By Wendy Anson, Ph.D.
Just-in-time adaptive interventions (JITAI) use sophisticated sensors to track our every move. And that means such devices can catch us closing down happy hour at The Pour House instead of closing the Z4 deal at the boss’s dealership. But these devices do more than just track. With their “adaptive intervention” capabilities, these mHealth JITAIs are also primed to deliver timed, tailored prompts to get us moving out of the bar and onto the car lot.
Researchers J. Graham Thomas and Dale Bond recently showed prompts to be an effective intervention for reducing sedentary behavior among people who are classified as obese. But how can you be sure tailored prompts are as timely or delayed, numerous or infrequent, or as long or short as they needed to be?
Just how prompt do #JITAI prompts need to be?
Do we know enough about the behavioral science of optimal intervention strategies to choose the most effectively timed interventions?
What Do We Know About mHealth Interventions?
In their recent article for the special issue of the American Psychological Association’s Society for Health Psychology journal, Health Psychology: eHealth/mHealth, funded by the NIH Office of Behavioral and Social Sciences Research (OBSSR), Thomas and Bond noted that because recent JITAI developments required collaboration among numerous experts across multiple fields (engineers, computers scientists, and behavioral intervention scientists), JITAIs are few and far between. Further, they claim that despite decades of research on general principles of behavioral intervention, little is actually known about how to put those principles together with innovative treatment delivery technology.
Thomas and Bond reviewed a study assessing how the frequency of intervention and the type of behavioral prescription affect targeted health behaviors. For example, the study evaluated whether more frequent prompts for behavior change are most effective or if in instead, a high frequency of prompts ultimately results in suboptimal adherence stemming from intervention fatigue or habituation to the prompts.
Their recent B-MOBILE study looked at sedentary behavior, defined as activities performed during waking hours that require very low energy expenditure of <1.5 metabolic equivalents (METs). Sedentary behavior activities occur while the person is sitting or lying down (Newton, Han, Zderic, & Hamilton, 2013). Sedentary behavior is higher in overweight/obese individuals and is associated with increased risk of poor cardiometabolic health (Bankoski et al., 2011; Henson et al., 2013), some cancers, and mortality.
New research suggests that interrupting prolonged periods of sedentary behavior (e.g., 20 to 30 minutess) with brief (e.g., more than or equal to 1 to 2 minutes) physical activity breaks of even a light intensity is positively associated with important indicators of cardiometabolic health, including waist circumference and high-density lipoprotein (HDL) cholesterol, among other effects (Carson et al., 2014; Dunstan et al., 2012; Healy et al., 2008; Healy, Matthews, Dunstan, Winkler, & Owen, 2011).
B-MOBILE Study Relies on mHealth Interventions to Prompt Physical Activity
In B-MOBILE, a smartphone and its onboard accelerometer were used to automatically monitor prolonged bouts of sedentary behavior and prompt the user to take brief walking breaks upon reaching a clinically significant threshold.
Thirty overweight/obese participants wore an objective activity monitor for a week at baseline and during three subsequent weeks. During the intervention weeks, three prompting and walking break conditions were tested to determine the optimal behavior prescriptions for reducing total time spent in sedentary behavior and increasing physical activity (to more than or equal to 1.5 METs). Conditions were: (a) a 3-minute break after 30 sedentary behavior minutes, (b) a 6-minute break after 50 sedentary behavior minutes, and (c) a 12-minute break after 120 sedentary behavior minutes.
Frequent periods of brief #physicalactivity can result in increased cardiometabolic health
The researchers evaluated (a) frequency of walking prompts, (b) adherence to walking prompts, (c) time spent in walking breaks, and (d) latency between walking prompts. The start of walking breaks varied by the three walking break conditions.
The B-MOBILE JITAI produced significant reductions in daily time spent in sedentary behavior for the 3-minute, 6-minute, and 12-minute conditions. Interestingly, the 3-minute condition produced significantly greater improvements compared to the 12-minute condition, resulting in significantly greater improvements in time spent in sedentary behavior and light intensity physical activity.
Although the authors admit that the study does sufficiently explain psychological factors regarding why more frequent prompts produced superior outcomes, they hazard that more frequent prompts may provide more opportunity for reinforcement (Kelleher & Gollub, 1962).
Prompt prompts help Just in time Adaptive Interventions #JITAI achieve healthful #behaviorchange
Read the Article
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About the Author
Wendy Anson, Ph.D.
Wendy Anson, Ph.D., is senior science writer and editor for the OBSSR at the NIH. She has written and developed literature reviews, book chapters, reports, grant sections, curricula, and award-winning educational films in the science and social science arena for medical schools, research hospitals, educational broadcasting organizations, and universities. Her Ph.D. is in educational psychology and technology.
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