Digital Human Representations for Health Behavior Change: A Structured Literature Review

Organizations have increasingly begun using digital human representations (DHRs), such as avatars and embodied agents, to deliver health behavior change interventions (BCIs) that target modifiable risk factors in the smoking, nutrition, alcohol overconsumption, and physical inactivity (SNAP) domain. We conducted a structured literature review of 60 papers from the computing, health, and psychology literatures to investigate how DHRs’ social design affects whether BCIs succeed. Specifically, we analyzed how differences in social cues that DHRs use affect user psychology and how this can support or hinder different intervention functions. Building on established frameworks from the human-computer interaction and BCI literatures, we structure extant knowledge that can guide efforts to design future DHR-delivered BCIs. We conclude that we need more field studies to better understand the temporal dynamics and the mid-term and long-term effects of DHR social design on user perception and intervention outcomes

Improving e-therapy for mood disorders among lesbians and gay men

Introduction This toolkit provides the first comprehensive set of guidelines for tailoring mood-disorder e-therapies to the needs of same-sex attracted people. It gives developers of e-therapies a set of practical recommendations for adjusting e-therapies to more effectively accommodate lesbians and gay men. These recommendations are supported by in-depth research that was designed specifically to inform this toolkit. Summaries of this research are provided in the toolkit and detailed findings are available in published research articles. This toolkit also provides information on the mental health-related challenges that are often faced by same-sex attracted people and links readers to key resources and organisations for further information. Checklists and other tools are included as aids for developers to assess the inclusiveness and relevance of e-therapies to lesbians and gay men. In short, this toolkit contains an extensive set of tools and explains why and how they could be implemented

Interactive Food and Beverage Marketing: Targeting Children and Youth in the Digital Age

Looks at the practices of food and beverage industry marketers in reaching youth via digital videos, cell phones, interactive games and social networking sites. Recommends imposing governmental regulations on marketing to children and adolescents

Technology-delivered adaptations of motivational interviewing for the prevention and management of chronic diseases: Scoping review

BACKGROUND: Motivational interviewing (MI) can increase health-promoting behaviors and decrease health-damaging behaviors. However, MI is often resource intensive, precluding its use with people with limited financial or time resources. Mobile health-based versions of MI interventions or technology-delivered adaptations of MI (TAMIs) might increase reach. OBJECTIVE: We aimed to understand the characteristics of existing TAMIs. We were particularly interested in the inclusion of people from marginalized sociodemographic groups, whether the TAMI addressed sociocontextual factors, and how behavioral and health outcomes were reported. METHODS: We employed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews to conduct our scoping review. We searched PubMed, CINAHL, and PsycInfo from January 1, 1996, to April 6, 2022, to identify studies that described interventions incorporating MI into a mobile or electronic health platform. For inclusion, the study was required to (1) describe methods/outcomes of an MI intervention, (2) feature an intervention delivered automatically via a mobile or electronic health platform, and (3) report a behavioral or health outcome. The exclusion criteria were (1) publication in a language other than English and (2) description of only in-person intervention delivery (ie, no TAMI). We charted results using Excel (Microsoft Corp). RESULTS: Thirty-four studies reported the use of TAMIs. Sample sizes ranged from 10 to 2069 participants aged 13 to 70 years. Most studies (n=27) directed interventions toward individuals engaging in behaviors that increased chronic disease risk. Most studies (n=22) oversampled individuals from marginalized sociodemographic groups, but few (n=3) were designed specifically with marginalized groups in mind. TAMIs used text messaging (n=8), web-based intervention (n=22), app + text messaging (n=1), and web-based intervention + text messaging (n=3) as delivery platforms. Of the 34 studies, 30 (88%) were randomized controlled trials reporting behavioral and health-related outcomes, 23 of which reported statistically significant improvements in targeted behaviors with TAMI use. TAMIs improved targeted health behaviors in the remaining 4 studies. Moreover, 11 (32%) studies assessed TAMI feasibility, acceptability, or satisfaction, and all rated TAMIs highly in this regard. Among 20 studies with a disproportionately high number of people from marginalized racial or ethnic groups compared with the general US population, 16 (80%) reported increased engagement in health behaviors or better health outcomes. However, no TAMIs included elements that addressed sociocontextual influences on behavior or health outcomes. CONCLUSIONS: Our findings suggest that TAMIs may improve some health promotion and disease management behaviors. However, few TAMIs were designed specifically for people from marginalized sociodemographic groups, and none included elements to help address sociocontextual challenges. Research is needed to determine how TAMIs affect individual health outcomes and how to incorporate elements that address sociocontextual factors, and to identify the best practices for implementing TAMIs into clinical practice

Virtual Patient Technology: Engaging Primary Care in Quality Improvement Innovations

BACKGROUND: Engaging health care staff in new quality improvement programs is challenging. OBJECTIVE: We developed 2 virtual patient (VP) avatars in the context of a clinic-level quality improvement program. We sought to determine differences in preferences for VPs and the perceived influence of interacting with the VP on clinical staff engagement with the quality improvement program. METHODS: Using a participatory design approach, we developed an older male smoker VP and a younger female smoker VP. The older male smoker was described as a patient with cardiovascular disease and was ethnically ambiguous. The female patient was younger and was worried about the impact of smoking on her pregnancy. Clinical staff were allowed to choose the VP they preferred, and the more they engaged with the VP, the more likely the VP was to quit smoking and become healthier. We deployed the VP within the context of a quality improvement program designed to encourage clinical staff to refer their patients who smoke to a patient-centered Web-assisted tobacco intervention. To evaluate the VPs, we used quantitative analyses using multivariate models of provider and practice characteristics and VP characteristic preference and analyses of a brief survey of positive deviants (clinical staff in practices with high rates of encouraging patients to use the quit smoking innovation). RESULTS: A total of 146 clinical staff from 76 primary care practices interacted with the VPs. Clinic staff included medical providers (35/146, 24.0%), nurse professionals (19/146, 13.0%), primary care technicians (5/146, 3.4%), managerial staff (67/146, 45.9%), and receptionists (20/146, 13.7%). Medical staff were mostly male, and other roles were mostly female. Medical providers (OR 0.031; CI 0.003-0.281; P=.002) and younger staff (OR 0.411; CI 0.177-0.952; P=.038) were less likely to choose the younger, female VP when controlling for all other characteristics. VP preference did not influence online patient referrals by staff. In high-performing practices that referred 20 or more smokers to the ePortal (13/76), the majority of clinic staff were motivated by or liked the virtual patient (20/26, 77%). CONCLUSIONS: Medical providers are more likely motivated by VPs that are similar to their patient population, while nurses and other staff may prefer avatars that are more similar to them

Decisions, Decisions: Developing Interactive Fiction for Health Communication

Young female undergraduate students frequently engage in sexual activity, often without using condoms. Such risky behavior poses serious physical health risks to these women, their current and future partners, and possibly their children. Consequences of unsafe sex like STIs and unplanned pregnancy can further have serious financial and psychological implications. Health communication campaigns that impart sexual health information and improve attitudes toward safer sex offer a promising means of addressing these serious public health issues. A strategic health communication effort will comprise solid theoretical bases, carefully designed program plans, and ample community involvement to create effective and appealing messages and materials.The Adventures in... project began when four graduate students created a small, vibrant interactive fiction story booklet as a novel means of sexual health outreach for female undergraduates. Initially part of the final assignment for a Health Communication class, the booklet interested several stakeholders at the University of Pittsburgh who gave the graduate students (the project team) opportunity to adapt the item and circulate it in the undergraduate population. Since adapting the booklet to fit cultural, institutional, and other considerations, the Adventures in... project has distributed copies of the item at several student events and received positive initial feedback from members of the target audience. Several challenges arose through the course of the project that delayed its development and limited its outreach, some of which may have been prevented through more careful planning. However, the project team has continued to adapt the message and material to serve the needs of the target population.Interactive fiction as health pedagogy appears to have strong theoretical premise and promise as a form of health communication. This project has public health significance because entertaining communication efforts that promote sexual health are necessary to address young adults' unsafe sex practices. The Adventures in... project consequently must continue its development and outreach efforts. Foremost, it should create more stories on other relevant health topics, expand its reach to other segments of the student population and to other college campuses, and adopt the increasingly popular and accessible online format

Games for health for children - current status and needed research

Videogames for health (G4H) offer exciting, innovative, potentially highly effective methods for increasing knowledge, delivering persuasive messages, changing behaviors, and influencing health outcomes. Although early outcome results are promising, additional research is needed to determine the game design and behavior change procedures that best promote G4H effectiveness and to identify and minimize possible adverse effects. Guidelines for ideal use of different types of G4H by children and adolescents should be elucidated to enhance effectiveness and minimize adverse effects. G4H stakeholders include organizational implementers, policy makers, players and their families, researchers, designers, retailers, and publishers. All stakeholders should be involved in G4H development and have a voice in setting goals to capitalize on their insights to enhance effectiveness and use of the game. In the future, multiple targeted G4H should be available to meet a population's diverse health needs in developmentally appropriate ways. Substantial, consistent, and sophisticated research with appropriate levels of funding is needed to realize the benefits of G4H

Build it so they will come? Feasibility and efficacy of a gamified personalized normative feedback alcohol intervention for sexual minority women.

Sexual minority women (SMW) disproportionately engage in heavy drinking and shoulder the burden of alcohol dependence. Much research has emphasized the need for culturally tailored alcohol interventions for this population, highlighting sexual minority stigma-related experiences, maladaptive coping, and misperceived peer drinking and coping norms as potential intervention targets. Focusing on the latter, this research examines the potential utility of personalized normative feedback (PNF) in reducing consumption among moderate and heavy drinking SMW. PNF is a popular, evidence-based intervention strategy associated with reliable (albeit modest) reductions in alcohol use in other heavy drinking populations. To remedy limitations associated with traditional PNF intervention formats and tailor this strategy to reflect the interests, social identities, and stigma experiences of SMW, a novel gamified intervention format was developed wherein PNF on drinking and coping behaviors was organically delivered to SMW within LezParlay, a larger competition designed to challenge negative stereotypes about lesbian, bisexual, queer (LBQ) women and increase the visibility of community members. The current study evaluates the efficacy and feasibility of this approach. In total, 2,677 LBQ women between the ages of 21 and 65 years signed up to take part in the LezParlay competition, with players logging over 44,0000 web app page views. Following several rounds of play, a sub-sample of 499 moderate-to-heavy drinking SMW were randomized to receive 1 of 3 sequences of PNF (i.e., alcohol+coping, alcohol+control, or control topics only) over two subsequent rounds. Alcohol use was assessed prior to randomization and two months post-intervention, along with potential demographic and sexual minority stigma-related moderators. Following the competition, these participants completed feedback surveys assessing acceptability, perceived benefits, and ideas for future versions of LezParlay. At follow-up, participants who received alcohol+coping and alcohol+control PNF significantly reduced their alcohol consumption relative to those who received control PNF only (d =.49 -.50). No differences were observed between treatment conditions overall; however, moderator analyses revealed alcohol+coping PNF to be more effective than alcohol only PNF among SMW who entered the study as heavier drinkers. Interpersonal stigma exposure also moderated intervention efficacy with enhanced effects observed among SMW in both treatment conditions reporting greater (relative to lesser) violence and harassment due to sexual minority status. Study participants found the competition to be highly acceptable and 93% reported psychological benefits, which most frequently included stigma reduction, social comparison, community connection, entertainment, self-confrontation, and mood enhancement. Findings support the feasibility and efficacy of this palatable approach to alcohol intervention for SMW, suggest that culturally tailored game mechanics may bolster PNF intervention engagement and potentially carry psychological benefits beyond core intervention content, and illuminate several priority directions for future research. Foremost, as findings suggest that PNF may particularly risk-reducing in the context of severe interpersonal stigma experiences like violence and harassment due to sexual minority status, additional research with SMW and members of other stigmatized groups is needed to more extensively examine potential interactions between norm correcting PNF and sexual minority stigma experiences in the context of heavy drinking and other health-risk behaviors. More broadly, this research advances several new directions for PNF intervention research, demonstrates the efficiency of hybrid feasibility/efficacy trial designs for evaluating digital health interventions, and illuminates the potential utility of incognito digital health intervention formats for nonclinical populations

Vaccinating Children for the Human Papillomavirus (HPV): Predictors of Parents Vaccinating Their Child and Providers Recommending a New Linguistically and Culturally Tailored Video Intervention Designed to Increase Vaccination Initiation and Completion

The public health problem of ensuring that teens and preteens receive the HPV vaccination series justified this study, using a convenience sample (N=122) of parents, 68 of whom were English-speaking parents (ESP) and 54 were Spanish-speaking parents (SSP). Among ESP, 94.1% (n=64) were females and 5.9% (n=4) were males. Among SSP, 98.1% (n=53) were females and 1.9% (n=1) was male. The mean age for ESP (n=68) was 41.16 years (min=27, max=72, SD=6.72). The mean age for SSP (n=54) was 38.72 years (min=26, max=55, SD =7.31). About 44.1% (n=30) of ESP were Hispanic/ Latino, and 98.1% (n=53) of SSP were Hispanic/Latino. Using backward stepwise regression analysis, in the whole sample (N=122), significant predictors of parents being in an action or maintenance stage for making sure their children received the HPV vaccination was predicted by: if child had received HPV vaccination (β=1.714, SEB=.599, p=.000) and yearly household income (β=.142, SEB=.200, p=.007) in a model accounting for 40.5% of the variance (R2=.420, AdjR2=.405). This study determined that a linguistically and culturally tailored (i.e., in English or Spanish) video on HPV and HPV vaccination of preteens and teens served as a brief online e-health intervention that was associated with significant parental movement across the stages of change (i.e., from precontemplation or contemplation stage, to preparation stage) and increased self-efficacy for three key behaviors: (1) talking to a pediatrician or family practice medical provider about the Human papillomavirus (HPV) infection and the HPV vaccination for children; (2) making sure their preteen and teen children receive the HPV vaccination; and (3) making sure their preteen and teen children receive all required doses (e.g., at least two or three doses) of the HPV vaccination. Also, 89.5% (n=17) of healthcare providers recommended the video. Qualitative data produced themes for recommending the video and improving it. Recommendations for an evaluation of the video intervention using a nationally representative sample are advanced, along with implications for widely disseminating and evaluating a new evidence-based approach codified in the video

Youth and the communication of Risk: developing connections between cancer council Australia and contemporary online youth culture

Through two focus groups, the project investigated how youth culture perceives online communication of risk. In two 90-minute sessions, investigators gaged the range of online activities that nine 18 - 24 year old university students engaged with. Through a guided discussion the participants explored how they would relate to the communication of health risk more generally and cancer risk more specifically.Participants’ online activity is very high and a range of social media forms are part of their everyday lives. In contrast, their use of traditional media is almost non-existent. Their relationship to accessing and being aware of health information demonstrated a range of views that pointed to quite new and different relationships to health and health professionals. To intersect with their online movements in the communication of health risk demands a sophisticated knowledge of their own searching patterns.Key ideas generated from the focus groups include: that it might be advantageous to group health risk beyond the specificity of cancer for online success; that an online persona would be useful to provide a face for the communication of risk; that a multi-platform campaign to raise the profile of a persona would be useful; and that success means moving between the serious and the light-hearted in a way that makes the persona a complete person of interest for them