Digital Health Interventions (DHIs) to Support the Management of Children and Adolescents with Sickle‐Cell Disease

Sickle‐cell disease (SCD) is a very complex disorder alluding to all areas of medicine. Nevertheless, basic preventive and therapeutic interventions in patients suffering from SCD are extremely simple. However, in everyday life it is sometimes virtually impossible to motivate children and young adolescents to effectively self‐manage their disorder at an early stage. Digital health interventions (DHIs) provide new opportunities to support self‐management behaviours. DHIs may facilitate daily and recurrent routines such as drug intake or appointments along with helping the patients to better cope with their disease. This may be realized through mobile‐training programmes, disease‐specific social networks using secure communication channels, diaries, blogs and even games. Indeed, there are fascinating opportunities for modern disease‐training programmes to take advantage of several media that can be combined and didactically optimized to meet the individual needs and intellectual abilities of different patients. The technological progress is rapid, extremely dynamic and highly creative. Our chapter gives an overview of the multifarious world of DHIs with a focus on smartphone applications known as mobile health apps (mHealth apps). We elucidate the potential reasons why we think that numerous apps for SCD patients have not been successful and which app features developers should consider if they want to create a popular patient app

Targeting parents for childhood weight management: development of a theory-driven and user-centered healthy eating app

Background: The proliferation of health promotion apps along with mobile phones' array of features supporting health behavior change offers a new and innovative approach to childhood weight management. However, despite the critical role parents play in children's weight related behaviors, few industry-led apps aimed at childhood weight management target parents. Furthermore, industry-led apps have been shown to lack a basis in behavior change theory and evidence. Equally important remains the issue of how to maximize users' engagement with mobile health (mHealth) interventions where there is growing consensus that inputs from the commercial app industry and the target population should be an integral part of the development process. Objective: The aim of this study is to systematically design and develop a theory and evidence-driven, user-centered healthy eating app targeting parents for childhood weight management, and clearly document this for the research and app development community. Methods: The Behavior Change Wheel (BCW) framework, a theoretically-based approach for intervention development, along with a user-centered design (UCD) philosophy and collaboration with the commercial app industry, guided the development process. Current evidence, along with a series of 9 focus groups (total of 46 participants) comprised of family weight management case workers, parents with overweight and healthy weight children aged 5-11 years, and consultation with experts, provided data to inform the app development. Thematic analysis of focus groups helped to extract information related to relevant theoretical, user-centered, and technological components to underpin the design and development of the app. Results: Inputs from parents and experts working in the area of childhood weight management helped to identify the main target behavior: to help parents provide appropriate food portion sizes for their children. To achieve this target behavior, the behavioral diagnosis revealed the need for eliciting change in parents' capability, motivation, and opportunity in 10-associated Theoretical Domains Framework (TDF) domains. Of the 9 possible intervention functions, 6 were selected to bring about this change which guided the selection of 21 behavior change techniques. Parents' preferences for healthy eating app features revolved around four main themes (app features, time saving and convenience, aesthetics, and gamification) whereupon a criterion was applied to guide the selection on which preferences should be integrated into the design of the app. Collaboration with the app company helped to build on users' preferences for elements of gamification such as points, quizzes, and levels to optimize user engagement. Feedback from parents on interactive mock-ups helped to inform the final development of the prototype app. Conclusions: Here, we fully explicate a systematic approach applied in the development of a family-oriented, healthy eating health promotion app grounded in theory and evidence, and balanced with users' preferences to help maximize its engagement with the target population

Graduate Education in Agricultural Communication: The Need and Role

Is there a meed for graduate studies in agricultural communication

Development of a theory and evidence-based, user-centred family healthy eating app

The proliferation of health promotion apps along with smartphone's array of features supporting health behaviour change, offers a new and innovative approach to childhood weight management. However, research on the content of current industry led apps reveals they lack a basis in behaviour change theory and evidence. Equally important remains the issue of how to maximise users' engagement with mHealth. Therefore the thesis aimed to address these gaps and design and develop an evidence and theory based, user-centred healthy eating app targeting parents for childhood weight management. The Behaviour Change Wheel framework (BCW), a theoretically-based approach for health behaviour change intervention development, along with a user-centred design philosophy and collaboration with industry, guided the development process. This involved a review of the evidence and conducting a series of nine focus groups (Study one and two), a usability workshop and a 'Think Aloud' study (study three) (N=70) comprised of Change4Life advisors, parents with overweight and healthy weight children aged 5-11 years, university students and staff and consultation with experts to inform the app development. Thematic analysis of focus groups helped to extract information related to relevant theoretical (using the Capability, Opportunity, Motivation, Behaviour Model (COM-B) and Theoretical Domains Framework (TDF)), user-centred and technological components to underpin the design and development of the app. Inputs from parents, case workers and experts working in the area of childhood weight management helped to identify the main target behaviour: to support parents' provision of age appropriate food portion sizes. To achieve this target behaviour, the behavioural analysis revealed the need for eliciting change in parents' Capability, Motivation and Opportunity and twelve associated TDF domains. Therefore, the thesis provides a more comprehensive analysis of the problem compared to previous theoretical accounts, demonstrating that parents' internal processes such as their emotional responses, habits and beliefs, along with social influences such as partners and grandparents and the environmental influences relating to aspects such as schools, the media, and household objects, all interact and impact on their portion behaviours. Theoretical domains were subsequently mapped to five intervention functions and twenty-three behaviour change techniques (BCTs) to bring about change in this target behaviour. BCTs were then translated into engaging app features drawing on parental preferences for healthy eating app features including ease of use, minimal data input, visual aids of food and gamification. Overall parents viewed the prototype app positively. The 'Think Aloud' study highlighted key areas to improve usability in such as navigability. Application of the BCW to the issue of childhood weight management yielded a novel conceptualisation of potential approaches to supporting parents' portion behaviours in the home environment. This thesis is also the first to fully explicate the systematic approach applied in developing a family-oriented mHealth app grounded in the BCW framework and evidence, and balanced with users' preferences to help maximise its potential engagement with the target population. Challenges and adaptations relating to the implementation of the BCW are discussed and suggestions for future research in mHealth development and childhood weight management are provided, along with the implications for public health practice

Do automated digital health behaviour change interventions have a positive effect on self-efficacy? A systematic review and meta-analysis

© 2019 Taylor & Francis. This is an Accepted Manuscript of an article published by Taylor & Francis in Health Psychology Review on 20/01/2020, available online: https://doi.org/10.1080/17437199.2019.1705873.Self-efficacy is an important determinant of health behaviour. Digital interventions are a potentially acceptable and cost-effective way of delivering programmes of health behaviour change at scale. Whether behaviour change interventions work to increase self-efficacy in this context is unknown. This systematic review and meta-analysis sought to identify whether automated digital interventions are associated with positive changes in self-efficacy amongst non-clinical populations for five major health behaviours, and which BCTs are associated with that change. A systematic literature search identified 20 studies (n=5624) that assessed changes in self-efficacy and were included in a random effects meta-analysis. Interventions targeted: healthy eating (k=4), physical activity (k=9), sexual behaviour (k=3), and smoking (k=4). No interventions targeting alcohol use were identified. Overall, interventions had a small, positive effect on self-efficacy (푔 = 0.190, CI [0.078; 0.303]). The effect of interventions on self-efficacy did not differ as a function of health behaviour type (Qbetween = 7.3704 p = 0.061, df = 3). Inclusion of the BCT ‘information about social and environmental consequences’ had a small, negative effect on self-efficacy (Δ푔= - 0.297, Q=7.072, p=0.008). Whilst this review indicates that digital interventions can be used to change self-efficacy, which techniques work best in this context is not clear.Peer reviewedFinal Accepted Versio

Understanding and Promoting Effective Engagement With Digital Behavior Change Interventions.

This is the author accepted manuscript. The final version is available from Elsevier via https://doi.org/10.1016/j.amepre.2016.06.015This paper is one in a series developed through a process of expert consensus to provide an overview of questions of current importance in research into engagement with digital behavior change interventions, identifying guidance based on research to date and priority topics for future research. The first part of this paper critically reflects on current approaches to conceptualizing and measuring engagement. Next, issues relevant to promoting effective engagement are discussed, including how best to tailor to individual needs and combine digital and human support. A key conclusion with regard to conceptualizing engagement is that it is important to understand the relationship between engagement with the digital intervention and the desired behavior change. This paper argues that it may be more valuable to establish and promote "effective engagement," rather than simply more engagement, with "effective engagement" defined empirically as sufficient engagement with the intervention to achieve intended outcomes. Appraisal of the value and limitations of methods of assessing different aspects of engagement highlights the need to identify valid and efficient combinations of measures to develop and test multidimensional models of engagement. The final section of the paper reflects on how interventions can be designed to fit the user and their specific needs and context. Despite many unresolved questions posed by novel and rapidly changing technologies, there is widespread consensus that successful intervention design demands a user-centered and iterative approach to development, using mixed methods and in-depth qualitative research to progressively refine the intervention to meet user requirements.This paper is one of the outputs of two workshops, one supported by the Medical Research Council (MRC)/National Institute for Health Research (NIHR) Methodology Research Programme (PI Susan Michie) and the Robert Wood Johnson Foundation (PI Kevin Patrick), and the other by the National Science Foundation (PI Donna Spruitj-Metz, proposal # 1539846)

High Effective Coverage of Vector Control Interventions in Children After Achieving Low Malaria Transmission in Zanzibar, Tanzania.

\ud \ud Formerly a high malaria transmission area, Zanzibar is now targeting malaria elimination. A major challenge is to avoid resurgence of malaria, the success of which includes maintaining high effective coverage of vector control interventions such as bed nets and indoor residual spraying (IRS). In this study, caretakers' continued use of preventive measures for their children is evaluated, following a sharp reduction in malaria transmission. A cross-sectional community-based survey was conducted in June 2009 in North A and Micheweni districts in Zanzibar. Households were randomly selected using two-stage cluster sampling. Interviews were conducted with 560 caretakers of under-five-year old children, who were asked about perceptions on the malaria situation, vector control, household assets, and intention for continued use of vector control as malaria burden further decreases. Effective coverage of vector control interventions for under-five children remains high, although most caretakers (65%; 363/560) did not perceive malaria as presently being a major health issue. Seventy percent (447/643) of the under-five children slept under a long-lasting insecticidal net (LLIN) and 94% (607/643) were living in houses targeted with IRS. In total, 98% (628/643) of the children were covered by at least one of the vector control interventions. Seasonal bed-net use for children was reported by 25% (125/508) of caretakers of children who used bed nets. A high proportion of caretakers (95%; 500/524) stated that they intended to continue using preventive measures for their under-five children as malaria burden further reduces. Malaria risk perceptions and different perceptions of vector control were not found to be significantly associated with LLIN effective coverage While the majority of caretakers felt that malaria had been reduced in Zanzibar, effective coverage of vector control interventions remained high. Caretakers appreciated the interventions and recognized the value of sustaining their use. Thus, sustaining high effective coverage of vector control interventions, which is crucial for reaching malaria elimination in Zanzibar, can be achieved by maintaining effective delivery of these interventions