Technology-based Self-monitoring Research Articles

Adding to the Evidence Base: Effects of I-Connect in a Secondary Special Education Rural Classroom

The purpose of this study was to examine the effects of a technology-based self-monitoring application, I-Connect, to enhance the on-task behavior of five secondary students (ages 15–16) with autism spectrum disorder, intellectual disability, and specific learning disability during Biology instruction in a rural special education classroom. We used an A-B-A-B withdrawal design with a generalization condition. The primary dependent variable was percent of intervals with on-task behavior as measured by momentary time sampling procedures. Results indicated overall higher levels of on-task behavior for all students when using I-Connect to monitor their behavior. However, there were also high percentages of overlapping data, and student satisfaction with the application was relatively low. Students used I-Connect in an employability seminar offered at their school as a means to generalize to a different setting. We provide implications for practice in rural settings and suggestions for future research related to I-Connect. We also provide recommendations for enhancing the social validity of technology-based self-monitoring for secondary students with disabilities.

Using Technology-Based Self-Monitoring to Promote On-Task Behavior

Paying attention during academic instruction plays a significant role in learning. Students with off-task behaviors are less likely to obtain desired learning outcomes. Technology-based self-monitoring is one of the strategies designed to address this issue. This article introduces technology-based self-monitoring (TBSM) for elementary educators of students with and without emotional and behavioral disorders. Specifically, we describe the development of self-monitoring technologies, present suggestions for designing effective TBSM interventions, and discuss I-Connect as an example to illustrate how TBSM interventions work.

Staying on Task: Use of Self-Monitoring and Peer Coaching to Support Inclusive Postsecondary Education

ABSTRACT Although applications (apps) for technology-based self-monitoring have received little attention in the literature for college-level students with intellectual disability (ID) in inclusive postsecondary education (IPSE) programs at institutions of higher education, novel tools regularly arrive and are applied within current support structures. I-Connect, a smartphone or web-based self-monitoring tool, has the potential to be an important instrument for promoting independence and access to inclusive academic and workplace environments. The current study used a multi-treatment A-B-A-B-C withdrawal single-case design to determine the effects of peer coaching and a smartphone-based self-monitoring app on the on-task behavior of a college student with autism and intellectual disability. Measurement included the impact of the I-Connect app and peer tutoring in combination with the app and the social validity of the intervention. Findings demonstrated a functional relation for the use of I-Connect with some limitations. The data showed promise for the addition of peer support and were confirmed by a social validity measure. The combination of technology-based self-monitoring supports with the peer supports typically available in inclusive postsecondary education (IPSE) programs can potentially increase key self-determination outcomes. The authors discuss further implications and suggestions for confirming these findings in subsequent inquiries.

Evaluating Technology-Based Self-Monitoring of Performance with Differential Reinforcement for Students with Disabilities.

This study evaluated the use of a technology-based self-monitoring of performance (SMP) with differential reinforcement to increase task completion and reduce off-task behavior for three 5th-grade students with disabilities. A concurrent multiple baseline design across participants was used to examine the impact of the intervention on the targeted behaviors when implemented by a general education teacher and its maintenance effects with a delay of reinforcement. The implementation involved training students to use a mobile app for SMP and providing differential reinforcement contingent on task completion and accuracy of self-monitoring during academic periods. The secondary measure of off-task behavior was included to evaluate the relationship between task completion and engagement. The results demonstrated that the technology-based SMP with differential reinforcement increased task completion and reduced off-task behavior for all students. Furthermore, the gradual fading of the reinforcement, with a 45 min delay, was successful for all students. The efficiency and immediacy of the intervention suggest that technology-based SMP with differential reinforcement holds promise as a practical, efficient, and effective school-based intervention.

A Teacher’s Guide to Technology-Based Self-Monitoring Strategies for Student Behavior

Students with disabilities may demonstrate high rates of off-task behavior, resulting in poor academic achievement. To decrease students’ off-task behavior, teachers can identify student-guided supportive strategies to limit the amount of time they dedicate to behavior management. Moreover, when teachers use effective student-guided strategies that reflect high social validity, ease of use, and low intrusiveness, benefits are maximized and students will maintain their use of the strategy. This article provides step-by-step procedures for designing a technology-based self-monitoring (TBSM) strategy that increases the acceptability and continued use of standard self-monitoring procedures. Necessary adjustments to typical self-monitoring strategies considering technology-based delivery methods, including selecting and evaluating mobile applications, are introduced.

Technology-Based Self-Monitoring and Visual Supports to Teach Question Asking Skills to Young Adults With Autism in Community Settings

Young adults with autism spectrum disorder (ASD) typically benefit from individually-designed interventions to engage in reciprocal conversation. We used a multiple baseline across participants design to evaluate the effects of a technology-based self-monitoring application (i.e., I-Connect) and visual supports to teach question asking skills to three males with ASD, ages 21–26. Participants selected community locations to participate in structured conversations with peers that were audio recorded. All participants demonstrated an immediate effect to increase their number of questions asked when using I-Connect to self-monitor. However, participant responding varied when visual supports were added. Maintenance also varied across participants. Findings indicated existing evidence-based practices for learners with ASD, such as self-monitoring and visual supports, can be combined in socially valid ways. Implications and suggestions for future research related to teaching conversation skills for young adults with ASD are discussed.

Increasing On-Task Behavior Using Technology-Based Self-Monitoring: A Meta-Analysis of I-Connect

Self-monitoring is a promising evidence-based intervention for students who benefit from supplemental supports to stay on-task during academic periods. I-Connect, a technology-based self-monitoring intervention with a substantial body of research, allows students to discretely recognize and record their behavior on a mobile or desktop app at scheduled intervals, to improve positive behavior and increase inclusion opportunities. This meta-analytic review examined the effect of I-Connect on the on-task behavior of students with or at risk for disabilities to determine the omnibus effect of using I-Connect across students and intervention packages. Students received 20–45 minutes of training before using I-Connect and most students monitored their on-task behavior every 30-seconds during 10-minute monitoring sessions. Under these conditions, I-Connect was found to demonstrate strong functional relations, an abrupt increase in on-task behavior and consistently positive parametric effects across all 14 elementary and secondary students receiving special education.

Evaluating the Effects of Technology-Based Self-Monitoring on Positive Staff-Consumer Interactions in Group Homes.

The quality and frequency of positive interactions between staff and consumers are related to reductions in consumer problem behavior and increases in other desired outcomes, such as leisure and self-help skills. Unfortunately, the frequency with which group home staff positively interact with consumers is often low and regularly requires intervention. We evaluated the effects of technology-based self-monitoring on positive interactions between staff and consumers during consumer leisure time. Participant data were collected off-site through video recordings from cameras already present in the group homes. During baseline, participant interactions were low. Upon introduction of an intervention containing self-monitoring completed via a tablet device, staff interactions increased and maintained when the intervention was in effect. Supplemental feedback via text message was provided to two of the three participants to reach criterion. These findings demonstrate the utility of technology-based self-monitoring for some individuals to increase positive staff-consumer interactions in group homes.

A Technology-Based Self-Monitoring Intervention for Secondary Students with High-Incidence Disabilities

Secondary students with high incidence disabilities who also display disruptive behaviors struggle to be successful in general education settings. As a result, general education teachers are looking for ways to utilize technology to provide them with opportunities to implement evidence-based interventions in their classrooms. In this study, teachers used MoBeGo, an iPad application, in a single-case withdrawal design (ABAB), to implement self-monitoring in high school general education classrooms with four students who received special education services for a high incidence disability. The results of this study indicate that teachers could implement MoBeGo with fidelity to improve students’ academic engagement and appropriate behavior. Additionally, both the teachers and students rated MoBeGo as a socially valid intervention. Implications for practice and future research are discussed.

The Effects of a Technology-Based Self-monitoring Intervention on On-Task, Disruptive, and Task-Completion Behaviors for Adolescents with Autism.

Individuals with autism spectrum disorders (ASD) often present with difficulty in sustaining engagement, attention, and have disruptive behavior in classroom settings. Without appropriate intervention, these challenging behaviors often persist and negatively impact educational outcomes.Self-monitoring is a well-supported evidence-based practice for addressing challenging behaviors and improving pro-social behaviors for individuals with ASD. Self-monitoring procedures utilizing a handheld computer-based technology is an unobtrusive and innovative way of implementing the intervention. A withdrawal design was employed to assess the effectiveness of a technologically-delivered self-monitoring intervention (I-Connect) in improving on-task and task completion behaviors and decreasing disruptive behavior with four adolescents with ASD. Results demonstrated improvements in on-task and task completion behaviors across all four participants and disruptive behavior improved for two participants.

The Effects of CellF-Monitoring on Students’ Academic Engagement: A Technology-Based Self-Monitoring Intervention

Students who are not academically engaged spend less time mastering material, are less likely to be successful in school, and are more likely to be disruptive. The purpose of the current brief report was to investigate the effects of a technology-based self-monitoring intervention on elementary students’ academic engagement during independent work time. The intervention, CellF-Monitor, is an iPad application that allows individuals to self-rate their on-task behavior. In this multiple-baseline, single-case-design study, four nominated students used the CellF-Monitor during independent work time in their regular education classrooms. Systematic direct observations, self-ratings, and teachers’ Direct Behavior Ratings of academically engaged and on-task behaviors were collected to measure students’ behavioral changes from baseline to the intervention and reinforcement phases. Visual analyses illustrated positive effects of the CellF-Monitor on academic engagement and on-task behavior, and findings were augmented by effect size estimates.

The Healthy Hearts and Kidneys (HHK) study: Design of a 2 × 2 RCT of technology-supported self-monitoring and social cognitive theory-based counseling to engage overweight people with diabetes and chronic kidney disease in multiple lifestyle changes

Patients with complex chronic diseases usually must make multiple lifestyle changes to limit and manage their conditions. Numerous studies have shown that education alone is insufficient for engaging people in lifestyle behavior change, and that theory-based behavioral approaches also are necessary. However, even the most motivated individual may have difficulty with making lifestyle changes because of the information complexity associated with multiple behavior changes. The goal of the current Healthy Hearts and Kidneys study was to evaluate, different mobile health (mHealth)-delivered intervention approaches for engaging individuals with type 2 diabetes (T2D) and concurrent chronic kidney disease (CKD) in behavior changes. Participants were randomized to 1 of 4 groups, receiving: (1) a behavioral counseling, (2) technology-based self-monitoring to reduce information complexity, (3) combined behavioral counseling and technology-based self-monitoring, or (4) baseline advice. We will determine the impact of randomization assignment on weight loss success and 24-hour urinary excretion of sodium and phosphorus. With this report we describe the study design, methods, and approaches used to assure information security for this ongoing clinical trial.Clinical Trials.gov Identifier: NCT02276742.

Evaluating Technology-Based Self-Monitoring as a Tier 2 Intervention Across Middle School Settings

Multitiered frameworks like Positive Behavior Interventions and Supports (PBIS) have been recommended for preventing and remediating behavior problems. In this study, technology-based self-monitoring was used as a Tier 2 intervention to improve the academic engagement and disruptive behavior of three middle school students who were identified as at risk for failure and needing immediate intervention. Results of the multiple baseline design across settings indicated the intervention was highly effective for one student and moderately effective for another. The third student required more intense support than offered in Tier 2. Issues of matching students to Tier 2 intervention based on multiple data sources, the alignment of technology-based self-monitoring with key features of Tier 2, limitations of the study, recommendations for future research, and implications for practice are discussed.

A Single-Subject Study of a Technology-Based Self-Monitoring Intervention

Students with ADHD often struggle with self-regulation skills. One strategy demonstrating considerable success in helping these students regulate their behavior is self-monitoring. Although there is an abundance of research on self-monitoring, research on the use of technology for self-monitoring is only beginning to emerge. The primary goal of this single-subject study was to examine the effects of an iPad application (SCORE IT) for self-monitoring on the behavior of three fifth-grade students with or at risk for ADHD who were exhibiting low rates of academic engagement in a general education environment. A secondary goal was to gain an in-depth understanding of the teacher’s perceptions of the feasibility and value of the intervention. Overall, the SCORE IT intervention resulted in substantial improvements in academic engagement, and teacher perceptions of the feasibility and worth of the intervention were reported as highly favorable. Limitations and future directions for research are discussed.

Using Data to Individualize a Multicomponent, Technology-Based Self-Monitoring Intervention

Technology in schools is abundant as is the call for evidence-based interventions for students who need additional support to be successful. One promising use of technology is for self-monitoring interventions aimed at improving classroom behavior. In this study, two middle school students with disabilities used a multicomponent, self-monitoring app on an iPad during their reading classes. Using a data-based individualization approach, teachers worked with the primary investigator to monitor students’ response to the intervention and adapt the intervention accordingly. A single-subject design was used to test the effects of the intervention, and a functional relation was established for both participants who improved their academic engagement and decreased their disruptive behavior. Additionally, participants indicated the intervention was socially valid. Limitations, implications, and future directions are discussed.

No Difference in Average Interdialytic Weight Gain Observed in a Randomized Trial With a Technology-Supported Behavioral Intervention to Reduce Dietary Sodium Intake in Adults Undergoing Maintenance Hemodialysis in the United States: Primary Outcomes of the BalanceWise Study

To evaluate the efficacy of behavioral counseling combined with technology-based self-monitoring for sodium restriction in hemodialysis (HD) patients. Randomized clinical trial. English literate adults undergoing outpatient, in-center intermittent HD for at least 3 months. Over a 16-week period, both the intervention and the attention control groups were shown 6 educational modules on the HD diet. The intervention group also received social cognitive theory-based behavioral counseling and monitored their diets daily using handheld computers. Average daily interdialytic weight gain (IDWGA) was calculated for every week of HD treatment over the observation period by subtracting the post-dialysis weight at the previous treatment time (t-1) from the pre-dialysis weight at the current treatment time (t), dividing by the number of days between treatments. Three 24-hour dietary recalls were obtained at baseline, 8weeks, and 16weeks and evaluated using the Nutrient Data System for Research. A total of 179 participants were randomized, and 160 (89.4%) completed final measurements. IDWGA did not differ significantly by treatment group at any time point considered (P>.79 for each). A significant differential change in dietary sodium intake observed at 8weeks (-372mg/day; P=.05) was not sustained at 16weeks (-191mg/day; P=.32). The BalanceWise Study intervention appeared to be feasible and acceptable to HD patients although IDWGA was unchanged and the desired behavioral changes observed at 8weeks were not sustained. Unmeasured factors may have contributed to the mixed findings, and further research is needed to identify the appropriate patients for such interventions.

“I Don’t Like Being Good!” Changing Behavior With Technology-Based Self-Monitoring

Self-monitoring has a well-established literature base for improving the behavior of students with a range of ages and abilities. Whereas self-monitoring often involves technology for prompting self-monitoring procedures, to date, only a few studies have examined the use of technology for recording self-monitored behavior. To extend the literature in this area, the effects of technology-based self-monitoring were examined using an iPad application called SCORE IT in which students and teachers rate students’ behavior and view automated graphs of progress toward goals. Using a baseline and intervention (ABAB) design to measure outcomes, improvements in behavior were established for both middle school participants—one with attention deficit hyperactivity disorder and another receiving noncategorical special education services for reading, math, and behavioral deficits. Findings, limitations, and recommendations for future research are discussed.

Tweets, Texts, and Tablets

Students with behavior problems often lack the self-regulation skills necessary for success. One strategy shown to improve these skills is self-monitoring. Traditionally, self-monitoring has been done using paper and pencil, with some sort of prompt to complete the procedures. Prompts have involved teacher cues as well as technology. Current innovation has resulted in using technology to both prompt and record self-monitored behaviors. This column explores the literature on technology-based self-monitoring, describes steps in the self-monitoring process with considerations for incorporating technology, and offers a classroom example of a student with attention-deficit/hyperactivity disorder using a self-monitoring application (i.e., app) on an iPad to improve behavior.

Biophysiologic Outcomes of the Enhancing Adherence in Type 2 Diabetes (ENHANCE) Trial

BackgroundBehavioral research to improve lifestyle in broadly defined populations of patients with type 2 diabetes is limited. ObjectiveWe evaluated a behavioral intervention featuring technology-based self-monitoring on biophysiologic outcomes of glycemic control and markers of cardiovascular risk. DesignIn this single-site, randomized clinical trial, participants were stratified by good and poor glycemic control (glycated hemoglobin <8% or ≥8%) and absence or presence of kidney disease, (estimated glomerular filtration rate ≥60 or <60 mL/min) and randomized within strata. Measurements were obtained at 0, 3, and 6 months. Participants/settingSelf-referred, community-dwelling adults with type 2 diabetes mellitus. InterventionThe intervention group received Social Cognitive Theory-based counseling paired with technology-based self-monitoring, and results were compared with an attention control group. Main outcome measuresGlycated hemoglobin, fasting serum glucose, lipid levels, blood pressure, weight, body mass index, and waist circumference were evaluated. Statistical analyses performedMean differences within and between randomization groups were compared over time. Intervention effects over time were estimated using random intercept models. ResultsTwo hundred ninety-six subjects were randomized, 256 (86.5%) completed 3-month and 246 (83.1%) completed 6-month assessments. Glycated hemoglobin was reduced in the intervention group by 0.5% at 3 months and 0.6% at 6 months (P<0.001 for each), and the control group by 0.3% (P<0.001) at 3 months and 0.2% (P<0.05) at 6 months; but between-group differences were not significant. In those with baseline glycated hemoglobin ≥8% and estimated glomerular filtration rate ≥60 mL/min, glycated hemoglobin was reduced in the intervention group by 1.5% at 3 months and 1.8% at 6 months (P<0.001 for each), and the control group by 0.9% (P<0.001) at 3 months and 0.8% (P<0.05) at 6 months; but between-group differences were not significant. In random intercept models, the estimated reduction in glycated hemoglobin of 0.29% was not significant. ConclusionsTwo behavioral approaches to improving general lifestyle management in individuals with type 2 diabetes mellitus were effective in improving glycemic control, but no significant between-group differences were observed.

Factors associated with probability of personal digital assistant-based dietary self-monitoring in those with type 2 diabetes

Knowledge of factors associated with the use of technology could inform the design of technology-based behavioral interventions. This study examined modifiable and nonmodifiable factors associated with technology-based self-monitoring. 123 participants with type 2 diabetes self-monitored diet using a personal digital assistant in a 6-month behavioral intervention. Multinomial logistic regression was used to examine probability of nonadherent and suboptimally adherent behavior relative to adherent behavior. Sociodemographic characteristics were not associated with probability of self-monitoring. Probability of adherence generally was greater in the weeks preceding no group session, and lower in the weeks following no group session or following skipped sessions. Non-modifiable factors suggested by the literature to be associated with poorer access to technology (lower income, older age, minority race, and lower education) were not associated with probability of self-monitoring in this population.