The Effects Of Brief Counseling, Transdermal Nicotine Replacement And Antidepressant Therapy On Smok

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Momentary Health Interventions Concepts and
Future Directions
Paul M. Cinciripini, Ph.D. Brian Carter, Ph.D. D
avid Wetter, Ph.D Department of Behavioral Scienc
e

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Areas of Intervention

• Improvement of health and well being
• Life style changes
• Smoking, exercise, alcohol, diet, stress
• Health outcome may be distal to intervention
  (risk reduction) and/or immediate (reduced blood
  pressure, cholesterol)
  
• Quality of life
• Depression, fatigue, pain management, sleep
• Enhancement of current well being
• May mediate success of another health
  intervention, with immediate and/or distal health
  outcome (e.g., Smoking cessation)
  

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Challenges to Health Interventions

• Implementing an effective intervention
• Compliance
• Maintaining interest and motivation
• Dynamic problem solving
• Counselor or healthcare provider-not typically
  in the moment with the patient
  
• Hand held interventions can contribute to all
• Include both self-report and objective
  assessments (physiological) done in real time
  
• Identify antecedents consequences more easily
  and apply corrective measures (e.g., intervene as
  early in the chain as possible)

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Why Use Handheld Computers ?

• Small, lightweight, easy to carry use-always
  there
  
• Multiple functions (e.g., appointment book,
  games) make them easy to integrate into daily
  living
  
• Deliver significant amounts of information on
  demand and simplify user access
  
• Prompt user for interaction with alarms
• Provide program initiated health information
• Use complex, interactive programming to implement
  planned health interventions in real time
  
• Can be integrated with other electronic forms of
  assessment or physiological monitoring devices

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Conceptualizing Momentary Health Interventions

• Three levels of momentary intervention
• Differ in primary approach to behavior change
• Education
• Monitoring feedback
• Delivery of specific intervention strategies
• Different strategies to increase a behavior
  (physical activity) vs. those to decrease one
  (smoking)
  
• Differ in user vs. device initiated
  assessments/prompts
  
• Differ in complexity of algorithms for delivering
  intervention content

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Levels of User and Program Assessment and
Intervention
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Level 1-Education Approach

• Convey knowledge about an at risk behavior,
  etiology, relationship with other factors
  
• General recommendations for improving health
  and/or reducing risk
  
• Not typically individualized
• Immediate access to therapeutic content

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Level 1 Example Content

• Print material using simple or complex search
  strategies
  
• E-books, treatment manuals, self-help books,
  selected readings for motivation (i.e, quotes),
  healthy menus,nutrition information, calories
  burned, etc.
• Large volume of information more easily accessed
• ability to bookmark, set favorites

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Levels of User and Program Assessment and
Intervention
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Level 2-Monitoring Feedback Approach

• Increase awareness of patterns and circumstances
  surrounding a target behavior
  
• Assess progress of an ongoing intervention,
  achievement of goals
  
• motivate and reinforce behavior change through
  feedback

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Level 2 Treatment Approach

• User initiated assessment
• frequency, intensity, duration and possibly
  context of the target behavior
  
• Device provides simple feedback
• Computer compiles formats information
• Categories, reports, tables, graphic images
• Document progress associated with different
  intervention techniques
  
• Present over daily, cumulative or unique time
  periods
  
• Present contextual information
• Simplifies complex information
• Calories, fats and other nutrient information,
  duration of exercise, anxiety level in certain
  situations

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Pocket Diet Tracker
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Vivonic Fitness Planner
                                
                              
                           
Easy-to-view nutritional breakoutsdetail what
you've consumed.
Record your daily nutritionalintake using the
extensivefoods database.
   
            
            
Check off your plannedexercises for the day as
yougo, or simply add new ones.
                        
                        
                                               
   

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Handy Health Care
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Universal Tracker System
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PACE Exercise Adherence Intervention for Breast
Cancer Patients with Fatigue

• Handheld intervention used as an adjunct to
  telephone counseling to increase adherence to
  walking program
  
• Participants can set goals, schedule walks,
  receive feedback on goals
  
• Application prompts walks, records data on length
  and intensity of walk participant enters data on
  fatigue, pain, and mood before and after walk
  

Basen-Engquist, K., Feasibility of a Physical
Activity Intervention to Reduce Fatigue in
Ovarian Cancer Survivors (P50 CA83639)
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Levels of User and Program Assessment and
Intervention
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Level 3 Education, Monitoring, Feedback
Intervention Delivery Approach

• Computer algorithms used to make treatment
  recommendations (e.g., digital therapist)
  
• May follow a treatment plan (e.g progressive
  exercise program)
  
• Recommendations specific to the individual /or
  circumstance
  
• The program coaches with prompts, tips, and in
  the moment intervention strategies
  
• (e.g., You havent been keeping to your exercise
  program in the past few days, lets trouble
  shoot the problem.)
  
• Monitor possible high risk events that may reduce
  compliance
  
• Poor sleep, fatigue, stress, TV viewing

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Health Information Tracking System

• No level 3 programs identified in search
• HITS being used in schools combined with health
  education counseling
  
• Developed by researchers at the National
  Institute of Education, Singapore (Wang, Chia,
  et. Al, 2002)
  
• Sold by ADE, a spin-off company
• Program allows for age and gender specific
  recommendations, for body weight, food intake
  energy expenditure.
  
• Takes into account current health status
• Monitors mood state over time
• Would need further development to be a level 3
  application
  

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• Meal/food planner plan meals based on the
  nutrients Nutrient/caloric status information
  nutrients calories consumed in comparison to
  recommended daily amounts.
• Activity/exercise planner plan physical activity
  based on the caloric expenditure of the activity
  or exercise.
  
• Weight loss/gain calculator computes time
  required for safe weight loss/gain

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Project Cassi
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Level 3 Examples Future Applications

• Smart devices
• Digital camera to estimate meal portion sizes
• Integrate with physiological monitoring
• Wearable computers provide intensity of
  exercise information and context specific data
  
• Heart rate, pressure sensors, steps
• Use voice to deliver information and enhance
  motivational messages
  
• Alarms, positive feedback, reminders,
  visualizations and supportive messages
  
• Record in therapist or patients own voice
• Live video contact
• Hand held camera

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Practical Challenges

• Devices are sophisticated and new. Requires
  excellent and experienced programmer
  
• They know code you know behavior. Invest in
  up-front planning, specifications and anticipate
  future needs
  
• Balance flexibility of function with costs and
  time
  
• More features means more can go wrong.
• Locking participants out of built in device
  functions is more challenging with sophisticated
  units
  
• Develop reliable testing protocols and test under
  many conditions
  
• Software development for new features (i.e., cell
  phone integration) or add on devices (camera) is
  presently limited
  

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Links

• Diet Tracker http//www.handango.com
• Handy Health Care http//www.handango.com
• Universal Tracker http//www.utracksys.com
• Vivonic Fitness Planner http//www.vivonic.com