Social Comparison Theory in the Context of Chronic Illness: Predictors and Consequences of Target Selection among Individuals with Type 2 Diabetes

Individuals often compare themselves to others (i.e., social comparisons) in order to determine their status in a given domain. Social comparisons may be particularly important for patients with chronic illness; patients often experience uncertainty and anxiety about their health, which increase the likelihood and utility of social comparisons. Among patients, social comparisons can have both positive and negative health-related consequences (for affect, motivation to improve one\u27s health care behaviors, etc.), depending upon several contextual features. Various steps in the social comparison process have been proposed, but not tested directly. The present study is an examination of the social comparison process among patients with Type 2 Diabetes Mellitus (T2DM) - a condition that is a growing public health concern for which psychosocial interventions can be beneficial. Patient participants used a web-mediated program to self-report individual difference characteristics prior to selecting from four comparison targets (descriptions of other patients with T2DM). Patients then rated their motivations for selection, read a description of their chosen patient, and reported on their response (e.g., current affect, motivation to improve self-care). Patients who endorsed greater symptom severity were more likely to choose sicker comparison targets, but choice was unrelated to personality characteristics. A model that incorporated several individual difference factors thought to be related to social comparison had moderate predictive value for comparison choice. The extent to which patients focused on differences and similarities between themselves and their chosen targets moderated affective and motivational response (respectively). These findings may contribute to the improvement of psychosocial interventions for patients with T2DM and other illnesses (e.g., components of cognitive intervention, educational materials that include patient testimonials, the composition of support groups)

Relations between social comparisons and physical activity among women in midlife with elevated risk for cardiovascular disease: an ecological momentary assessment study.

Women in midlife (ages 40-60) show decreases in physical activity (PA) that exacerbate risk for cardiovascular disease. Social comparisons (i.e., self-evaluations relative to others) are known to influence PA in other groups, but their association in this population is unknown. The present study used ecological momentary assessment to examine this relation among women in midlife with hypertension or another CVD risk condition (N = 75,

Social Comparison Features in Physical Activity Promotion Apps: Scoping Meta-Review.

BACKGROUND: Smartphone apps promoting physical activity (PA) are abundant, but few produce substantial and sustained behavior change. Although many PA apps purport to induce users to compare themselves with others (by invoking social comparison processes), improvements in PA and other health behaviors are inconsistent. Existing literature suggests that social comparison may motivate PA for some people under some circumstances. However, 2 aspects of work that apply social comparison theory to PA apps remain unclear: (1) how comparison processes have been operationalized or harnessed in existing PA apps and (2) whether incorporating sources of variability in response to comparison have been used to tailor comparison features of apps, which could improve their effectiveness for promoting PA. OBJECTIVE: The aim of this meta-review was to summarize existing systematic, quantitative, and narrative reviews of behavior change techniques in PA apps, with an emphasis on social comparison features, to examine how social comparison is operationalized and implemented. METHODS: We searched PubMed, Web of Science, and PsycINFO for reviews of PA smartphone apps. Of the 3743 initial articles returned, 26 reviews met the inclusion criteria. Two independent raters extracted the data from these reviews, including the definition of social comparison used to categorize app features, the percentage of apps categorized as inducing comparison, specific features intended to induce comparison, and any mention of tailoring comparison features. For reference, these data were also extracted for related processes (such as behavioral modeling, norm referencing, and social networking). RESULTS: Of the included review articles, 31% (8/26) categorized app features as prompting social comparison. The majority of these employed Abraham and Michie\u27s earliest definition of comparison, which differs from versions in later iterations of the same taxonomy. Very few reviews specified what dimension users were expected to compare (eg, steps, physical fitness) or which features of the apps were used to induce comparison (eg, leaderboards, message boards). No review referenced tailoring of comparison features. In contrast, 54% (14/26) reviews categorized features for prompting behavioral modeling and 31% (8/26) referenced tailoring app features for users\u27 personal goals or preferences. CONCLUSIONS: The heterogeneity across reviews of PA apps and the absence of relevant information (eg, about dimensions or features relevant for comparison) create confusion about how to best harness social comparison to increase PA and its effectiveness in future research. No evidence was found that important findings from the broader social comparison literature (eg, that people have differing preferences for and responses to social comparison information) have been incorporated in the design of existing PA apps. Greater integration of the mobile health (mHealth) and social comparison literatures may improve the effectiveness of PA apps, thereby increasing the public health impact of these mHealth tools. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-https://osf.io/nh4td/

A multi-study approach to refining ecological momentary assessment measures for use among midlife women with elevated risk for cardiovascular disease.

Background: Ample evidence indicates that everyday perceptions of the social environment can affect health behaviors; these include social comparisons (i.e., self-evaluations compared to others) and positive versus negative social interactions. However, relations between social perceptions and healthy behaviors have received little attention among specific medical populations for whom an improved understanding of behavioral determinants could inform updates to tailored interventions. Research methods that capture and differentiate between stable, person-level differences and dynamic, within-person variability in these relations would be particularly useful, both for identifying their nature in daily life and informing improvements to tailored interventions. Methods: We conducted a series of three formative research studies to adapt and test the measures and instructions for an ecological momentary assessment (EMA) protocol with midlife women who had elevated risk for cardiovascular disease (CVD; e.g., current diagnosis of hypertension, type 2 diabetes). Study 1 involved a pilot test of initial EMA items, sent to participants\u27 smartphones 5 times per day for 7 days (N=13; M Results: Item performance in Study 3, including the frequencies of reporting social comparisons and interactions, was compared to that in Study 1 using multilevel modeling; these tests showed meaningful improvement in reporting patterns between Studies 1 and 3 (e.g., changes of d=0.33-0.75 where appropriate). Conclusions: Together, findings from this series of studies demonstrate the utility of a multi-study approach to refining EMA methods for use with midlife women who have elevated CVD risk, which may generalize to other populations of interest

Preferences for Support Resources Among Loved Ones of Adults Prescribed Opioid Medications

The opioid epidemic continues to be a leading cause of overdose and related deaths in America. While most interventions are focused on the individuals with opioid and substance use disorder (OUD/SUD); the impact caregivers and family can have on the treatment of patients with OUD is non-existent. The purpose of this study is to collect pilot data on peers, friends, and family members of patients with SUD/OUD to understand the barriers in psychosocial support and maintaining treatment retention; barriers to accessing medication assisted therapy (MAT) and naloxone; and caregiver fatigue and barriers for caregivers. The collected data will be used to develop a digital health intervention (DHI) in the form of a mobile application/web page. To develop the survey, a review of the current literature on PubMed relating to OUD/SUD and stigma, caregiver fatigue, efficacy of DHIs, readiness to change, and promoting naloxone use was conducted. The results of the review support the fact that caregivers of patients with OUD/SUD experience fatigue and often do not have accurate knowledge of how to help patients. Furthermore, DHIs were found to improve access to treatment and reduce stigma and associated barriers. The next step of the study will be to recruit caregivers, peers, and family members of individuals with OUD to conduct surveys and development of the DHI

The history and future of digital health in the field of behavioral medicine.

Since its earliest days, the field of behavioral medicine has leveraged technology to increase the reach and effectiveness of its interventions. Here, we highlight key areas of opportunity and recommend next steps to further advance intervention development, evaluation, and commercialization with a focus on three technologies: mobile applications (apps), social media, and wearable devices. Ultimately, we argue that future of digital health behavioral science research lies in finding ways to advance more robust academic-industry partnerships. These include academics consciously working towards preparing and training the work force of the twenty first century for digital health, actively working towards advancing methods that can balance the needs for efficiency in industry with the desire for rigor and reproducibility in academia, and the need to advance common practices and procedures that support more ethical practices for promoting healthy behavior

A Scoping Review of Behavior Change Techniques Used to Promote Physical Activity Among Women in Midlife

Women in midlife experience health risks that could be mitigated by regular physical activity and reduced sedentary time, but this population rarely achieves physical activity levels that would protect their health. As a result, many behavioral interventions are designed to promote physical activity in this population, which are purportedly guided by theoretical models of health behavior (change) and activate an associated set of behavior change techniques (BCTs). The efficacy and effectiveness of these interventions appear to be limited, however, raising questions about their design and adaptation for women in midlife. Several aspects of these interventions are currently unclear. Specifically, which women they target (i.e., how midlife and sedentary or inactive are defined), which theoretical models or behavior BCTs are used, and how BCTs are activated in such interventions. A synthesis of this information would be useful as an initial step toward improving physical activity interventions for this at-risk group, and thus, represented the goal of the present scoping review. Eligibility required publication in a peer-reviewed journal in English between 2000 and 2021, inclusion of only women in midlife who did not have any medical or other restrictions on their physical activity (e.g., cancer diagnosis), and free-living physical activity or sedentary behavior as the target outcome (with associated assessment). Of the 4,410 initial results, 51 articles met inclusion criteria, and these described 36 unique interventions. More than half of the articles (59%) named an underlying theoretical model and interventions included an average of 3.76 identifiable BCTs (range 1-11). However, descriptions of many interventions were limited and did not provide enough detail to determine whether or how specific BCTs were activated. Interventions also used a wide range of inclusion criteria for age range and starting activity level, which has implications for targeting/tailoring and effectiveness, and many interventions focused on marginalized populations (e.g., women from racial/ethnic minority backgrounds, those un- or under-insured). The present review identifies some strengths and highlights important limitations of existing literature, as well as key opportunities for advancing the design and potential utility of physical activity interventions for women in midlife

Personalization Paradox in Behavior Change Apps:Lessons from a Social Comparison-Based Personalized App for Physical Activity

Social comparison-based features are widely used in social computing apps. However, most existing apps are not grounded in social comparison theories and do not consider individual differences in social comparison preferences and reactions. This paper is among the first to automatically personalize social comparison targets. In the context of an m-health app for physical activity, we use artificial intelligence (AI) techniques of multi-armed bandits. Results from our user study (n=53) indicate that there is some evidence that motivation can be increased using the AI-based personalization of social comparison. The detected effects achieved small-to-moderate effect sizes, illustrating the real-world implications of the intervention for enhancing motivation and physical activity. In addition to design implications for social comparison features in social apps, this paper identified the personalization paradox, the conflict between user modeling and adaptation, as a key design challenge of personalized applications for behavior change. Additionally, we propose research directions to mitigate this Personalization Paradox

Development of a Mobile Assessment Tool for Understanding Social Comparison Processes Among Individuals With Schizophrenia: Two-Phase Survey Study

BackgroundDigital tools may help to address social deficits in schizophrenia, particularly those that engage social comparison processes (ie, evaluating oneself relative to others). Yet, little is known about social comparison processes in schizophrenia or how best to capture between- versus within-person variability, which is critical to engaging comparisons in digital interventions. ObjectiveThe goals of this pilot study were to (1) better understand affective responses to social comparisons among individuals with schizophrenia, relative to healthy controls, using a validated global self-report measure; and (2) test a new brief, mobile assessment of affective responses to social comparison among individuals with schizophrenia, relative to the full measure. This study was conducted in 2 phases. MethodsWe first compared self-reported affective responses to social comparisons between individuals with schizophrenia (n=39) and healthy controls (n=38) using a traditional self-report measure, at 2 time points. We examined the temporal stability in responses and differences between groups. We then evaluated the performance of brief, mobile assessment of comparison responses among individuals with schizophrenia, completed over 12 weeks (n=31). ResultsIndividuals with schizophrenia showed greater variability in affective responses to social comparison than controls on traditional measures and completed an average of 7.46 mobile assessments over 12 weeks. Mobile assessments captured within-person variability in affective responses in the natural environment (intraclass correlation coefficients of 0.40-0.60). Average scores for mobile assessments were positively correlated with responses to traditional measures. ConclusionsAffective responses to social comparison vary both between and within individuals with schizophrenia and capturing this variability via smartphone surveys shows some evidence of feasibility. As affective variability is a potential indicator of poor outcomes among individuals with mental health conditions, in the future, a brief, mobile assessment of affective responses to social comparisons may be useful for screening among individuals with schizophrenia. Further research on this process is needed to identify when specific comparison messaging may be most effective in digital interventions and could suggest new therapeutic targets for illnesses such as schizophrenia

The Roles of Social Comparison Orientation and Regulatory Focus in College Students’ Responses to Fitspiration Posts on Social Media: Cross-sectional Study

BackgroundInformation shared via social media influences college students’ self-perceptions and behavior, particularly, “fitspiration” posts (ie, images of healthy food, people exercising, or fitness quotations). There are mixed findings regarding the mental health implications of fitspiration and its potential to motivate healthy behavior. Individual differences such as social comparison orientation and regulatory focus could aid in determining for whom fitspiration may be helpful versus harmful, though these characteristics have received limited attention in terms of students’ fitspiration perceptions. ObjectiveThis cross-sectional study examined associations between students’ fitspiration use (ie, intentional versus unintentional exposure while using social media), response tendencies (ie, feelings about the self and motivation to be physically active), social comparison orientation, and regulatory focus. MethodsCollege students (N=344; 239/344, 69.5% women) completed an electronic survey in which they self-reported demographic information, the frequency of their social media use, exposure to fitspiration posts, typical feelings in response to fitspiration posts, and typical motivation for physical activity after viewing fitspiration posts. They also completed validated self-report measures of social comparison orientation and regulatory focus. ResultsCollege students reported frequent exposure to fitspiration posts on social media and that they experienced negative feelings in response to these posts more often than positive feelings. Average motivation for physical activity was rated as feeling motivated “some of the time.” However, students who reported more negative feelings after viewing fitspiration also reported greater motivation to be physically active after exposure. Associations between the frequency of intentional fitspiration use and motivation for physical activity after viewing fitspiration posts were moderated by social comparison orientation (b=−0.01, P=.03) but not by regulatory focus (b=−0.002, P=.67). ConclusionsNegative feelings about the self may be motivating for students with weak social comparison orientation, as fitspiration may highlight a discrepancy between one’s real and ideal self that does not prompt dejection or disengagement. However, negative feelings for prevention-focused students might not be as motivating because there are no salient negative models to avoid. Further research into these associations is warranted and could inform future efforts to promote student health and well-being during college