Design & Evaluation of Mobile Technology for Health Behavior Change

Design & Evaluation of Mobile Technology for Health Behavior Change

Greg Norman, PhDDepartment of Family & Preventive Medicine

University of California, San Diego 1

Center for Wireless & Population Health Systems

2

3

Center for Wireless & Population Health Systems

• Kevin Patrick, MD• Greg Norman, PhD• Jacqueline Kerr, PhD• Linda Hill, MD• Jeannie Huang, MD• Simon Marshall, PhD• Cheryl Rock, PhD• James Fowler, PhD• Karen Calfas, PhD• Bill Griswald, PhD

Research on systems of wireless, clinical, and home technologies to measure and improve lifestyle and other health-related behaviors in:

-- Healthy adolescents-- Overweight and obese children and adults-- Depressed adults -- Adolescents risk for type 2 diabetes-- Adolescents with chronic disease-- Older adults to promote successful aging-- Adolescents recovering from leukemia-- Young adults to prevent weight gain-- Adults with schizophrenia-- Exposure biology research-- Cancer comparative effectiveness research

Center for Wireless and Population Health Systems

4

CWPHS.UCSD.EDU

Intervention & Methodology• Expert Systems• Kiosks• Interactive Websites• SMS Mobile Phones• Exergames• Mobile Apps

• Measure Development• Classification• Longitudinal Data

Analysis• Randomized Controlled

Trials• Mediation & Moderation• Geographic Information

Systems (GIS)5

mHealth = Integrates intervention & measurement systems

Overview:

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SMS Text Messaging Intervention for Weight Loss

SMART: Social/Mobile Approach to Reduce WeighT

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Problem

• Trend of increasing obesity.• Behaviors that can impact obesity

include physical activity, sedentary behavior, and dietary behaviors.

• Need for effective approaches to obesity prevention and treatment.

1999

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1999, 2009

(*BMI 30, or about 30 lbs. overweight for 5’4” person)

2009

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Behavioral Risk Factor Surveillance System, CDC.

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9

Rational for Mobile Interventions

light-intensity activities: 6.5 hours/day

sedentary time: 9.3 hours/day

moderate to vigorous activities: 0.7 hours/day

1. Context relevant2. Point of decision3. Just in time4. On the go5. Convenient6. Unobtrusive

Persuasive Design

WirelessTechnologiesData Analytics

*

Body Sensor Network

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Social Networks

Geographic Information Systems (GIS) & GPS data

• Parks• Distance & density & acreage

• Schools• Distance & density

• Recreation Facilities• Distance & density

• 2010 Census data• Housing unit density

• Parcel & Land Use• Commercial, industrial, institutional,

residential, office, open space, vacant• Retail parcel count

• CoStar / SD County Tax Assessor • Retail floor area ratio

• Coastline• Distance to coast

• Local & Major Roads• Intersection & cul-de-sac counts

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mDIET & ConTxt

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Mobile Diet Intervention through Electronic Technology

PURPOSERandomized Clinical Trials to evaluate the use of Text Messages (SMS) to improve dietary behaviors and weight outcomes in obese men and women.

mDIET:mobile Dietary Intervention through Electronic Technology

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Funded by the National Cancer Institute

R21 CA115615-01A1

Resulted in the first report in the literatureof an RCT evaluating SMS/MMS for weight loss

mDIET: Study Design & Sample

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• Sample N = 63• 81% Women • Mean age 45.9 years

• Women ranged 26 – 55 yrs.• Men ranged 33 – 55 yrs.

• Race/Ethnicity• 76.2% Caucasian or White• 15.9% African American or Black• 3.2% Asian American/Pacific Islander/Native Hawaiian• 4.8% Prefer not to state• 22.2% Hispanic

Randomized Controlled Trial: Participants were randomized to either an Intervention (mDIET) or Control group (usual care).

Completed 3 in-office measurement visits over a 4 month period

mDIET Components

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• Daily Text & Picture Messages– Participant could choose the # of messages to receive & times to receive the messages

(2-5 messages per day)– Daily messages are statements or questions

• Printed Materials for recommended weekly reading– Behavioral Skills, Nutrition, and PA topics (e.g. Self-monitoring, Portion Control, Routine

Physical Activity) First half provided in Binder at baseline; Second half provided at mid-point measurement visit; participants were given a pedometer

• Monthly Brief Counseling Calls (5-10 minutes)– Progress and counseling calls from their Health Coach addressing strategies,

social support, problem solving, etc.

• Goals– Primary: Daily 500 calorie deficit (through calorie reduction and an increase in calories

burned by reaching and maintaining a 12,000 steps/day goal)

• Self-Monitoring– Weekly weigh in (text weight) and daily food & exercise journal

Types of mDIET Messages Type of Text or Picture Message Example

Motivational Sayings Never say never, you can do it! Keep up the good work!)

Nutrition & Physical Activity Tips Try 10 baby carrots and a tablespoon of fat-free dressing for a 100 calorie snack; Want extra steps? Take the stairs today

Nutrition & Physical Activity Reminders Remember to move more today to reach your 12,000 step goal; Be sure to practice portion control strategies at your next meal

Short-Term Goal Reminders Think about what you can do in the next 4 hours to be healthy

Behavior Questions Have you practiced portion control strategies today? Have you reached your 12,000 step goal today?

Weekly Weight Questions What is your weight?

Weekly Weight Graphs Chart of weekly weights

Portion Control Picture Messages Pictures of portion sizes 17

Personalized Text Messages• Eating Behaviors

– 4 items on the EBI were emphasized (based on our own logic rules)

• Name– Some text messages included their first name (e.g. Congrats, Maria!

You continue to improve. You're clearly working hard and it shows).

• Grocery Store– Participants were asked to identify the grocery store that they most

frequently visit (e.g. Did you buy fruits and vegetables from Trader Joes this week?)

• Social Supporter– Participants were asked to identify someone in their personal life

(family member, friend, co-worker) that could part of their social support system (e.g. Have you been telling Mark about your weight loss success?)

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Message Activity

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3000 Messages

1500 Intervention Rules

Time of Day / Day of Week ?User’s Week in Program ?

Previous Messages ?Previous Replies ?

User EBI ?.........

Time of Day

User Database

Sender

Receiver

SMS Out

SMS In

Client Management System

How mDIET Works…

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ASP Web-pages MS/SQL Database Java Application Mail Gateway

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Mobile Diet Intervention through Electronic Technology

mDIET: Results

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Participant Feedback on mDIET

• “Steady reminder – keeping health on my mind”• “Felt commitment every day – could not let myself forget my goals”• “They served as an excellent reminder to watch what I ate”• “Keeps me focused”• “Constant reminders to believe in myself and make the right

choices”• “I found that texting your weight every week was extremely helpful”• “I miss my 6am message!”

Overall satisfaction with mDIET program for weight loss 95.6% of participants would recommend mDIET to friends/family

| Slide 23

ConTxtPURPOSE• To develop and test the efficacy of a SMS intervention for

weight loss among overweight and moderately obese (BMI 27-39.9) men and women ages 21–60.

• The ConTxt study builds upon our work with pilot SMS weight loss study mDIET.

• The ConTxt study aims to expand the logic of the SMS messages and ecological components for over 300 English-speaking participants and Spanish-speaking participants.

ConTxt Team & Support Staff

Investigators

Investigators Staff StudentsPrincipal Investigator

Kevin Patrick

Co-InvestigatorsGreg Norman

Simon MarshallCheryl RockBill Griswold

Elva Arredondo

Study CoordinatorLindsay Dillon

MeasurementCarlyn Peterson

Recruitment/Intervention

Angelica Barrera-Ng

Tech DevelopmentMark Sullivan

Fred Raab

CMS/DataAllison Flick

Ph.D. StudentJulie Kolodziejczyk

GraduatePreeti Baweja

Misty Lacks

Undergrad InternsErika GonzalezMegan AlcalayKaren Yeung

Kanchi KejriwalHelen Shea

Dianne Valenciano

| Slide 25

RCT Study Design

309 Subjects, 21-60 years old male & female, Weight: 27 < BMI < 39.9

English & Spanish speakingText Messages Users (or willing to learn)

• RCT ERNROLLMENT BEGAN: October 2011

• Community Recruitment: Email listservs, flyers, community events, print and/or radio advertisements

n = 103SMS Only

n = 103SMS Only + Counseling

n = 103Comparison

Control/Comparison• Standard of Care Information via printed materials:

• Diet/Nutrition• Physical Activity• General Health

• Monthly mailings

• 4-Month opportunity to “cross-over” and receive 4-months of the ConTxt intervention AFTER completion of 12-month assessment.

Intervention Components• Weekly printed materials on core behavioral and weight loss

strategies

• Daily SMS messages: • TAILORED MESSAGES: weight loss/management strategies; goal

setting; behavioral barriers; weight monitoring; skill mastery; physical activity; and location

• PERSONALIZED MESSAGES: name; location; social supporter; grocery store; children/pets

• STANDARD MESSAGES: weight loss strategies; self monitoring

SMS + COUNSELING CALLSReceive bi-weekly and monthly counseling calls to assess progress, skill

development, and barriers

| Slide 28

ConTxt: 16-Week Cycle Topics

• 1. Self-monitoring & Goal Setting

• 2. Calories• 3. Meal Planning• 4. Pedometers & CV

Exercise• 5. Portion Control• 6. Sedentary Time• 7. Barriers• 8. Routine PA

• 9. Eating Out• 10. Managing Social

Situations• 11. Vigorous PA• 12. Substitution• 13. Healthy on a Budget• 14. Strength &

Stretching• 15. Body Image• 16. Sticking with It

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Weight Behavior Inventory (WBI)1. Shopped when I was not hungry.2. Shopped from a list.3. Stored food in containers where it was not

readily visible or in a closed cabinet.4. Kept healthy ready-to-eat or portion

controlled snacks for myself.5. Removed high calorie foods from my home,

office or room.6. If I was served too much, I left food on my

plate.7. Only ate when I was hungry.8. Decided ahead of time what I would eat for

meals and snacks.9. Reduced portion sizes.10. Changed food preparation techniques.11. Left a few bites of food on my plate.12. Followed a structured meal plan.13. Recorded or wrote down the type and

quantity of food eaten.14. Avoided eating while watching TV.15. Reduced my calorie intake.16. Cut out/reduced sweets or junk food.17. Cut out/reduced between meal snacks.

18. Cut out/reduced late night snacking.19. Ate less meat.20. Ate less fat.21. Drank less alcohol or changed type of drink

to reduce calories.22. Increased fruits and vegetables.23. Used frozen entrees such as Lean Cuisine or

Smart Ones.24. Decreased frequency or portion sizes of

desserts.25. Altered my daily routine to get more

lifestyle physical activity.26. Used the stairs instead of the elevator.27. Wore a pedometer.28. Reduced the amount of time spent

watching TV.29. Used home exercise equipment.30. Exercised at a gym or participated in an

exercise class.31. Worked out with a personal trainer.32. Exercised for period of 30 minutes or more.33. Recorded or graphed my physical activity.34. Weighed myself regularly or daily.35. Recorded or graphed my weight.

Types of Text MessagesID MESSAGE “TYPE”1 Weight Messages includes weekly weight question and responses, weight milestone messages, and weight

“competitive messages.”

2 Weekly Content Messages these messages relate to the corresponding printed materials

3 Self-Monitoring Messages these messages relate to self-monitoring tips, facts, reminders

4 Physical Activity Messages these are messages that are “tailored” based on a participants preferred physical activity: run/walk, swim, bike, gym activities, or generic. The preferred physical activity will be set at the baseline visit.

5 Motivational Messages these are inspirational or motivational messages

6 Daily Pedometer Messages includes daily pedometer tracking question, potential responses, pedometer milestone messages, and pedometer “competitive messages.”

7 User Initiated Messages includes Restaurants, Meals, Food Cravings, Physical Activity, and Location

8 Urge/Food Craving Messages these are messages that are “tailored” based on a participants “guilty” food craving: chocolate, sweets, salty, comfort foods or generic. The food craving will be set at the baseline visit.

9 WBI Willingness Question includes the willingness question & response.Note: these also fall under the general WBI category of 15

Types of Text MessagesID MESSAGE “TYPE”10 WBI Knowledge Messages messages that are sent to participants that answer N to the willingness question

11 WBI Barrier Questions (includes the barrier question and goal)

12 WBI Barrier Messages (these messages are messages that are sent to participants that answer Y or No Response to the willingness question and are tailored based on the response to the barrier question).

13 WBI Assessment Questions (includes the assessment question and response)

14 WBI Maintenance Messages (these are messages that are sent if a participant scores a 4 or 5 on the assessment question)

15 GENREAL WBI Messages includes ALL the WBI messages above: Message type 9 – 14

16 Appointment Reminder Messages

(includes messages that will be sent based on certain dispositions in CMS)

17 FUTURE Messages messages that can be used for the “User Preference” messages based on tagging, like/unlike)Note: The logic for these are not in place

18 Physical Activity Location Messages

these are messages that are “tailored” based on a participants preferred physical activity location: home, gym, office, outside. The preferred physical activity location will be set at the baseline visit.

SMS Logic & FlowSunday Weekly WBI Messages

Weekly MasteryAssessment (Friday)

Willingness

Send SMS: “Are you willing to set goals for [WBI] this week?

(y/n)”

Send Multiple Choice Barrier

Question

a) Barrier 1

b) Barrier 2

c) Barrier 3

d) Barrier 4

NO YES

Knowledge Text

Messages

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Skills/ Tips Text

Messages

Barrier SMS Messages

(M, T, W, TH, SA)

Send SMS:“On a scale of 1 (never) to 5 (always), how often did

you [insert WBI] in the past week?”

Mastery = Weekly Average (after 3 weeks) >/= to 4

Answer

4 or 5

Answer

1, 2, or 3

WBI Maintenance Messages

(M, T, W, TH, SA)

Tagging Text Messages

Subject Matter Core Strategies Reminder, Tip, Fact,

Question/Assessment Personalized on set categories?

Does it relate to location?

1 Calories 15 Intention Formation 22 Reminder 27 Social Supporter 1 38 Yes

2 Organization 16 Self-Monitoring 23 Tip/Hint/Strategy 28 Social Supporter 2 (i.e. kids name)

3 Meal Planning 17 Goal Setting: 24 Fact/Information 30 Social Supporter 3 (pet name)

4 Cardiovascular Exercise 18Goal Review: Participating in reviewing their goals - statement or question

25 Question/Assessment 31 Physical Activity Type

5 Portion Control 19 Positive Feedback 26 Response 32 Physical Activity Location #1

6 Volumetrics 20Problem Solving/Overcoming Barriers

33 Park

7 Sedentary Behavior 21 "Surf the urge" 34 Activity Location 28 Eating Out 40 Negative Feedback 35 Restaurant #19 Social Situations 36 Restaurant #2

10 Vigorous Intensity PA 37 Food Craving/Food Urge

11 Substitution/Replacement 39 First Name

12 Healthy on a Budget 41 Grocery Store13 Strength Training14 Stretching

Tagging Text Messages Examples

Message Tags Tag Type

1. Confidence is feeling satisfied with who and what we are.

24 Fact, Information

2. Your goal this week is to sit down and plan your weekly meals. You can do it, Diane.

2, 3, 15, 23, 26, 39

Organization, meal planning, intention formation, strategy, response, first name

3. You can send us a text with the word chocolate, sweets, salty, or comfort if you are craving one of those foods and need help!

15, 21, 23 Intention formation, hint, strategy

User Ratings of Messages58 randomized to SMS have been in the program for 0 to 17 weeks. 36 rated at least one message. Number of messages an individual rated ranged from 0 to 144, mean 13.8, sd = 23.6, median = 4.

327 messages have been rated 1 to 16 times

User Ratings of Text MessagesMessage Tags Likes Tag Type

1. There's no limit to the number of chances you get to start exercising again. If you give up or skip a week, try again.

20, 15, 4, 23

11/11 Problem solving, intention formation, exercise, hint, tip

2. Do you LIKE these messages? Remember to text LIKE or L after any messages you LIKE.

22 16/16 Reminder

3. Check out the restaurant's website and look at their menu to plan what you're going to eat before you go.

8, 2, 3, 23, 15

8/10 Eating out, organization, Intention formation, hint, strategy

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SMART: Social/Mobile Approach to Reduce WeighTPURPOSETo leverage mobile phones, social networks, and the web for weight loss among 18-35 year old young adults. Funded with a 5-year grant from NHLBI/NIH.

SMART Study Team

| Slide 39

Investigators Staff Students

Principal InvestigatorKevin Patrick

Co-InvestigatorsGreg Norman

Simon MarshallCheryl RockKaren Calfas

James FowlerBill Griswold

Jeannie HuangTom Robinson

BJ Fogg

Study CoordinatorAnjali Kansagara

MeasurementMelanie Epstein

InterventionChristina Servetas

Tech DevelopmentEvan CookFred Raab

CMS/DataAllison Flick

Ph.D. StudentErnesto Ramirez

Laura Pina

Undergrad InternsAnnie Phan-huy

Alexis LeonCathy CalinisanArek HiridisahLauren Friend

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SMART Study Design

400 Subjects, 18-35 years old male & female, Weight: 25 < BMI < 34.9

University students at three colleges in the San Diego area

Owns a personal computer

Owns a mobile phone and uses text messaging

Facebook user / willing to start using Facebook

ENROLLMENT Began: June 2011n = 200

Comparisonn = 200

Treatment

PRIMARY AIM: At least 5-10% weight loss at 24 months

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Study Population: College Students

Campus RCT NSDSU 160UCSD 160

CSUSM 80Total 400

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Study Outcomes

Primary outcome - Weight status at 24 monthsSecondary outcomes -

• Weight status at other time points• PA/Diet/Sedentary/Sleep• Quality of life• Depression• Use of technologies & relationship to outcomes

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Group A vs Group B Group A - Interactive Technology vs. Group B - “Self-guided”

SMART| Slide 43

Group BSelf-guided Weight-loss Program

• Binder with introductory “program” materials• Monthly website topics• Weekly health tips• Weekly online polls• Paid incentive.

• Tools: Binder with introductory program materials, scale, pedometer

• 15-min “greeter session”• 30-min in-person kick-off session• 10 “lifelines” cashed in for virtual (Skype) face time

or phone calls over a 24-month period– Problem solving around barriers

• Mobiles apps• Social support via Facebook• Email• Text messaging• Behavioral recommendations

– Decrease daily calorie intake by 500-1000 cal/day– Increased PA by 10% until at 60min/day and 80% of target HR

• Knowledge – Content on TTM website– Focus on five core behaviors

• Paid incentive for measurement visits

Group AInteractive Weight-loss Program

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Comparison Condition

• Standard of Care information via a static website:www.smarthealthtools.com

• Weekly emails: – introduction to monthly health-related topic first week of

each month– a health tip every second week– a health events calendar every third week– a poll question on website every fourth week

• Consent via Facebook but no further interaction on Facebook

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SMARTSocial Mobile Approaches to Reduce Weight

1 - Participant

2 - Friend of Participant

3 - Friend of Friend

SMART Study

Facebook an intact social network

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A “User-centered” InterventionWeb

Email

Smart-phoneApps

Other ToolsBathroom ScalePedometer

Be sure to check your email for this this week’s topic from ThreeTwoMe

Mobile Txt Msgs

46

Intervention: Health Coach Session

| Slide 47

SMART: Social Mobile Approaches to Reduce Weight

• Before the visit: send questionnaire for “getting to know you” • 30-minute Health Coach focus:

– Communicating SMART study goals: 5-10% weight loss; 500-1000 calorie deficit per day; increase physical activity: 0 10% gradually moderate to vigorous intensity exercise for 60 min/day (calculate target HR)

– Set personal goals for subject. How much weight loss do they want to achieve?– Focus on: motivation, readiness, current behaviors, lifestyle, current knowledge of WL behaviors, practices, issues, problems,

behaviors – Focus on orienting them to the study; how to use the study and the study tools (apps, FB, social support)– Convey key messages:

• We want to hear from you whether you’re losing or gaining weight. We’re here to help you.• We know from other studies that people who interact with study tools tend to be more successful.• In order for you to be in the study, you must be willing to do this.• You have to interact everyday. Some things will work for you; others won’t.• We have many tools. Find the tools that work for you.• If you’re not losing weight, use your ‘lifeline’ and contact your health coach.

• 10 Lifelines for “emergencies” or if they “fall off the wagon”.

t=0 mo t=6 mo t=12 mo t=18 mo t=24 mo

30-min in-person

health coach visit

10 “lifelines”Up to 15-min each

Can be used from month 2 through month 24

15-min greetersession

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Intervention: Web

| Slide 48


ThreeTwoMeTerm for the SMART interventionDeveloped as a unique “brand”www.threetwome.com

• 16 weekly topics in blocks of six

• Deeper dive on each topic • “Homework” for each topic

via “Practice it”.

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Intervention: Web

| Slide 49


ThreeTwoMeTerm for the SMART interventionDeveloped as a unique “brand”www.threetwome.com

Users can set their own profile settings on:

EmailSMSCell phone

And, update/change as frequently as they like.

Intervention: Blog

| Slide 52


• Blog posts in conjunction with real-time events (e.g. holidays, academic schedules, etc.)

• Cross-reference to Facebook

• Launching pad for campaigns

• Christina, our Health Coach, posts these with occasional “guest posts”

Intervention: Facebook Page

| Slide 53


• Christina – “The Health Coach”

• # of “Likes” overall

• # of “Likes” per post

• # of Impressions

• % feedback on the post

• Video on National Food Day

ThreeTwoMe : Suite of AppsMobile Apps

APP TARGET BEHAVIORS & STRATEGIES

Self-Monitoring

Intention Formation

Goal-Setting

GoalReview Feedback Knowledge

Be Healthy X X X

TrendSetter X X X X

Goal Getter X X X

Facts & Quizzes X X

All apps accessible via Mobile Web Facebook

Facts & Quizzes A knowledge app to help learn and recall key facts.

Goal GetterYour friends motivate you to reach your goals through secret messages, surprise, and rewards

Be Healthy A healthy tip a day keeps the doctor away.

Healthy Tips that are acted upon can be shared with others…

Reminders are strategies based on the “WBI” or weight behavior

inventory Others developed by SMART. Tracking based on keyword

associations will serve as triggers

Coming Soon

| Slide 61


• ThreeTwoMe is a continuously evolving intervention.

• ThreeTwoMe continues to build, enhance, replace as popular culture and trends change with time, preferences, and behaviors.

• Coming Soon: o “Adopt a Chicken” app from Stanfordo App contesto TTM API

New ArchitectureAll apps integrate with an API for additional features.

• Extracting common features (e.g. goals, notifications, sharing) and packaging them into an API service

• Avoid repetition of code in each app (problematic in current architecture)

• Open doors for third-party developers(possibly a developer app challenge)

• Simplify the start-up development time required to get a new app functional(test new ideas faster, with less investment)

• Create new apps without modifying the Three Two Me infrastructure

The New AppThe benefits for a new application, and how the user will use Three Two Me to enhance their experience.

• Apps can target specific behaviors

• A basic “Push Up Counter” app can compliment its simple and unique features with our core features

• User’s are informed and required to approve all app connections with TTM

• Provide the UI for creating goals, managing trends, and creating / displaying incentives, social sharing

• New apps can still work great standalone(Store information locally using HTML5 Local Storage)

Intervention: Dosage/Participant Engagement

# ITEM & CHANNELREQ? DOSE DELIVERED

MINIMUM ENGAGEMENT (Range) DOSE RECEIVED

EQUIVALENT TIME UNIT / ENGAGEMENT

GLOBAL ENGAGEMENT SCORE

1 Health Coach In-person Y 1 meeting/2 years 1 meeting/2 years 0-1 30 minute 0,1

2 Weight TXT Y 1 message/week 1 reply (0 to 7) 0-7 1 minute 0,1

3 Sunday Email Y 1 email/week 1 read/week 0-1 1 minute 0,1

4 Facebook Y 7 posts/week1 (post/comment/like) / week 0 to N 1 minute 0,1

5 Website Y Constant 1 pageview/week 0 to N 1 minute 0,1

6 Knowledge area Y

7 Blog No 1 blog post/week 1 blog read / week 1 minute 0,1

8 Lifelines -Virtual No 0 to 10 0 10 minute 0,1

9 BH App No 7 BH/week 1 (0 to 7) 1 minute 0,1

10 GG App No 0 to N 1 (0 to N) 1 minute 0,1

11 TS App No 0 to N 1 (0 to N) 1 minute 0,1

Intervention: Dosage/Participant Engagement

Summary of Average Weekly Engagement

TTM page

views weekKnowledge

week Blog weekGoal getter

weekTrend setter

weekBe healthy

week

N Valid 105 87 76 106 106 82

Missing 1 19 30 0 0 24

Mean 21.3569 5.1281 1.9532 1.4497 4.1561 1.1232

Std. Deviation 21.79927 6.14461 2.49827 2.65809 7.16594 1.19342

Minimum .27 .06 .10 .00 .17 .07

Maximum 104.00 36.00 11.86 15.67 53.00 5.06

Percentiles 25 6.0357 .7778 .4167 .0000 .6667 .2500

50 12.7143 2.6923 1.0000 .4093 1.7802 .6667

75 28.4643 7.3571 2.1227 1.6875 5.0000 1.5877

Recruitment

SMART| Slide 66


Co-branded poster

Bookmarks

Quarter-sheet fliers w/QR codes Magnets

Stickers

Recruitment

Challenge 1

• Challenge – Intervention will change over time• Downside – different participants will get different

apps, new apps & features introduced• Upside – more engaging experience over 2 years of

program• The Plan – always have tools for the 5 core change

strategies

Challenge 2

• Challenge – Controls participants could get access to apps.

• Downside – Study contamination, internal validity threatened.

• Upside – would be an indicator of success.• The Plan – try to control, measure extent of

contamination.

Challenge 3

• Challenge – Participants could become friends through program.

• Downside – clustering of participants, lose independence of observations.

• Upside – could help people achieve goals.• The Plan – will measure extent of clustering, can

anticipate some clustering, can incorporate in statistical models.

Challenge 4

• Challenge – Facebook changes over time.• Downside – could have negative impact nature of

intervention and what we can learn. • Upside – could improve delivery of intervention and

what we can learn.• The Plan – roll with the changes.

Conclusions

• Mobile phone is a viable platform for health behavior change.

• SMS & apps for delivering interactive intervention content.

• Requires new ways to evaluate engagement.• Advantages of just in time, when and where needed,

convenient, simple.• Adaptive interventions to the individual and to groups.• Expect ‘small’ changes in weight loss that accumulate

over time. 73

Documents

Design & Evaluation of Mobile Technology for Health Behavior Change