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PositivelyPregnant: Using guided prompts in a stress-management app for pregnant women

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Proceedings of the 32nd International BCS Human Computer Interaction Conference (HCI)

Human Computer Interaction Conference

4 - 6 July 2018

Mobile app, Pregnancy, Perinatal support, Mental health, User study, e-health, Prompts

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      Abstract

      This paper reports on our interdisciplinary research on stress management for pregnant women. We developed a mobile app – PositivelyPregnant – for supporting the mental wellbeing of pregnant women in New Zealand. The app aims to support women in using the time during pregnancy to build resilience and plan a healthy future for the whole family. We report the results from a study using PositivelyPregnant, carried out at 24 weeks gestation with 88 women. We particularly explored the use of prompts for continued engagement.

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      Periodic Prompts and Reminders in Health Promotion and Health Behavior Interventions: Systematic Review

      Background Health behavior interventions using periodic prompts have utilized technology, such as the Internet, that allows messages to be sent to participants in cost-effective ways. To our knowledge, no comprehensive evidence review has been performed specifically to evaluate the effectiveness of communicating regular messages and to examine how characteristics of the prompts change the effectiveness of programs aimed at reminding people to adopt healthy behaviors, maintain those they already practice, and cease unhealthy behaviors. Objective A systematic literature review was performed to investigate the effectiveness of limited contact interventions targeting weight loss, physical activity, and/or diet that provided periodic prompts regarding behavior change for health promotion. The review sought to identify specific characteristics of these interventions that may be associated with superior results. Methods Electronic literature searches were performed between February and April, 2008. Articles were included if periodic prompts were used as an intervention or a component of an intervention, a behavioral or biological outcome measure was used, and an ongoing health promotion behavior was targeted. A rating system was applied to each study to provide a quantitative representation of the quality of the evidence provided by each article. Results There were 19 articles with a combined sample size of 15,655 that met the inclusion criteria, and 11 studies reported positive findings regarding the utility of periodic prompts. Several articles showed enhanced effectiveness when prompts were frequent and personal contact with a counselor was included. Long-term behavior change and health improvements were not examined by this review because of a lack of long-term follow-up in the literature. Conclusions In light of promising results of most studies, additional research on limited contact interventions targeting health behaviors including weight loss, physical activity, and/or diet is merited that utilizes rigorous methods including control groups; follow-up data collection; and testing of prompt frequencies, specific intervention components, or prompt characteristics. Future research would be especially valuable if it improves understanding of the most effective types of periodic prompts for fostering long-term behavior change in order to maximize use of this tool in limited contact health promotion programs. Specifically, various types of communication technology should be used and evaluated to expand and refine their use.
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        The Effectiveness of Prompts to Promote Engagement With Digital Interventions: A Systematic Review

        Background Digital interventions have been effective in improving numerous health outcomes and health behaviors; furthermore, they are increasingly being used in different health care areas, including self-management of long-term conditions, mental health, and health promotion. The full potential of digital interventions is hindered by a lack of user engagement. There is an urgent need to develop effective strategies that can promote users’ engagement with digital interventions. One potential method is the use of technology-based reminders or prompts. Objective To evaluate the effectiveness of technology-based strategies for promoting engagement with digital interventions. Methods Cochrane Collaboration guidelines on systematic review methodology were followed. The search strategy was executed across 7 electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Web of Science, the Education Resources Information Center (ERIC), PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). Databases were searched from inception to September 13, 2013, with no language or publication type restrictions, using three concepts: randomized controlled trials, digital interventions, and engagement. Gray literature and reference lists of included studies were also searched. Titles and abstracts were independently screened by 2 authors, then the full texts of potentially eligible papers were obtained and double-screened. Data from eligible papers were extracted by one author and checked for accuracy by another author. Bias was assessed using the Cochrane risk of bias assessment tool. Narrative synthesis was performed on all included studies and, where appropriate, data were pooled using meta-analysis. All findings were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results A total of 14 studies were included in the review with 8774 participants. Of the 14 studies, 9 had sufficient data to be included in the meta-analyses. The meta-analyses suggested that technology-based strategies can potentially promote engagement compared to no strategy for dichotomous outcomes (relative risk [RR] 1.27, 95% CI 1.01-1.60, I2=71%), but due to considerable heterogeneity and the small sample sizes in most studies, this result should be treated with caution. No studies reported adverse or economic outcomes. Only one study with a small sample size compared different characteristics; the study found that strategies promoting new digital intervention content and those sent to users shortly after they started using the digital intervention were more likely to engage users. Conclusions Overall, studies reported borderline positive effects of technology-based strategies on engagement compared to no strategy. However, the results have to be interpreted with caution. More research is needed to replicate findings and understand which characteristics of the strategies are effective in promoting engagement and how cost-effective they are.
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          More Than a Text Message: Dismantling Digital Triggers to Curate Behavior Change in Patient-Centered Health Interventions

          Digital triggers such as text messages, emails, and push alerts are designed to focus an individual on a desired goal by prompting an internal or external reaction at the appropriate time. Triggers therefore have an essential role in engaging individuals with digital interventions delivered outside of traditional health care settings, where other events in daily lives and fluctuating motivation to engage in effortful behavior exist. There is an emerging body of literature examining the use of digital triggers for short-term action and longer-term behavior change. However, little attention has been given to understanding the components of digital triggers. Using tailoring as an overarching framework, we separated digital triggers into 5 primary components: (1) who (sender), (2) how (stimulus type, delivery medium, heterogeneity), (3) when (delivered), (4) how much (frequency, intensity), and (5) what (trigger’s target, trigger’s structure, trigger’s narrative). We highlighted key considerations when tailoring each component and the pitfalls of ignoring common mistakes, such as alert fatigue and habituation. As evidenced throughout the paper, there is a broad literature base from which to draw when tailoring triggers to curate behavior change in health interventions. More research is needed, however, to examine differences in efficacy based on component tailoring, to best use triggers to facilitate behavior change over time, and to keep individuals engaged in physical and mental health behavior change efforts. Dismantling digital triggers into their component parts and reassembling them according to the gestalt of one’s change goals is the first step in this development work.
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            Author and article information

            Affiliations
            School of Psychology

            University of Waikato, New Zealand
            Computer Science Department

            University of Waikato, New Zealand
            Contributors
            Conference
            July 2018
            July 2018
            : 1-5
            10.14236/ewic/HCI2018.179
            © Barber et al. Published by BCS Learning and Development Ltd. Proceedings of British HCI 2018. Belfast, UK.

            This work is licensed under a Creative Commons Attribution 4.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

            Proceedings of the 32nd International BCS Human Computer Interaction Conference
            HCI
            32
            Belfast, UK
            4 - 6 July 2018
            Electronic Workshops in Computing (eWiC)
            Human Computer Interaction Conference
            Product
            Product Information: 1477-9358 BCS Learning & Development
            Self URI (journal page): https://ewic.bcs.org/
            Categories
            Electronic Workshops in Computing

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