Employing Environmental Data and Machine Learning to Improve Mobile Health Receptivity

Behavioral intervention strategies can be enhanced by recognizing human activities using eHealth technologies. As we find after a thorough literature review, activity spotting and added insights may be used to detect daily routines inferring receptivity for mobile notifications similar to just-in-time support. Towards this end, this work develops a model, using machine learning, to analyze the motivation of digital mental health users that answer self-assessment questions in their everyday lives through an intelligent mobile application. A uniform and extensible sequence prediction model combining environmental data with everyday activities has been created and validated for proof of concept through an experiment. We find that the reported receptivity is not sequentially predictable on its own, the mean error and standard deviation are only slightly below by-chance comparison. Nevertheless, predicting the upcoming activity shows to cover about 39% of the day (up to 58% in the best case) and can be linked to user individual intervention preferences to indirectly find an opportune moment of receptivity. Therefore, we introduce an application comprising the influences of sensor data on activities and intervention thresholds, as well as allowing for preferred events on a weekly basis. As a result of combining those multiple approaches, promising avenues for innovative behavioral assessments are possible. Identifying and segmenting the appropriate set of activities is key. Consequently, deliberate and thoughtful design lays the foundation for further development within research projects by extending the activity weighting process or introducing a model reinforcement.BMBF, 13GW0157A, Verbundprojekt: Self-administered Psycho-TherApy-SystemS (SELFPASS) - Teilvorhaben: Data Analytics and Prescription for SELFPASSTU Berlin, Open-Access-Mittel - 201

Is pregnancy a teachable moment for diet and physical activity behaviour change? An interpretative phenomenological analysis of the experiences of women during their first pregnancy

OBJECTIVES: Pregnancy may provide a 'teachable moment' for positive health behaviour change, as a time when women are both motivated towards health and in regular contact with health care professionals. This study aimed to investigate whether women's experiences of pregnancy indicate that they would be receptive to behaviour change during this period. DESIGN: Qualitative interview study. METHODS: Using interpretative phenomenological analysis, this study details how seven women made decisions about their physical activity and dietary behaviour during their first pregnancy. RESULTS: Two women had required fertility treatment to conceive. Their behaviour was driven by anxiety and a drive to minimize potential risks to the pregnancy. This included detailed information seeking and strict adherence to diet and physical activity recommendations. However, the majority of women described behaviour change as 'automatic', adopting a new lifestyle immediately upon discovering their pregnancy. Diet and physical activity were influenced by what these women perceived to be normal or acceptable during pregnancy (largely based on observations of others) and internal drivers, including bodily signals and a desire to retain some of their pre-pregnancy self-identity. More reasoned assessments regarding benefits for them and their baby were less prevalent and influential. CONCLUSIONS: Findings suggest that for women who conceived relatively easily, diet and physical activity behaviour during pregnancy is primarily based upon a combination of automatic judgements, physical sensations, and perceptions of what pregnant women are supposed to do. Health professionals and other credible sources appear to exert less influence. As such, pregnancy alone may not create a 'teachable moment'. Statement of contribution What is already known on this subject? Significant life events can be cues to action with relation to health behaviour change. However, much of the empirical research in this area has focused on negative health experiences such as receiving a false-positive screening result and hospitalization, and in relation to unequivocally negative behaviours such as smoking. It is often suggested that pregnancy, as a major life event, is a 'teachable moment' (TM) for lifestyle behaviour change due to an increase in motivation towards health and regular contact with health professionals. However, there is limited evidence for the utility of the TM model in predicting or promoting behaviour change. What does this study add? Two groups of women emerged from our study: the women who had experienced difficulties in conceiving and had received fertility treatment, and those who had conceived without intervention. The former group's experience of pregnancy was characterized by a sense of vulnerability and anxiety over sustaining the pregnancy which influenced every choice they made about their diet and physical activity. For the latter group, decisions about diet and physical activity were made immediately upon discovering their pregnancy, based upon a combination of automatic judgements, physical sensations, and perceptions of what is normal or 'good' for pregnancy. Among women with relatively trouble-free conception and pregnancy experiences, the necessary conditions may not be present to create a 'teachable moment'. This is due to a combination of a reliance on non-reflective decision-making, perception of low risk, and little change in affective response or self-concept

Evaluation of an Online ‘Teachable Moment’ Dietary Intervention

Abstract Purpose - To evaluate an online ‘teachable moment’ intervention to promote healthy eating for overweight and food intolerance symptoms. Design/methodology/approach – The study involves a 2 x 2 factorial design with two conditions: group (weight loss vs food intolerance) and condition (intervention vs control). The intervention aimed to generate a ‘teachable moment’ by providing knowledge regarding the relationship between food and the problem (overweight or food intolerance), focusing on the negative aspects of the problem, creating a behavioural model, and encouraging hope and reinvention. Participants receiving the intervention (n = 22) completed measures of dietary behaviour and either weight or food intolerance symptoms before receiving the intervention and again one month later. Control participants (n = 20) provided measures but did not receive the intervention. Findings - There were no significant reductions in weight or food intolerance symptoms. However, compared to control participants, participants in the intervention conditions reported greater intentions to eat healthily (p = .01) and improved healthy eating behaviour over time, following both an intention-to-treat (p = .046) and explanatory analysis (p = .042). Practical implications - Encouraging individuals to perceive their everyday situation as a time for change and adopt healthier behaviour early on, may prevent future diet-related medical events. This has benefits for both the individual and for health care costs. Originality/value - A quick and easy to administer online ‘teachable moment’ intervention improves dietary behaviour and can be minimally adapted to suit individuals with differing health needs

Can Positive Mood or Mindfulness Interventions Increase Body Satisfaction?

Research has indicated that body dysmorphic disorder (BDD) and eating disorder interventions have historically targeted clinically diagnosed individuals. These interventions target specific predicting risk factors such as negative affect and body dissatisfaction. The current study focused on the relationship between negative affect and body dissatisfaction for a nonclinical population. The central questions were (i) whether the posited relationship between negative affect and body dissatisfaction could be replicated for a nonclinical population and (ii) if interventions that target mood would also lead to increases in self-perceived body satisfaction. The efficacy of mood interventions as a means to target body dissatisfaction was investigated. Experiment 1 demonstrated the effectiveness of the negative mood manipulation in decreasing mood and body satisfaction. In contrast, Experiment 2 demonstrated the effectiveness of the positive mood manipulation in increasing mood and body satisfaction. Experiment 3 examined the effectiveness of the proposed body dissatisfaction interventions, a positive mood induction and a body scan mindfulness meditation, in increasing mood and body satisfaction. Positive affect and body satisfaction significantly increased over time following the proposed body dissatisfaction interventions and the control manipulation. Implications of the results and future directions are discussed

Impact of Seasonality and Food Security on Growth and Morbidity in Children under 2 Years in Rural Honduras

Child malnutrition remains a significant problem worldwide with children under two years of age at particular risk. Even mild to moderate child undernutrition in food insecure households has been associated with poor growth, increased rates of infection and poor development. Rural Honduras undergoes a rainy and a dry season each year. Households rely on subsistence agriculture and as the dry season progresses, they have fewer food reserves and limited cash resources. It is anticipated that this will lead not only to decreased measures of food security, but also that children in food secure households will have higher rates of growth and lower rates of disease than children from food insecure households. This study aims to determine predictors of household food security, the impact of seasonality on food security and the utility of food security at predicting rates of growth and disease in children under two in rural Honduras. One hundred and forty-one mother-infant pairs participated in this longitudinal, observational study. Food security was assessed at baseline and at the close of the study period utilizing a 14 question Food Insecurity Questionnaire. Additional measures included: a baseline demographic assessment and monthly child health questionnaire. Analyses of food security were completed using both a paired sample t-test and a repeated measures ANOVA to determine the impact of season (dry versus rainy) on food security. A multivariate regression model using backwards selection determined the best fit model for predicting total food security in both dry and rainy seasons. Multivariate regression modeling identified the food security questions that were the best predictors of growth and illness during dry season controlling for age cohort and gender. Food security was significantly lower during the dry season (mean 32.98±4.35) compared to the rainy season (mean=36.44±5.23) (p\u3c0.001). Bivariate analyses showed decreased rates of food security in households with female children (N=65; mean 32.5±4.98) compared to households with male children (N=74; mean 34.0 ±5.3; p=0.099) during the dry season. In addition, rates of food security in households with younger children (ages 6-12 months of age) were lower than households with older children (ages 12-19 months of age) in both dry and rainy season (p=0.110; p=0.038). Multivariate regression modeling identified the food security measures and maternal and child characteristics that predicted total food security during rainy (p=0.002) and dry season (p\u3c0.001). Multivariate regression models used questions from the food security questionnaire to predict parent-reported days of illness controlling for age and gender. Different groupings of food security questions were significant predictors for parent-reported days of diarrhea, fever, shortness of breath, and vomiting, but not days of cough. Our findings confirm higher rates of food insecurity during the dry season than during the rainy season in rural Honduras. They identify maternal and child characteristics that increase the risk and severity of food insecurity in children and also illustrate the link between different indicators of household food security and rates of child growth and morbidity

“Things like tinned burgers and tinned macaroni, I ate as a kid - I would not look at it twice!” : Understanding changing eating practices across the lifecourse

Acknowledgment: The authors are grateful to the Scottish Government for funding the work from which this paper was developed through its 2011-16 Strategic Research Programme.Peer reviewedPostprin

COUPLES AND WEIGHT LOSS SURGERY: EXPERIENCING SUCCESS

Bariatric surgery, also known as weight loss surgery (WLS) is an intervention for individuals who are suffering from obesity and weight-related health complications which often accompany being 100 pounds or more overweight (Smith et al., 2011). Even though bariatric surgery has been shown to be a life-saving and life-enhancing operation, efforts to seek out surgery options, qualify and prepare for the procedure, recover from surgery, and then adapt new routines to support surgery are challenging not only for the patient, but also for the people with whom the patient spends the most time—their romantic partners (Applegate & Friedman, 2008; Bylund, Benzein, & Carina, 2013; Moore & Cooper, 2016; Sarwer, Dilks, & West-Smith, 2011). This dissertation was a means to explore relational, food, and WLS success experiences that take place within couples when at least one person has had bariatric surgery. Comparisons between life before, during, and after WLS were discussed with focused attention given to relationship dynamics and daily food routines (Bocchieri, Meana, & Fisher, 2002). The couple’s definition of WLS success and the means by which they have been successful were launching points for more in-depth conversation. Data was generated through 2 interviews per couple (n = 11) with patients who met selection criteria for the study—committed long-term relationship and of the same residence for at least the past 5 years with at least 1 person having been successful with WLS. Success was defined by the WLS patient, however they had to be at least 2 years post-WLS, the critical time period where postoperative weight regain has been shown to occur, in order to participate (Magro et al., 2008; Ogden, Avenell, & Ellis, 2011; Pories et al., 2016). A thematic analysis with multiple rounds of coding was conducted after data saturation was met and couples indicated their agreeableness with results through a short, follow-up survey which also functioned as a form of member-checking. Overall, couples’ relationship dynamics were characterized as secure and WLS gave them another way to give support, engage in teamwork, and ultimately become closer. Patients and spouses explained that they loved each other unconditionally, no matter what the patient weighed, and this had been the reality for their entire relationship. Thus, security was the theme for relationship dynamics with support, teamwork, and closer as subthemes. Spouses expressed their desire to help the WLS patient when it came to being open to change and then making necessary modifications in habits and lifestyle. The commitment to change happened before WLS and a mind-shift happened after WLS that enabled both people to adjust their thinking, consistently evaluate their routines, and continue to change their behaviors. As a result, commit and mind-shift were the themes and subsequent changes (diet, exercise, and mindsets) were the subthemes. A secure relationship and commitment to making “better choices” assisted the patient in experiencing WLS success and this meant that their spouse experienced success, too; “it’s our success together.” The theme for WLS success was follow-through and subthemes were results, comfort, happy, and freedom. Hope was also a by-product of success and it was the grand-theme of this study