1.
Implementation Intention and Reminder Effects on Behavior Change in a Mobile Health System: A Predictive Cognitive Model.
Pirolli, P, Mohan, S, Venkatakrishnan, A, Nelson, L, Silva, M, Springer, A
Journal of medical Internet research. 2017;(11):e397
Abstract
BACKGROUND Implementation intentions are mental representations of simple plans to translate goal intentions into behavior under specific conditions. Studies show implementation intentions can produce moderate to large improvements in behavioral goal achievement. Human associative memory mechanisms have been implicated in the processes by which implementation intentions produce effects. On the basis of the adaptive control of thought-rational (ACT-R) theory of cognition, we hypothesized that the strength of implementation intention effect could be manipulated in predictable ways using reminders delivered by a mobile health (mHealth) app. OBJECTIVE The aim of this experiment was to manipulate the effects of implementation intentions on daily behavioral goal success in ways predicted by the ACT-R theory concerning mHealth reminder scheduling. METHODS An incomplete factorial design was used in this mHealth study. All participants were asked to choose a healthy behavior goal associated with eat slowly, walking, or eating more vegetables and were asked to set implementation intentions. N=64 adult participants were in the study for 28 days. Participants were stratified by self-efficacy and assigned to one of two reminder conditions: reminders-presented versus reminders-absent. Self-efficacy and reminder conditions were crossed. Nested within the reminders-presented condition was a crossing of frequency of reminders sent (high, low) by distribution of reminders sent (distributed, massed). Participants in the low frequency condition got 7 reminders over 28 days; those in the high frequency condition were sent 14. Participants in the distributed conditions were sent reminders at uniform intervals. Participants in the massed distribution conditions were sent reminders in clusters. RESULTS There was a significant overall effect of reminders on achieving a daily behavioral goal (coefficient=2.018, standard error [SE]=0.572, odds ratio [OR]=7.52, 95% CI 0.9037-3.2594, P<.001). As predicted by ACT-R, using default theoretical parameters, there was an interaction of reminder frequency by distribution on daily goal success (coefficient=0.7994, SE=0.2215, OR=2.2242, 95% CI 0.3656-1.2341, P<.001). The total number of times a reminder was acknowledged as received by a participant had a marginal effect on daily goal success (coefficient=0.0694, SE=0.0410, OR=1.0717, 95% CI -0.01116 to 0.1505, P=.09), and the time since acknowledging receipt of a reminder was highly significant (coefficient=-0.0490, SE=0.0104, OR=0.9522, 95% CI -0.0700 to -0.2852], P<.001). A dual system ACT-R mathematical model was fit to individuals' daily goal successes and reminder acknowledgments: a goal-striving system dependent on declarative memory plus a habit-forming system that acquires automatic procedures for performance of behavioral goals. CONCLUSIONS Computational cognitive theory such as ACT-R can be used to make precise quantitative predictions concerning daily health behavior goal success in response to implementation intentions and the dosing schedules of reminders.
2.
Evaluation of mobile phone and Internet intervention on waist circumference and blood pressure in post-menopausal women with abdominal obesity.
Park, MJ, Kim, HS
International journal of medical informatics. 2012;(6):388-94
Abstract
PURPOSE The present study evaluated whether an intervention using a short message service (SMS) by personal cellular phone and Internet would reduce cardiovascular risk factors in post-menopausal women with abdominal obesity over 12 weeks. METHODS This is a quasi-experimental design with pre and post tests. Participants were recruited from the gynecology outpatient and family medicine departments of a tertiary care hospital located in an urban city of South Korea. Only 67 subjects completed the entire study, 34 in the intervention group and 33 controls. The goal of intervention was to reduce waist circumference (WC), body weight (BW) and blood pressure (BP) levels. Before the intervention, demographic variables, WC, BW, BP, fasting plasma glucose (FPG) and serum lipids were measured as pre-test data. The WC, BW, BP, FPG and serum lipids were measured again 12 weeks later. Patients in the intervention group were requested to record their WC, BW, BP, type and amount of diet and exercise in a weekly web-based diary through the Internet or by cellular phone. The researchers sent weekly recommendations on diet and exercise as an intervention to each patient, by both cellular phone and Internet. The intervention was applied for 12 weeks. RESULTS WC and BW significantly decreased by 3.0 cm and 2.0 kg, respectively, at 12 weeks compared with the baseline in the intervention group. However, the mean changes in the control group significantly increased by 0.9 cm and 0.7 kg. Systolic BP (SBP) and diastolic BP (DBP) significantly decreased by 6.5 and 4.6 mmHg in the intervention group, respectively. The mean changes in the control group were not significant in either SBP or DBP. A significant mean decrease in total cholesterol (TC) was observed for the intervention group by 12.9 mg/dl, while the control group showed a significant mean increase by 1.5mg/dl. Low-density lipoprotein-cholesterol (LDL-C) for the intervention group showed a significant mean decrease 11.3mg/dl. The mean change in the control group was, however, not significant. CONCLUSION Web-based individual intervention using both SMS and Internet improved WC, BW, BP, TC, and LDL-C during 12 weeks in post-menopausal women with abdominal obesity.
3.
Cellular phone and Internet-based individual intervention on blood pressure and obesity in obese patients with hypertension.
Park, MJ, Kim, HS, Kim, KS
International journal of medical informatics. 2009;(10):704-10
Abstract
PURPOSE The present study evaluated whether an intervention using a short message service (SMS) by cellular phone and Internet would improve blood pressure, weight control, and serum lipids of obese patients with hypertension during 8 weeks. METHODS This is a quasi-experimental design with pre- and follow-up tests. Participants were recruited from the family medicine outpatient department of tertiary care hospital located in an urban city of South Korea. Twenty-eight patients were assigned to an intervention group and 21 to a control group. The goal of intervention was to bring blood pressure, body weight, and serum lipids levels close to normal ranges. Patients in the intervention group were requested to record their blood pressure and body weight in a weekly web based diary through the Internet or by cellular phones. The researchers sent optimal recommendations as an intervention to each patient, by both cellular phone and Internet weekly. The intervention was applied for 8 weeks. RESULTS Systolic (SBP) and diastolic blood pressures (DBP) significantly decreased by 9.1 and 7.2 mmHg respectively at 8 weeks from the baseline in the intervention group (p<0.05). However, after 8 weeks from the baseline both SBP and DBP in the control group had not changed significantly. Yet, There were significant mean decreases in body weight and waist circumference by 1.6 kg (p<0.05) and 2.8 cm (p<0.05) in the intervention group, respectively. In the control group increases in body weight and waist circumference (p<0.05) mean changes were also significant. High density lipoprotein cholesterol (HDL-C) significantly increased, with a mean change of 3.7 mg/dl at 8 weeks from baseline in the intervention group (p<0.05). The mean change of HDL-C in the control group was, however, not significant. CONCLUSION During 8 weeks using this web-based intervention by way of cellular phone and Internet SMS improved blood pressure, body weight, waist circumference, and HDL-C in patients with obese hypertension.
4.
Feasibility of using the TOSCA telescreening procedures for diabetic retinopathy.
Luzio, S, Hatcher, S, Zahlmann, G, Mazik, L, Morgan, M, Liesenfeld, B, Bek, T, Schuell, H, Schneider, S, Owens, DR, et al
Diabetic medicine : a journal of the British Diabetic Association. 2004;(10):1121-8
Abstract
AIMS: The TOSCA project was set up to establish a tele-ophthalmology service to screen for diabetic retinopathy (DR) in Europe. The aim of this study was to determine the feasibility of establishing telemedicine-based digital screening for detecting DR and to evaluate the satisfaction of both patients and healthcare professionals with the screening procedures used within the TOSCA project. METHODS The study was a non-randomized, multicentre study carried out in four different countries over a period of 3 months. Patients (n = 390) with diabetes aged > 12 years were included. Two digital retinal images per eye (macular and nasal) were taken and exported to a central server. Patients were asked to complete a questionnaire to assess satisfaction. Accredited graders carried out grading remotely and the results were reported back to the referring centre. Previously graded patient data chosen randomly to represent examples of both DR and no DR were also sent anonymously to the grading centre at a frequency of approximately every 10 patients. RESULTS Most (99%) of the images were assessable enabling a retinopathy grade to be assigned to the patient. Patients found the retinal photography procedures acceptable; only 6% in one centre would not recommend the procedure. Healthcare professionals (photographers and graders) were also satisfied with the overall procedures. The average time taken to grade each patient was approximately 5 min. CONCLUSIONS This study demonstrated that it is feasible to electronically transmit and grade retinal images remotely using the TOSCA process. Built-in quality assurance procedures proved acceptable.