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
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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
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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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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
Smart-phoneApps
Other ToolsBathroom ScalePedometer
Be sure to check your email for this this week’s topic from ThreeTwoMe
Mobile Txt Msgs
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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
SMART: Social Mobile Approaches to Reduce Weight
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
SMART: Social Mobile Approaches to Reduce Weight
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
SMART: Social Mobile Approaches to Reduce Weight
• 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
SMART: Social Mobile Approaches to Reduce Weight
• 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
SMART: Social Mobile Approaches to Reduce Weight
• 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
SMART: Social Mobile Approaches to Reduce Weight
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