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The Implications of Advances in Information Technology (IT). The Happy Ending Experience. Fundamentals of Happy Ending. Fully automated smoking cessation intervention Internet & cell-phone Target group: smokers motivated to quit

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fundamentals of happy ending
Fundamentals of Happy Ending
  • Fully automated smoking cessation intervention
  • Internet & cell-phone
  • Target group: smokers motivated to quit
  • Core idea: The quitter needs different help at different times
    • tunnelling
three distinct phases
Three distinct phases
  • Three distinct phases

2 weeks + 4 weeks + 11 months

the information architecture of he
The information architecture of HE
  • This figure shows a sample week from each phase, where each cell represents a unique contact point between client and program that particular day
the information architecture of he1
The information architecture of HE
  • A new unique web-page (□)
  • Each day, week 1 through week 6
  • Todays assignment – interactive diary
the information architecture of he2
The information architecture of HE

Legend:

─ one text-message (SMS) a day

= two text-messages a day

≡ three text-messages a day

the information architecture of he3

“today, your blood pressure has been reduced to that of a non-smoker.”

The information architecture of HE
  • Motivational conflict:
    • short-term positive consequences of starting to smoke again - inflated
    • value of the long term positive consequences of abstinence - deflated
  • Psycho-educative approach
  • Quitting-chronology requires tunnelling
the information architecture of he4
The information architecture of HE

Choices: (1) reduce stress; (2) regulate

negative affect; or (3) fuel motivation

Available 24 hours a day for one year

No human contact – pre-recorded messages only

the information architecture of he5
The information architecture of HE

Relapse prevention system

rct design
RCT design
  • Data collection: web based surveys
    • Initiating mail + 2 reminders
    • then telephone interview with non-responders
the implication of acvances in it

THE implication:

AUTOMATIZATION

of interventions

THE implication of acvances in IT

Σ technological

development

FLEXIBILITY

fitting interventions to users

Todays assignment:

What are the implications of advances in information technology (IT) for the future of health psychology interventions?

the implication of acvances in it1

THE implication:

AUTOMATIZATION

of interventions

THE implication of acvances in IT

high reach

low cost

provided that

high reach

low cost

if

EFFICACY

then

SUCCESS

Σ technological

development

FLEXIBILITY

fitting the information to users

when

Sequencing

(timing) e.g. tunneling,

24/7 availability

what

Selection

e.g. tailoring

how

Signal mode

web, email, SMS, IVR

re-active & pro-active

the implication of acvances in it2

THE implication:

AUTOMATIZATION

of interventions

THE implication of acvances in IT

provided that

high reach

low cost

if

EFFICACY

then

SUCCESS

Σ technological

development

FLEXIBILITY

fitting the information to users

when

Sequencing

(timing) e.g. tunneling,

24/7 availability

what

Selection

e.g. tailoring

how

Signal mode

web, email, SMS, IVR

re-active & pro-active

flexibility state of the art fitting interventions to users
Flexibility – state of the artFitting interventions to users

SEQUENCING

SELECTION

tunneling

tailoring

just-in-time

therapy

iterative

tailoring

DIALOG/

RELATION

timeline

past ... ... future

ONE SIZE FITS ALL

Timeline

SEQUENCING

SELECTION

Stop-Tabac (Etter et. al.)

Proschasca’s Expert system

Happy Ending

mature

digital therapy

tunneling

tailoring

just-in-time

therapy

iterative

tailoring

DIALOG/

RELATION

therapy model
Therapy model

Innsight

Alliance

Change

arguments for tunnelling
Arguments for tunnelling
  • Required by the therapeutical model
    • tunnelling affords a relationship to the user
    • relationship is a possibility condition for dialog and therapy
  • Different help at different times
    • because the psychological processes are different
  • Keep up the interest
implication summary
Implication – summary
  • Automatization + flexibility = success
  • Automatization of interventions
    • stick to it!
    • to preserve the high-reach-low-cost feature of mass media
  • Exploit the flexibility!
    • flexibility is the key to efficacy
  • Learn from clinical psychology
    • take advantage of the therapeutical processes we know from clinical psychology
    • from sequencing and selection towards dialog and relation
    • do not forget sequencing strategies (like tunnelling) on the way
questions
Questions
  • Intervention / RCT-results / implications of advances in IT
  • Other dimensions of flexibility?
  • The role of chat rooms and discussion forums for e-health interventions?
    • some of you may be more optimistic than I am...
nicotine replacement therapy nrt

Trial 1

Nicotine Replacement Therapy (NRT)
  • Proportion of NRT users:
    • 93% in treatment vs. 87% in control (N.S.)
  • Higher NRT-adherence in treatment:
    • Days/week of NRT use, mean: 4.5 vs. 3.6; SD = 2.9; t(382) = 3.11, p = .002
    • Weeks of use, mean: 8.3 vs. 7.0; SD = 4.9; t(316) = 2.22, p = .03
  • NRT-adherence did NOT mediate 1yr. sustained abstinence!
program adherence and abstinence
Program adherence and abstinence
  • 65% ADHERENCE
  • Adherence to various components are highly correlated. Using a backward conditional procedure, answering the log-off call, came out as the only significant predictor – adding the other variables did not increase explained variance.
  • When tested alone, however, log-on and reading web-pages did also sig. predict abstinence (helpline-calls did not).

Adherence – each component tested alone:

  • log-off: R² = 25%
  • log-on: R² = 16%
  • web-pages: R² = 8%
  • help-line: N.S.
baseline sample characteristics
Baseline sample characteristics

Trial 1 Trial 2

———————— ————————

Treatment Control Treatment Control

—————————————————————————N 197 199 144 146

Male 49.2 % 50.3 % 50.0 % 50.0 %

College degree 42.1 % 39.7 % 48.6 % 52.1 %

Age 35.9 (10.0) 36.4 (10.5) 39.5 (11.0) 39.7 (10.8)

FTND 4.8 (2.2) 4.9 (2.2) 4.5 (2.3) 4.6 (2.2)

self-efficacy 4.9 (1.3) 5.1 (1.3) 5.1 (1.4) 5.1 (1.3)

—————————————————————————

Note. Numbers represent mean ± standard deviation for continuous variables and percentages

of subjects for dichotomous variables.

response rates
Response rates (%)

Trial 1 Trial 2

——————— ———————

Treatment Control Treatment Control

——————————————————————

preparation N.A. N.A. 91.7 89.7

1 month 98.5 97.0 96.5 87.0

3 months 93.4 91.0 93.8 89.7

6 months 95.4 94.0 86.1 82.2

12 months 95.9 91.5 91.0 83.3

——————————————————————

Note. No significant differences in trial one. Response rates at 1 month in trial 2 was significantly lower in control condition (highlighted with red boldface).

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