Technology-mediated Interventions Research Articles

Predictors of outcome from computer-based treatment for substance use disorders: Results from a randomized clinical trial

BackgroundAlthough empirical evidence for the effectiveness of technology-mediated interventions for substance use disorders is rapidly growing, the role of baseline characteristics of patients in predicting treatment outcomes of a technology-based therapy is largely unknown. MethodParticipants were randomly assigned to either standard methadone maintenance treatment or reduced standard treatment combined with the computer-based therapeutic education system (TES). An array of demographic and behavioral characteristics of participants (N=160) was measured at baseline. Opioid abstinence and treatment retention were measured weekly for a 52-week intervention period. Generalized linear model and Cox-regression were used to estimate the predictive roles of baseline characteristics in predicting treatment outcomes. ResultsWe found significant predictors of opioid abstinence and treatment retention within and across conditions. Among 21 baseline characteristics of participants, employment status, anxiety, and ambivalent attitudes toward substance use predicted better opioid abstinence in the reduced-standard-plus-TES condition compared to standard treatment. Participants who had used cocaine/crack in the past 30 days at baseline showed lower dropout rates in standard treatment, whereas those who had not used exhibited lower dropout rates in the reduced-standard-plus-TES condition. ConclusionsThis study is the first randomized controlled trial, evaluating over a 12-month period, how various aspects of participant characteristics impact outcomes for treatments that do or do not include technology-based therapy. Compared to standard alone treatment, including TES as part of the care was preferable for patients who were employed, highly anxious, and ambivalent about substance use and did not produce worse outcomes for any subgroups of participants.

Technology-mediated interventions for enhancing medication adherence.

Despite effective therapies for many conditions, patients find it difficult to adhere to prescribed treatments. Technology-mediated interventions (TMIs) are increasingly being used with the hope of improving adherence. To assess the effects of TMI, intended to enhance patient adherence to prescribed medications, on both medication adherence and clinical outcomes. A secondary in-depth analysis was conducted of the subset of studies that utilized technology in at least one component of the intervention from an updated Cochrane review on all interventions for enhancing medication adherence. We included studies that clearly described an information and communication technology or medical device as the sole or major component of the adherence intervention. Thirty-eight studies were eligible for in-depth review. Only seven had a low risk of bias for study design features, primary adherence, and clinical outcomes. Eighteen studies used a TMI for education and/or counseling, 11 studies used a TMI for self-monitoring and/or feedback, and nine studies used electronic reminders. Studies used a variety of TMIs, with telephone the most common technology in use. Studies targeted a wide distribution of diseases and used a variety of adherence and clinical outcome measures. A minority targeted children and adolescents. Fourteen studies reported significant effects in both adherence and clinical outcome measures. This review provides evidence for the inconsistent effectiveness of TMI for medication adherence and clinical outcomes. These results must be interpreted with caution due to a lack of high-quality studies.

Performance of Fourth-Grade Students with Learning Disabilities on Multiplication Facts Comparing Teacher-Mediated and Technology-Mediated Interventions: A Preliminary Investigation

Instructional applications (apps) are educational software programs that can be accessed via mobile technologies (e.g., iPad, smartphone) and used to help students acquire various academic skills, including mathematics. Although research suggests that app-based instruction (AI) can be effective, there is a paucity of research comparing AI, to teacher-directed instruction (TDI) or to a combination of instructional approaches (CI) involving both AI and TDI in tandem. In an alternating treatments design, we compared AI, TDI, and CI conditions during instruction targeting multiplication facts with six students with learning disabilities. Results were inconsistent across students, and no condition emerged as consistently better than the others. Students completed social validity rating scales, and all approaches were favored by at least one student. Our results support findings from previous research involving similar comparisons between these instructional formats in which no (or minimal) differences across conditions were detected. We conclude that there may not be a meaningful difference between the outcomes achieved using AI, TDI, or CI for many students. Results are discussed in terms of directions for the future research.