Virtual Validity: mHealth Simulation Games, Diagnostic Indicators, and Behavior Change

Abstract

Risky decisions (e.g., having unprotected sex; using methamphetamine) are often context dependent, automatic, and affectively based, but the contextual triggers that contribute to those risks may not be well understood by the individual him or herself. Virtual game simulations, designed to capture real-life situations, for example for PTSD sufferers, (Rizzo et al., 2009; McLay et al., 2011) are used by clinicians to diagnose then, personalize therapy. Because Read et al. (2006) have designed interactive virtual date environments (VE) to simulate the risk challenges MSM typically encounter in real life, could MSM’s virtual decisions be used to diagnose men’s risks in everyday life? However, to date, no tests of a simulation game’s virtual validity (link between game and real-world risk-taking) have been conducted: That was this project’s goal. We tested the hypothesis that decisions made within the VE would be correlated with real-life risky choices made in the past 3 months (e.g., unprotected sex, alcohol use, methamphetamine use). High-risk men who have sex with men of color (18-30yr old MSM of Latino & African-American descent) were recruited online via hook-up/social networking sites on both mobile apps and through the Internet. Participants reported past risky behaviors and then made a series of automatically recorded choices in an online VE. We found that those who drank alcohol in the past 90 days were likely to choose to drink alcohol in the VE, p(116)=.332, P=.000. Similarly, those who took methamphetamine in the last 90 days, were also likely to choose to take methamphetamine in the VE, p(116)=.866, P=.000. Those who were the insertive partner most in real-life (over 60% of the time), chose to be the insertive partner in the VE, and those who were the receptive partner most in real-life (over 60% of the time), chose to be the receptive partner in the VE, Anal Sex Position p(90)=.747, P=.000. Finally, those who chose to have unprotected anal intercourse (UAI) in the VE, were more likely to have engaged in risky anal sex in the past 90 days, UAI (Time 1) p (116)=.612, P=.000. These findings suggest the potential value of VE for unobtrusively diagnosing, predicting, and understanding the circumstances under which real-life risk-taking might take place. These findings suggest virtual simulation games could be used in apps and over the web to diagnose MSM’s real-life risky choices, potentially yielding more behavior change, even for those with contextual challenges they don’t understand.

Use of an Automated Telephone Response System for a Women’s Lifestyle Physical Activity Program

Abstract

Physical inactivity is ranked fourth as a global risk factor for mortality. Internationally, physical inactivity disproportionately affects women (33.9%) as compared to men (27.9%). A need exists for innovative physical activity behavioral interventions for women using affordable, accessible technology. The 48-week, community based Women’s Lifestyle Physical Activity Program for African American women strived to meet this need by creating an intervention that includes the use of 6 group visits and a personalized step goal. One of three study conditions also received 11 motivational tips to overcome barriers via an automated telephone response system (ATRS), while another received 11 motivational personal calls and a third received no calls. The purpose of this presentation is to present the development and then examine the use of phone technology in the ATRS condition. The research questions are: 1) What was the preferred means of receiving the automated calls (cell phone, home phone, work phone)? 2) Did the number of automated calls completed differ by the means of receiving the calls? 3) What were the challenges encountered with an ATRS?

A randomized cluster, Latin Squares, clinical trial design was used with the order of the conditions randomly assigned to six community sites. Over three years each of the study sites received each of the three study conditions. Five group visits occurred every five weeks in the first 24 weeks with a booster visit in the second 24 weeks. Women in the ATRS condition received one to two calls between group visits that delivered motivational tips. They could listen to more than one tip.

Ninety-seven women of the total 288 enrolled were in the ATRS condition. Of these women, 68% provided cell numbers, 69% provided home numbers, and 27% provided work numbers. The majority of women chose to have messages delivered to their cell phones (73%), followed by home phones (22%), or work phones (5%). The women listened to an average of 9.5 motivational tips. Specific challenges encountered were phone numbers that were not in service throughout the study, which was encountered with 10.8% of the phones at least one time during the study as well as unanswered calls (8.9%). Selected solutions designed to address challenges included closely tracking weekly call reports, using participants’ alternative contacts and email to reach them, and always updating participant phone numbers during data collections.

This study has demonstrated that automated telephone messages can be successfully delivered via cell phone technology.

Engaging Individuals to Promote Diabetes Risk Awareness with txt4health: A Program Evaluation of Beacon Community txt4health Pilots in Southeast Michigan and Greater Cincinnati

Abstract

There are an estimated 25.8 million American children and adults, roughly 8.3% of the U.S. population, living with diabetes. Diabetes is particularly burdensome on minority populations where health disparities persist. Mobile technologies are an attractive method for reaching broad populations given the high penetration of cell phones across diverse groups, and may be a useful strategy for raising awareness of type 2 diabetes. To raise awareness of the risks associated with type 2 diabetes, pilots of txt4health, an automated 14-week text message program, were launched by the Southeast Michigan and Greater Cincinnati Beacon Communities. This investigation sought to evaluate the txt4health program pilot in Southeast Michigan and Greater Cincinnati through documenting participant usage of txt4health, as well as user perceptions of the program.

In this two part evaluation, we conducted a retrospective records analysis of individual-level txt4health system usage data from participants in Southeast Michigan and Greater Cincinnati to determine usage of the program. We also conducted a multimodal user survey with 161 txt4health users recruited through the program to understand participant perceptions of program satisfaction, participant use, and self-reported perceptions of behavior change. Preliminary results from the retrospective records analysis reveal that across both pilots, 5,570 participants initiated enrollment in txt4health, of which 33% completed the two-step enrollment process. Once enrolled, the majority of participants set a weight loss goal (74%), and tracked their weight (89%) and physical activity (65%) at least once during the program; however 56% dropped out before the end of the program, with 70% of dropouts occurring before the end of the fourth week. Among program completers, rates of weekly weight tracking were low with 22% of participants logging weekly weights at least five times, yet rates of weekly physical activity tracker were greater with 49% logging weekly physical activity at least five times. Despite high attrition across the pilots, surveyed txt4health users report high levels of program satisfaction, with 67% reporting satisfaction scores of eight or higher on a ten point scale (10 =most satisfied; M=8.2, SD=1.6). The majority of participants report that txt4health helped them make lifestyle and behavior changes related to diet and physical activity. While broadly focused public health text message interventions may have a great reach, individual engagement among participants widely varies, suggesting that this type of approach may not be appropriate for all, but is a feasible and acceptable delivery modality for a large subset of people.

Air Aware: A smartphone app to increase awareness of environmental factors triggered for symptoms of breathing-related illnesses

Abstract

Breathing-related chronic illnesses such as asthma and chronic obstructive pulmonary disorder (COPD) affect millions of people. People with these conditions are especially impacted by environmental and weather-related factors that contribute to symptom exacerbation. This includes worsening dyspnea, anxiety, fatigue and depression. Self-monitoring of symptoms is becoming an increasingly popular tool in treatment for these illnesses. One such tool is being developed by the Department of Medical Social Sciences (MSS) at Northwestern University Feinberg School of Medicine. This tool is an iOS based mobile application that incorporates validated measures from the NIH PROMIS system with publicly available environmental and weather-related data through RSS and API interfaces. The application associates a person’s dyspnea, anxiety and fatigue symptoms with environmental variables such pollution and pollen levels and weather related data such as temperature and humidity levels for a given GPS location. These variables are obtained by calling publicly available web services that take GPS data as inputs. The GPS readings are obtained through the GPS API available in the iOS devices. Since a person’s sensitivity to these external factors is highly individualized, the application first prompts users to complete a short battery of PROMIS computer adaptive tests (CAT) under a variety of environmental conditions and then calculates correlation coefficients. These prompts are enabled through the notification system available in the iOS platform. CATs reduce patient burden by administering highly targeted items to the user and stops when enough information is received. Once the application has collected enough data to determine if a correlation(s) exists, it will alert the user when environmental or weather conditions are at a level that would indicate a symptom is likely to occur. Since correlation does not equate causation, the application does not provide specific treatment recommendations for the symptoms; instead it aims to increase awareness of the existing conditions and how it may affect one’s immediate well-being. User acceptance and effectiveness will be evaluated in a future feasibility study. This will aid in the refinement of criteria for determining the alert mechanism based on historical stored data.

Experience with mobile technology among patients with tuberculosis in San Diego, California and Tijuana, Mexico

Abstract

Each year, nearly 9 million cases of tuberculosis (TB) occur worldwide, resulting in 1.4 million deaths. While curable, long treatment regimens (6–24 month) negatively impact adherence for many patients, resulting in ongoing illness, continued transmission, and development of drug-resistant TB. Directly observed therapy (DOT) is recommended for improving adherence. DOT consists of TB providers watching their patients ingest each medication dose. However, DOT is costly, labor intensive and impractical in remote or resource-poor settings. To reduce these barriers, we developed the “Video DOT” (VDOT) system, whereby patients use mobile phones to record and send daily videos of themselves taking medications, which are then viewed remotely by DOT workers. To gauge feasibility of this technology-based approach, we assessed prior experience with mobile phones and willingness to adopt mHealth interventions in a sample of TB patients in the US/Mexico border region.

VDOT was pilot-tested in a single-arm trial among TB patients in San Diego, CA (n= 43) and Tijuana, Mexico (n=9). Participants were interviewed before and after using VDOT for an average of 5.5 months (range 1–11 months). Ages ranged from 18–86 years old, 50% of patients were male and 50% were Hispanic. Education ranged from 24% completed primary education or less to 57% completing at least some college. Prior to study enrollment, 94% of participants owned a cell phone (55% were smartphones), of which most reported experience sending photos (72%) or videos (57%) from a cell phone, and 64% reported sending text messages daily. Age was the only factor significantly associated (p-values < .05) with owning a cell phone, owning a smart phone, sending pictures and videos, and daily text messaging. Experience with technology was similar between San Diego and Tijuana participants. Compared to baseline ranking on a 10-point scale, participants felt more comfortable using cell phones (+.77, p=0.008), phone cameras (+1.43, p=0.006), phone video cameras (+1.68, p=0.009), internet (+.68, p=0.100), email (+.72, p=0.226) and text messaging (+.29, p=0.299) at follow-up.

Cell phone use was very common among a demographically-diverse sample of TB patients. Younger patients had the most experience with smartphones prior to study enrollment, making this demographic especially prepared to adopt mHealth interventions. The experience of using smartphones for VDOT also led to an increase in comfort using mobile phone functions in both low and high-resource settings. These findings suggest that smartphones provide a feasible platform for TB treatment monitoring applications.

MobileCARE- Innovative Approaches for Combat Trauma Education and Documentation

Abstract

Learning Objectives:

1. Participants will identify the successes and challenges of developing and implementing a total mobile data management system in a level 1 trauma center.
2. Participants will demonstrate the value of integrated solutions combining mobile devices, electronic medical records, education and telemedicine/decision-support for when decisions are most critical.
3. Participants will appreciate the importance of the user experience and acceptance when selecting appropriate technology for their mobile health projects

Mobile technologies harbor the potential to transform healthcare by improving clinician workflow and decision-making, which ultimately enhances quality of care and patient outcomes. The time sensitive nature inherent in trauma and critical care requires physicians to quickly access information to make correct decisions. In the past 5 years, we have been developing a mobile software platform and data management system that combines clinical documentation, education and telemedicine/decision-support. The goal is to provide clinicians with an integrated system of tools to facilitate the process of care. MobileCARE delivers a suite of integrated applications that completely supports a physician’s workflow. Clinicians are able to create documentation, view test results, medical notes and surgical documentation in real time. It also provides access to a mobile learning trauma and critical care curriculum and the ability to communicate through telemedicine with other team members. To better understand the use of mobile technologies in the clinical environment, we conduct usability and user acceptance testing as a guide to implementation. We also have conducted knowledge and skill acquisitions tests of the learning modules.The system are currently being evaluated in the trauma intensive care unit of a busy urban Level 1 trauma center. Physicians use it to document patient admissions and daily patient status with the information immediately available to all users across multiple platforms. Knowledge and skill acquisition tests have demonstrated that the mobile learning modules are equivalent to traditional classroom lectures (Figure 1), and that their use improved performance in the simulated environment (Figure 2). MobileCare is a complete software solution that provides significant functionality in the clinical environment. The impact on the safe and efficient delivery of care will continue to be realized. This technology is especially beneficial where continuity of care is required, as with patients with chronic disease or multiple acute conditions.

Figure 1

Figure 2