Examining the Use of Mobile Technology to Deliver Tailored Sexual Assault Prevention in a Classroom Environment in the Military: Development and Usability Study

BackgroundAdvances in mobile technology over the last 10 years have expanded its use in scientific research. However, there are challenges in creating a reliable system for intervention content delivery and data collection in an environment with limited internet connectivity and limited staffing capacity. The Sexual Communication and Consent (SCC) study used tablets to provide individualized Sexual Assault Prevention and Response training in a classroom environment that was both technologically and support staff limited. ObjectiveWe developed the SCC Basic Military Training app and a separate Sexual Assault Response Coordinator app to support individualized training within the new SCC program. This paper presents the functionality, protocols, challenges, and feasibility of deploying mobile technology in an educational environment in the military with limited resources. MethodsWe developed both mobile apps targeting the Apple iOS ecosystem. The Basic Military Training app provided a screening instrument that routed the trainee into 1 of 5 specific intervention programs. Over 2 days of basic military training set 2 weeks apart, trainees received a combined 6 hours of program-specific tablet training, combined with universal, interactive classroom training, led by qualified instructors. The Sexual Assault Response Coordinator app, used to deliver supplemental content to a subgroup of trainees, was made available for voluntary and private use at the Sexual Assault Response Coordinator’s office on base. All anonymous data were manually transferred onto laptops, where the data were aggregated into files and securely transferred to the project staff for analysis. The study was conducted at the Lackland Air Force Base, Joint Base San Antonio, with 9196 trainees providing the data. ResultsA total of 7742 trainees completed both the sessions of the SCC program and a series of evaluative assessments. Some trainees did not receive day 2 training, and only received day 1 training because the COVID-19 pandemic shortened the study period. Of the 190 SCC classes taught, only one class was unable to complete tablet training because of Apple licensing–related technology failure. The 360 study tablets were distributed across 3 classrooms (120 per classroom) and were handled at least 16,938 times with no reports of breakage or requiring replacement. Wi-Fi access limitations exacerbated the complexity of Apple licensing revalidation and the secure transfer of data from the classroom to project personnel. The instructor staff’s limited technical knowledge to perform certain technical tasks was challenging. ConclusionsThe results demonstrated the feasibility of deploying a mobile app for tablet-based training in a military educational environment. Although successful, the study was not without technical challenges. This paper gives examples of technical lessons learned and recommendations for conducting the study differently, with the aim that the knowledge gained may be helpful to other researchers encountering similar requirements

An Evidence-Based HIV Risk–Reduction Intervention for Young African American Women in the US South Using mHealth: Adaptation and Development Study

BackgroundYoung African American women have higher rates of sexually transmitted infections, including HIV, than those of young women of other racial and ethnic groups. Gender-, culture-, and age-specific interventions are needed to end the HIV epidemic. The Women’s CoOp (WC) is an HIV risk–reduction intervention that is proven to be efficacious in various face-to-face formats. ObjectiveThis study aims to adapt the delivery method of an evidence-based intervention, the WC, from an in-person format to a self-guided mobile health (mHealth) format while ensuring that core elements are maintained for intervention comparability and fidelity. MethodsSeveral adaptation phases were conducted by using the Personal Health Informatics and Intervention Toolkit (PHIT) as a guiding point to create the mobile app version of the WC. Throughout 5 phases, we established the implementation groundwork for the app; conducted formative research activities to test the initial draft of the app and obtain feedback; applied the PHIT toolkit programming structure to produce the mHealth version of the WC intervention; conducted usability testing and pretesting with interested parties, followed by in-house testing by WC interventionists and PHIT developers; and deployed the app to tablets and distributed it to study participants. The app underwent regular maintenance updates during the study. ResultsThe team converted the seven elements of the WC as accurately as possible for comparability to determine efficacy in a mobile app format while changing little about the basic delivery methods. For instance, cue card presentations of the materials delivered by the intervention staff were presented within the app but with voice-over narration and in a self-guided format rather than being led by a staff member. Other aspects of the intervention did not lend themselves to such straightforward adaptation, such as hands-on condom proficiency practice and one-on-one goal-setting activities. In these cases, the subject matter experts and app developers worked together to find comparable analogs to be used within the app. Once developed, tested, and finalized, the mHealth WC app was deployed into local health departments as part of a randomized trial. ConclusionsThis systematic adaptation process created an accurate mHealth equivalent of an existing, in-person behavioral health intervention. Although participants’ reception of the app during the formative developmental phase was overall positive, maintaining fidelity to the in-person delivery compromised the natural capabilities of a mobile app, such as further gamification, different types of interactivity, and integrated notifications and messaging, which could be helpful for participants’ adherence to the intervention schedule. Given the development and implementation of the app, the next step is to examine the impact of the app and its efficacy in HIV and substance use risk-reduction

Biofeedback-Assisted Resilience Training for Traumatic and Operational Stress: Preliminary Analysis of a Self-Delivered Digital Health Methodology

Background: Psychological resilience is critical to minimize the health effects of traumatic events. Trauma may induce a chronic state of hyperarousal, resulting in problems such as anxiety, insomnia, or posttraumatic stress disorder. Mind-body practices, such as relaxation breathing and mindfulness meditation, help to reduce arousal and may reduce the likelihood of such psychological distress. To better understand resilience-building practices, we are conducting the Biofeedback-Assisted Resilience Training (BART) study to evaluate whether the practice of slow, paced breathing with or without heart rate variability biofeedback can be effectively learned via a smartphone app to enhance psychological resilience. Objective: Our objective was to conduct a limited, interim review of user interactions and study data on use of the BART resilience training app and demonstrate analyses of real-time sensor-streaming data. Methods: We developed the BART app to provide paced breathing resilience training, with or without heart rate variability biofeedback, via a self-managed 6-week protocol. The app receives streaming data from a Bluetooth-linked heart rate sensor and displays heart rate variability biofeedback to indicate movement between calmer and stressful states. To evaluate the app, a population of military personnel, veterans, and civilian first responders used the app for 6 weeks of resilience training. We analyzed app usage and heart rate variability measures during rest, cognitive stress, and paced breathing. Currently released for the BART research study, the BART app is being used to collect self-reported survey and heart rate sensor data for comparative evaluation of paced breathing relaxation training with and without heart rate variability biofeedback. Results: To date, we have analyzed the results of 328 participants who began using the BART app for 6 weeks of stress relaxation training via a self-managed protocol. Of these, 207 (63.1%) followed the app-directed procedures and completed the training regimen. Our review of adherence to protocol and app-calculated heart rate variability measures indicated that the BART app acquired high-quality data for evaluating self-managed stress relaxation training programs. Conclusions: The BART app acquired high-quality data for studying changes in psychophysiological stress according to mind-body activity states, including conditions of rest, cognitive stress, and slow, paced breathing

Catalogue of Geadephaga (Coleoptera: Adephaga) of America, north of Mexico

All scientific names of Trachypachidae, Rhysodidae, and Carabidae (including cicindelines) recorded from America north of Mexico are catalogued. Available species-group names are listed in their original combinations with the author(s), year of publication, page citation, type locality, location of the name-bearing type, and etymology for many patronymic names. In addition, the reference in which a given species-group name is first synonymized is recorded for invalid taxa. Genus-group names are listed with the author(s), year of publication, page citation, type species with way of fixation, and etymology for most. The reference in which a given genus-group name is first synonymized is recorded for many invalid taxa. Family-group names are listed with the author(s), year of publication, page citation, and type genus. The geographical distribution of all species-group taxa is briefly summarized and their state and province records are indicated.One new genus-group taxon, Randallius new subgenus (type species: Chlaenius purpuricollis Randall, 1838), one new replacement name, Pterostichus amadeus new name for Pterostichus vexatus Bousquet, 1985, and three changes in precedence, Ellipsoptera rubicunda (Harris, 1911) for Ellipsoptera marutha (Dow, 1911), Badister micans LeConte, 1844 for Badister ocularis Casey, 1920, and Agonum deplanatum Ménétriés, 1843 for Agonum fallianum (Leng, 1919), are proposed. Five new genus-group synonymies and 65 new species-group synonymies, one new species-group status, and 12 new combinations (see Appendix 5) are established.The work also includes a discussion of the notable private North American carabid collections, a synopsis of all extant world geadephagan tribes and subfamilies, a brief faunistic assessment of the fauna, a list of valid species-group taxa, a list of North American fossil Geadephaga (Appendix 1), a list of North American Geadephaga larvae described or illustrated (Appendix 2), a list of Geadephaga species described from specimens mislabeled as from North America (Appendix 3), a list of unavailable Geadephaga names listed from North America (Appendix 4), a list of nomenclatural acts included in this catalogue (Appendix 5), a complete bibliography with indication of the dates of publication in addition to the year, and indices of personal names, supraspecific names, and species-group names