Combining persuasive technology and behaviour change techniques to support health behaviour change in people with COPD

Background: Persuasive technology is a term used to describe ‘any interactive computing system designed to change people’s attitudes or behaviours’ (Fogg, 2003, p.1). This thesis seeks to explore how persuasive technology could be combined with behaviour change techniques (BCTs) and used to help people with chronic obstructive pulmonary disease (PwCOPD) to make changes to their health behaviours. Methods: Two systematic reviews with meta-analyses were conducted to identify BCTs associated with effective interventions in this population (Study 1 and 2). A series of mixed-methods, N-of-1 studies were used to assess an existing persuasive technology (a mobile phone app) with PwCOPD (Study 3). And finally, interviews and surveys were used to collect the opinions of key stakeholders towards the use of persuasive technology to increase physical activity in PwCOPD (Study 4). Results: Study 1 identified that self-regulatory BCTs were effective in smoking cessation interventions for PwCOPD. Study 2 identified that intervention components that targeted physical activity delivered as part of a multi-faceted intervention were most effective. Study 3 showed that the mobile phone app was used daily, five of the seven participants increased their mean daily step count, although greater support would be needed to set independent physical activity goals. Study 4 found that there was support for persuasive technology to take a more active role to encourage physical activity. However, incorporating aspects such as competition divided opinion. Discussion: The findings reported illustrate the potential of combining persuasive technology with BCTs to support behaviour changes in PwCOPD. This approach was largely found to be acceptable and strategies to increase both the acceptance, and the utility, of this approach are suggested. Future research should continue to explore how best to use BCTs in conjunction with persuasive technology to support and encourage PwCOPD to makes changes to their health behaviours

Implementing a text message-based intervention to support type 2 diabetes medication adherence in primary care: a qualitative study with general practice staff

Background: The Support through Mobile Messaging and digital health Technology for Diabetes (SuMMiT-D) project has developed, and is evaluating, a mobile phone-based intervention delivering brief messages targeting identified behaviour change techniques promoting medication use to people with type 2 diabetes in general practice. The present study aimed to inform refinement and future implementation of the SuMMiT-D intervention by investigating general practice staff perceptions of how a text message-based intervention to support medication adherence should be implemented within current and future diabetes care. Methods: Seven focus groups and five interviews were conducted with 46 general practice staff (including GPs, nurses, healthcare assistants, receptionists and linked pharmacists) with a potential role in the implementation of a text message-based intervention for people with type 2 diabetes. Interviews and focus groups were audio-recorded, transcribed and analysed using an inductive thematic analysis approach. Results: Five themes were developed. One theme ‘The potential of technology as a patient ally’ described a need for diabetes support and the potential of technology to support medication use. Two themes outlined challenges to implementation, ‘Limited resources and assigning responsibility’ and ‘Treating the patient; more than diabetes medication adherence’. The final two themes described recommendations to support implementation, ‘Selling the intervention: what do general practice staff need to see?’ and ‘Fitting the mould; complementing current service delivery’. Conclusions: Staff see the potential for a text message-based support intervention to address unmet needs and to enhance care for people with diabetes. Digital interventions, such as SuMMiT-D, need to be compatible with existing systems, demonstrate measurable benefits, be incentivised and be quick and easy for staff to engage with. Interventions also need to be perceived to address general practice priorities, such as taking a holistic approach to care and having multi-cultural reach and relevance. Findings from this study are being combined with parallel work with people with type 2 diabetes to ensure stakeholder views inform further refinement and implementation of the SuMMiT-D intervention

An investigation into the empowerment effects of using online support groups and how this affects health professional/patient communication

Objective: The current research investigates the potential of online support groups (OSGs) to foster empowerment and how membership might affect the patient/health professional relationship. Methods: 246 participants across 33 OSGs completed an online questionnaire. Results: All empowerment processes and outcomes identified by van Uden-Kraan et al. [1] were found to be present. All empowerment outcomes were adequately predicted by empowerment processes. The majority (82.2%) of participants had discussed information found online with their health professional and most (74.2%) were satisfied with the response. Around 60% of participants felt membership of an OSG had affected the relationship with their health professional and from qualitative responses the effects were mostly positive. Conclusion: OSGs have the potential to produce empowerment outcomes for those who choose to use them. Furthermore, users report a positive reaction to information found online from their health professionals. Practice implications: Although not all patients will benefit from using OSGs, health professionals suggesting their use could ensure that they reach the maximum receptive audience. Furthermore, this research could be used to encourage a more 'net friendly' attitude amongst health professionals. © 2010 Elsevier Ireland Ltd

ASSESSING THE MECHANISM OF ACTION OF A TEXT MESSAGE INTERVENTION DESIGNED TO SUPPORT MEDICATION ADHERENCE IN THE SUMMIT-D TRIAL: PROTOCOL FOR MEDIATION ANALYSIS

The overall aim of the present analysis is to develop a better understanding of the mechanisms by which the SuMMiT-D intervention might produce effects in people receiving brief messages, and to identify whether these effects differ between different groups of recipients

Developing evidence-based text messages to target diet and physical activity behaviour for people with type 2 diabetes mellitus

The aim of this project was to develop an acceptable text message-based intervention targeting diet and physical activity behaviours, based on behaviour change techniques for people with type 2 diabetes. There were four objectives: 1. Create text messages to change key target behaviours based on behaviour change techniques with evidence of effectiveness 2. Assess how well the messages represent the intended behaviour change techniques 3. Assess the anticipated acceptability of the proposed messages to people with type 2 diabetes 4. Assess the experienced acceptability of the text messages to people with type 2 diabete

What do people with type 2 diabetes want from a brief messaging system to support medication adherence?

Background: Many people with type 2 diabetes do not take their treatment as prescribed. Brief messages to support medication use could reach large numbers of people at a very low cost per person, but current interventions using brief messages rarely adequately describe the content of the messages, nor base these messages on explicit behavior change principles. This study reports the views of people with type 2 diabetes concerning the acceptability of 1) a messaging system and 2) proposed messages based on behavior change techniques (BCTs) and beliefs and concerns around taking medication. Methods: The proposed system and brief messages were discussed in focus groups of people with type 2 diabetes recruited through general practices in England. Transcripts were analyzed thematically. Participants: Twenty-three participants took part in one of five focus group discussions. All participants were over 18 years, were taking tablet medication for their diabetes, and had access to a mobile phone. Key exclusion criteria were recent hospitalization for hyper- or hypoglycemia or diagnosis with a terminal illness. Results: Four themes were identified as relating to the acceptability of the messaging system: “opportunities and limitations of technology”, “us and them (who is the system for?)”, “responsibility for adherence”, and “diabetes management beyond medication”. Participants recognized the benefit of using technology. Those with high confidence in their ability to adhere were keen to make a distinction between themselves and those who did not adhere; participants were more comfortable taking responsibility for medication than diet and exercise. Acceptability of the messages hinged on avoiding “preaching to the converted”. Conclusions: These findings show that brief messaging could be acceptable to the target population for a range of diabetes-related behaviors but highlight the need for such a system to be perceived as personally relevant. Acceptable messages would need to maintain novelty for the target population.</p

Identification of Three Different Types of Smokers Who Are Not Motivated to Quit:Results From a Latent Class Analysis

Objective: The majority of smokers are not motivated to quit within 30 days. We examined whether these smokers are a homogeneous group, hypothesizing that subtypes of unmotivated smokers could be identified. Method: Included were 500 smokers not ready to quit within 30 days who completed an online survey assessing variables known to be associated with quitting. Results: Latent Class Analysis revealed 3 unmotivated smoker subtypes. Health-Concerned Smokers, (HCS; n = 166) had a significantly greater proportion of previous smoking-related illness and high risk perceptions. Smokers with Psychosocial Barriers (SPB; n = 192) had a significantly greater proportion of younger smokers, partners who smoked, other household smokers, and children. Unconvinced Smokers (UCS; n = 142) had the lowest proportion of those who: were motivated and confident to quit, had smoking-related illnesses, and perceived the risks of smoking and benefits of quitting. UCS had the highest proportion with optimistic bias, and no prior quit attempts. A greater proportion of HCS had high motivation to quit versus SPB and UCS. In model validation, 60.6% of UCS said they never plan to quit versus 31.8% of SPB and 22.3% of HCS; SPB and HCS had lower odds of never planning to quit versus UCS. Of those who plan on quitting at some point, 75.2% of HCS and 62.6% of SPB plan on quitting within 1 year, versus 46.4% of UCS; the cumulative odds of planning to quit later were higher among UCS. Conclusions: Smokers who are not motivated to quit are not a homogeneous group; tailored intervention approaches and targeted messages might be needed to motivate quitting