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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 non-smoker.”

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 non-smoker.”

Relapse prevention system


Rct design
RCT design non-smoker.”

  • Data collection: web based surveys

    • Initiating mail + 2 reminders

    • then telephone interview with non-responders


Abstinence
Abstinence non-smoker.”


Abstinence1
Abstinence non-smoker.”


Abstinence2
Abstinence non-smoker.”


The implication of acvances in it

THE implication: non-smoker.”

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: non-smoker.”

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: non-smoker.”

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 art non-smoker.” Fitting interventions to users

SEQUENCING

SELECTION

tunneling

tailoring

just-in-time

therapy

iterative

tailoring

DIALOG/

RELATION


Timeline

past ... ... future non-smoker.”

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 non-smoker.”

Innsight

Alliance

Change


Arguments for tunnelling
Arguments for tunnelling non-smoker.”

  • 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 non-smoker.”

  • 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 non-smoker.”

  • 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 non-smoker.”

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 non-smoker.”

  • 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 non-smoker.”

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 (%) non-smoker.”

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).