies targeting adult males. Further research into this population group is therefore required.

Abstract P138: Defining and Predicting Adherence to an Online Lifestyle Program: 12-Month Results from the PHIT Study

BACKGROUND: Traditionally, behavioral lifestyle programs have been delivered in person with adherence defined as number of sessions attended. With growing use of online interventions, an understanding of how to assess and enhance adherence to such programs is needed. In this analysis, we examine: 1) measures of adherence to an online lifestyle program; 2) how measures differ from month 6 to month 12 of an 18-month program; and 3) predictors of continued active status. METHODS: The Pittsburgh-Hershey Internet-based Translation (PHIT) study is an online adaptation of the Diabetes Prevention Program delivered in coordination with primary care. We recruited 124 patients; 61 were randomized to an 18-month online intervention, including lessons; weight, diet, and physical activity (PA) self-monitoring; and feedback from a lifestyle coach. A participant is inactive when he/she has not logged in for ≥28 days or responded to phone calls. We abstracted program use data as potential adherence measures: active/inactive status, log-in in past 7 days, self-monitoring, and number of lessons completed. Potential predictors of active status included sociodemographic variables, computer skill, and baseline BMI. Differences between 6- and 12-month measures were calculated with t-test or Wilcoxan rank test. Predictors of active status were determined with logistic regression. RESULTS: Of 61 participants in the intervention group, 42 (69%) were women, 54 (89%) were white, and 30 (49%) had college degree or higher. At 6 months, 29 (45%) of participants were active in the program. Eighteen (30%) had log-in, 13 (26%) posted a weight , and 11 (18%) self-monitored diet and PA in past 7 days. All measures of adherence declined at 12 months, although only active status (with 17 (28%) active) was significantly lower (p=0.03) than 6 months. At 12 months, 9 (15%) had a log-in, 7 (12%) posted a weight, 7 (12%) self-monitored diet and PA in past 7 days. At 6 months, participants had completed an average of 7.5 (SD 6.2) of 16 expected lessons; at 12 months, participants had completed an average of 9.2 (SD 8.3) lessons of 24 expected lessons. None of the variables considered predicted active status at 6 months. At 12 months, men were four times as likely as women to be active (OR=3.8; p=0.03). Participants with higher baseline BMI (OR=0.88; p=0.04) and difficulty paying for basics (OR=0.12; p=0.04) were less likely to be active at 12 months. Age, education and computer skill did not predict active status at either time point. CONCLUSION: Active status declined significantly between 6 and 12 months and use of online self-monitoring tools was low at both time points. Females, heavier persons, and those with financial constraints may need additional support to stay engaged. Future research should address how measures of adherence relate to program outcomes such as weight loss and how to improve adherence to online interventions over time.

Identifying Factors for Optimal Development of Health-Related Websites: A Delphi Study Among Experts and Potential Future Users

BackgroundThe Internet has become a popular medium for offering tailored and targeted health promotion programs to the general public. However, suboptimal levels of program use in the target population limit the public health impact of these programs. Optimizing program development is considered as one of the main processes to increase usage rates.ObjectiveTo distinguish factors potentially related to optimal development of health-related websites by involving both experts and potential users. By considering and incorporating the opinions of experts and potential users in the development process, involvement in the program is expected to increase, consequently resulting in increased appreciation, lower levels of attrition, and higher levels of sustained use.MethodsWe conducted a systematic three-round Delphi study through the Internet. Both national and international experts (from the fields of health promotion, health psychology, e-communication, and technical Web design) and potential users were invited via email to participate. During this study an extensive list of factors potentially related to optimal development of health-related websites was identified, by focusing on factors related to layout, general and risk information provision, questionnaire use, additional services, and ease of use. Furthermore, we assessed the extent to which experts and potential users agreed on the importance of these factors. Differences as well as similarities among experts and potentials users were deduced.ResultsIn total, 20 of 62 contacted experts participated in the first round (32% response rate); 60 of 200 contacted experts (30% response rate) and 210 potential users (95% response rate) completed the second-round questionnaire, and 32 of 60 contacted experts completed the third round (53% response rate). Results revealed important factors consented upon by experts and potential users (eg, ease of use, clear structure, and detailed health information provision), as well as differences regarding important factors consented upon by experts (eg, visual aids, self-monitoring tool, and iterative health feedback) or by potential users only (eg, bread crumb navigation and prevention of receiving spam).ConclusionsThis study is an important first step in determining the agreed-upon factors that should be taken into account when developing online health promotion programs. The public health impact of these programs will be improved by optimizing the development process in line with these factors.

Qualitative Exploration of the Acceptability of a Mobile Phone and Pedometer‐Based Physical Activity Program in a Diverse Sample of Sedentary Women

The objectives of this paper were to explore the acceptability of components of a mobile phone/pedometer-based physical activity program and to understand motivators and barriers to increase physical activity in a diverse sample of sedentary women. Face-to-face semi-structured interviews were conducted following a 3-week pilot mobile phone/pedometer-based physical activity intervention. Forty-one sedentary women participated in the study. Subjects were interviewed using a semi-structured interview guide. A qualitative description method was used to thematically analyze the interviews. Two investigators reviewed the transcripts independently and identified codes based on the main concerns in the interview questions. Three themes emerged from qualitative data shedding light on the perceived acceptability and usefulness of a mobile phone/pedometer-based intervention: (1) Monitor me: mobile phone/pedometer as self-monitoring tools, (2) Motivate me: cycle of feedback in goal setting and usefulness/uselessness of daily random messages, (3) Mobilize me: engaging and adapting physical activity to fit one's own lifestyle. Mobile phone and pedometer-based physical activity programs might be helpful in keeping sedentary women engaged and motivated to increase their physical activity. A randomized controlled trial of this intervention is warranted.

An Intelligent Sensing System for Sleep Motion and Stage Analysis

Monitoring the movements of the human during sleep can potentially give us a good estimation of aspects of the bodily as well as mental state of a human. When such data are combined, either with the knowledge of a sleep pathologist or with a special automated diagnosis system, they could prove quite useful towards the diagnosis of various types of sleep disorders such as parasomnias, insomnia, and dyspnea. Furthermore, such data could also be useful towards diagnosis of various medical conditions, and towards quantitative evaluation of the effects of drug therapy that is administered to a patient who is suffering from poor sleep quality, an important indication of which is the duration and patterns of various sleep stages. The intelligent sensing system that we present consists of a thermal infrared camera, a budget three-electrode budget EEG device, and algorithms for analysis and motion processing which we designed for this system. The main measurables that we derived from our system are of three kinds: a) descriptions of sleep stages (personalized probabilistic model), b) movement graphs, and c) relations between stages and motion. An empirical study with two subjects was carried out, where sensory recordings for multiple nights were captured and analyzed, illustrating the capacity of our sensory system towards providing the above measurables, and quite importantly, towards acting as a strong foundation for future wider deployment of in-home sleep self-monitoring and diagnosis tools.

An exploratory study into whether self‐monitoring improves adherence to daily flossing among dental patients

This exploratory study evaluated the effectiveness of an action-control behavioral intervention on adherence to dental flossing in patients with periodontal disease. Action control, that is, monitoring one's behavior and evaluating it against a self-set standard, has been suggested as a self-regulatory strategy that can assist people who intend to engage in behavioral change. In a single-center, single-blind prospective trial, 73 dental patients received a behavioral intervention, which was either matched or mismatched to their stage of behavioral change. Through responses to a standardized self-report measure, participants were classified either as motivational (i.e., not ready to change) or volitional (i.e., contemplating change) with regard to dental flossing. The intervention consisted of a simple self-monitoring tool for dental flossing in the form of a diary. Flossing frequency, dental plaque, and bleeding scores were measured before and at 4 weeks postintervention. Flossing frequency, dental plaque, and bleeding scores improved (P < 0.001) in both stage-matched and stage-mismatched patients. A brief behavioral intervention enhances adherence to dental flossing, regardless of participants' stage of change. Keeping a flossing diary can increase dental flossing and reduce plaque and bleeding scores in patients with periodontal disease, in the short term.

Self-monitoring of self-regulation during math homework behaviour using standardized diaries

This study aims at enhancing math learning and general self-regulation by supporting daily self-regulated learning during math homework. The authors use standardized diaries as a self-monitoring tool to support self-regulatory behaviour. Following the theory of self-monitoring, frequent selfmonitoring of self-regulation will lead to an enhancement of self-regulated learning. Complete data stem from a sample of 195 8th grade students. 95 students from the experimental group answer questions in diaries for a period of 49 days and participate in the pre-post measurement whereas the control group only works on the pre- and posttests. The diary consists of questions regarding main components of self-regulation. The time-series analyses of the diary variables show a positive linear trend for self-regulation. The results of the analyses of variance for the pre-post experimental-control group comparison yielded time by group interactions for self-regulation and the math test.