A Tablet Game for Risk Reduction and HIV Prevention in Adolescents

Kimberly Hieftje,¹Lindsay Duncan,¹Benjamin Sawyer,²Sabrina Haskell,²Lynn Fiellin,^1
1Yale University,²Digitalmill, ³Schell Games

Journal MTM 1:4S:8, 2012
DOI:10.7309/jmtm.32

Abstract

Background: Thirty-nine percent of new HIV infections in 2009 occurred among individuals aged 13-29 years. Videogames are ubiquitous, can improve health behavior, but have not been evaluated as a tool for HIV/AIDS prevention in adolescents.

Purpose:  To develop and evaluate a videogame designed to help teens acquire and practice skills to avoid or reduce overall and HIV risk behaviors.

Methods: Yale’s Play2PreventTM, Digitalmill, and Schell Games are developing PlayForward: Elm City Stories, a videogame that incorporates evidence-based tools for behavior change. We will evaluate the efficacy of thegame by conducting a randomized trial in 330 youths assigned to play PlayForward or a commercial videogame. Subjects will play two sessions/week of their assigned game for six weeks. Assessments will evaluate the game’s efficacy for reducing risk and promoting good decision making.

Results: The videogame will be ready for testing as a final playable iPad product in late Fall 2012. The player uses a personalized avatar to “travel” through life, making decisions and facing challenges in a repetitive and meaningful way, equipping them with skills that potentially translate to real life. During this talk we will describe how an originally planned desktop application was quickly retooled for touch interface tablets. While many traditional desktop and Web-based applications will easily move to tablet and mobile phone frameworks, understanding some of the nuances involved will provide new insights. We will outline specific approaches to game development for behavior change and discuss the potential global implications of our work.

Conclusions:  This videogame represents a paradigm shift, hopefully providing evidence for the role of games as risk reduction and HIV/AIDS prevention in youth. Videogame technology has the potential to expand the available vehicles for HIV/AIDS prevention to the increasing number of electronic gaming platforms including mobile technologies, creating a new venue for public health interventions.

Feasibility of a Virtual Exercise Coach to Promote Walking in Community-Dwelling Persons with Parkinson’s Disease

Nancy K Latham,¹TerryEllis,²Tamara De Angelis,² Katy Hendron,²CathiA Thomas,³ MarieSaint-Hilaire,³ Timothy Bickmore^4
1Boston University School of Public Health,²Boston University, ³Boston University Medical Campus,⁴College of Computer and Information Science, Northeastern University

Journal MTM 1:4S:7, 2012
DOI:10.7309/jmtm.31

Abstract

Objective: Exercise improves function and quality of life in persons with Parkinson’s Disease (PD), but few people adhere long-term to home-based programs. A Virtual Exercise Coach (VEC) is an animated character viewed on a notebook computer in the subject’s home that emulates face to face interactions. The effectiveness of VECs to improve exercise adherence in people with PD or any other neurodegenerative disease has never been explored. The aim of this study is to explore the feasibility, acceptability and preliminary evidence of efficacy of a VEC to promote daily walking in community dwelling persons with PD over a one month period.

Methods: 20 sedentary subjects with a diagnosis of PD participated in this Phase I clinical trial. Subjects were instructed to interact with the VEC for 5 minutes, wear a pedometer and walk daily for one month. Mobility (six-minute walk and gait speed) and exercise self-efficacy were assessed at baseline and one-month. Retention rate, satisfaction and interaction history were assessed at 1-month.

Results: Participants were 55% female, mean age 65.6. At study completion, there was a 100% retention rate and subjects had an average satisfaction score of 5.6/7 (with seven maximal satisfaction) with the VEC. Mean adherence to daily walking was 85% of prescribed sessions. Both gait speed and the 6-minute walk test significantly improved (P<0.05) from baseline to one month. No adverse events were reported.

Conclusions: Sedentary persons with PD successfully used a computer and interacted with a VEC. Retention, satisfaction and adherence to daily walking were high over one-month and significant improvements were seen in mobility assessments. Longer, controlled trials are needed to assess the effectiveness of the VEC in promoting adherence to long-term exercise in persons with PD.

IN Touch: impact of and lessons learned from an mHealth intervention for overweight and obese youth

KatherineKim,¹ ChristinaSabee,¹ HollyLogan¹

¹San Francisco State University

Journal MTM 1:4S:6, 2012
DOI:10.7309/jmtm.30

Abstract

Minority and low-income communities are disproportionately affected by obesity, a risk factor for diabetes, heart disease, and cancer. The iN Touch pilot study was conducted to determine whether use of a mobile Observations of Daily Living (ODL) tracking application with health coaching impacted a variety of health outcomes.

The study was a mixed methods pilot using a pre-post-comparison of a single group. Minority youths age 13-24 who were overweight or obese (BMI > 85th percentile for age and gender in adolescents and BMI > 25.0 in adults) from three clinics in San Francisco were enrolled. Twenty-four of 34 participants completed the study (70.59%).

Participants were provided an iPod Touch with a customized ODL application from TheCarrot.com that included exercise, food, mood and socializing. Weekly summaries were available to providers. Participants met in person with a lay health coach. Measures included BMI, waist and hip measurements, depression (PHQ-2) and modified patient activation measure (PAM) which assesses the patient’s knowledge, skills and confidence to manage health and healthcare. Barriers and facilitators to use of technology were evaluated using semi-structured interviews.

Paired t-tests revealed a significant improvement in PAM scores (M = 3.21, SD = 7.472); t(23) = 2.10, p = 0.047 and waist circumference (M = -1.21 inches, SD = 2.52); t(22) = -2.21, p = 0.038. There were no other significant changes. Participants’ use of the technology varied significantly, ranging from almost none to multiple times per day. Interviews suggested the technology was easy to use, data entry burden was minimal, and ability to record ODLs was beneficial.

We demonstrated significant preliminary success with iN Touch suggesting it is a promising tool for self-management for overweight/obese youths when used in a health coaching program. This application may also provide valuable patient-centered data that is not currently in electronic health records.

Efficacy of IVR-Based Brief Intervention for Alcohol Problems

GailL. Rose^1
1University of Vermont

Journal MTM 1:4S:5, 2012
DOI:10.7309/jmtm.29

Abstract

Alcohol screening and brief intervention (SBI) is a clinical approach to reducing alcohol consumption and harms whose efficacy is well established. In spite of empirical support for the intervention, and its endorsement by entities such as the National Institutes of Health (NIH) and the US Preventive Services Task Force, implementation in clinical settings is limited. Delivery of SBI to heavy drinkers may be expanded with technology.

We developed an Interactive Voice Response (IVR) system that delivers Brief Intervention (BI) according to NIH clinician’s guidelines. Pilot studies supported feasibility, and now we are evaluating efficacy with a randomized, controlled trial. Objectives are threefold: evaluate the efficacy of IVR-BI for reducing drinking; determine the impact of IVR-BI on patient-physician interaction; and determine patient characteristics associated with treatment effect.

Patients presenting to primary care clinics are called by research staff three days before their appointment and asked to participate. Consenting patients are transferred to IVR for a brief behavioralhealth screening questionnaire (IVR-Screen), the results of which are automatically routed to their electronic medical record (EMR). Participants drinking above NIH guidelines for low-risk drinking qualify for the IVR-BI; consenting patients are randomized immediately and either complete or do not complete the IVR-BI. Participants are interviewed by research staff after their health care visit and again 3- and 6-months later.

To date, 21 have been randomized to IVR-BI vs. usual care, with follow-up interviews pending. Interviews will assess participants’ alcohol-related conversations with their primary care providers, their drinking behavior, and any treatment experiences they have had. Results of 3-month interview data on an anticipated 300 participants will be available for presentation at the time of the mHealth summit. The future potential of this IVR-EMR integrated system for delivering health screening and education relates not only to alcohol but to other behavioral problems as well.

Universal Depression Prevention via Mobile Phones

R.Whittaker, S.Merry,  K.Stasiak, H.Mc-Dowell, I.Doherty, M.Shepherd, E.Dorey, S.Ameratunga, A.Rodgers,

Journal MTM 1:4S:4, 2012
DOI:10.7309/jmtm.28

Abstract

Depressive disorder in adolescence is common, disabling, and heightens the risk of suicide. Universal depression prevention programmes can be effective but are resource intensive and difficult to scale up.

We developed a universal depression prevention programme for adolescents (MEMO) that is delivered solely via their mobile phones.The messages were developed from cognitive behavioural therapy (CBT) by experts in adolescent psychiatry and psychology, delivered within video diary style messages from teenagers, video messages from celebrities, mobisodes (30 second cartoon episodes), text messages and a simple mobile website. Coherence and memorability were provided by a logo, music, and three key words in every message.

We conducted a prospective double-blind randomized controlled trial in adolescents aged 13-17 years from 15 high schools across Auckland, New Zealand. Interested students (n=1348) consented to receive a mobile phone programme about living positively and were randomised (n=855) to either MEMO or a full attention control programme with the same frequency and types of messages. Trained researchers conducted individual interviews with participants at baseline, 9 weeks (post-programme) and 12 months. Students identified with high risk of depression or self-harm at baseline were excluded.

The Child Depression Rating Scale (CDRS-R) mean scores initially improved post-programme (mean change 0.61[SD 6.29]) then worsened by 12 months. There were no significant differences between MEMO and control groups (mean change from baseline to 12 months -1.18 [SD6.76] MEMO and -0.92 [SD 6.67] control), even when adjusted for multiple factors and in sensitivity analyses. There were also no differences between groups in self-rated scores of depressive symptoms and general functioning, or in the diagnosis of depression during the study period.

We were unable to demonstrate a significant benefit in depression scores in those receiving our intervention compared with a control mobile programme. There are several potential explanations that will be discussed.

BreathEasy: A Smartphone App to Manage Asthma in an Underserved Population

BarbaraL Massoudi¹, StephenRothemich²

¹Center for the Advancement of Health IT, RTI International²Department of Family Medicine, Virginia Commonwealth University

Journal MTM 1:4S:3, 2012
DOI:10.7309/jmtm.27

Abstract

Asthma is a common, chronic illness, affecting over 23 million U.S. adults who face daunting challenges in managing their disease conditions on a daily basis. RTI and the Virginia Commonwealth University developed and piloted a smartphone app, built on the latest clinical guidelines for treatment and self-monitoring of individuals with asthma, to assist adults with asthma to better manage their care and disease condition.

BreathEasy, part of RWJF’s Project HealthDesign, was developed through a user-centered design approach with iterative development and feedback cycles. Patients used an Android-based smartphone to record their observations of daily living (ODLs), including asthma and mental health symptoms, medication use, symptom triggers, physical activity, and activity limitations, among others. Clinicians (physician/nurse pairs) used a Web-based dashboard to review patient data and visualize trends and patterns in the ODL data on a regular basis, in accordance with a disease management approach.

Six months of fielding with 30 patients in two urban practices has shown the app to be generally well accepted by both patients and clinicians, and findings indicate that collection and review of ODL data has resulted in positive changes in communication and care management. Changes in medication compliance and management, referrals to specialists, and diagnoses of comorbid conditions were attributed to use of the app. Patients reported using the ODL information in many ways, including recognizing when symptoms had become problematic, being more aware of symptom triggers, and better following recommendations made by their doctor.

These findings indicate early success of this smartphone and dashboard app to manage asthma. Further studies should focus on an evaluation including a control group and more closely approaching a controlled clinical trial. By providing a novel method of reporting patient-generated data to clinicians between office visits, this app shows promise for improving the quality of care of asthma patients.