The Impact of Two Social Cognitive Smartphone Modules

Transcription

1 The Impact of Two Social Cognitive Smartphone Modules on App Usage JA S ON FA N N ING, PHD, SARAH ROBERTS, M S, CHARLES HILLMAN, PHD, SEA N M ULLEN, PHD, LEE RIT T ERBAND, PHD, EDWA R D MCAULEY, PHD

2 Background PHYSICAL ACTIVITY A complex, dynamic behavior Subject to many barriers and changing motivators Healthy behavior theories are helpful EHEALTH & MHEALTH Web and mobile technologies are attractive vehicles for intervention delivery Many Challenges

3 Background FACTORIAL TRIALS COLLINS ET AL 2014 Two key advantages in the context of this study 1. Test the individual and combined impact of individual ingredients 2. Reduce the sample size needed for these comparisons Group A Group B Group C Group D Goals Points

4 MAPS: Experimental Design Four-arm, 12 week randomized factorial trial Evidence-based mhealth components Schoeppe 2016 Social Cognitive Theory Ritterband s Model for Internet Interventions Objective Examine effectiveness of two theory-based tools Guided Goal-Setting Points-Based Feedback Self-Efficacy Outcome Expectations Sociostructural Factors Goals Behavior

5 MAPS: Base App

6 MAPS: Goals

7 MAPS: Points-Based Feedback Incremental, instantaneous feedback Points are weighted by difficulty or importance of activity Points earn levels Levels earn badges Badges earn titles

8 MAPS: Allocation A (Goals + Points + Basic App) B (Goals + Basic App) C (Points + Basic App) D (Basic App)

9 Participants Low active adults N = 116 Aged Own an iphone or Android smartphone Access to mobile web Access to text messaging English speaking Free from cognitive impairment Physically able to engage in ambulatory exercise Willing to be randomized into any intervention condition Variable Mean (SD)/Frequency (%) Age (7.57) Gender Female 93 (80) Male 23 (20) Married 89 (77) White 101 (87) College Graduate 98 (84) Earning $75,000/year 60 (52)

10 Measures Physical Activity Actigraph Time (p <.01) Points (p =.04) Efficacy Exercise Self-Efficacy McAuley, 1993 Time x Points (p =.01) Lifestyle Self-Efficacy McAuley, 2009 Time x Goals x Points (p =.01) Barriers Self-Efficacy McAuley, 1992 Time x Points (p =.03) Barriers Perceived Barriers Scale Rogers, 2005 Time (p =.01) Goal Setting Exercise Goal Setting Questionnaire Rovniak, 2002 Time (p <.01) Points (p =.01) Outcome Expectations Multidimensional Outcome Expectations for Exercise Scale Wojcicki, 2009 Physical outcome expectations: Time x Points (p =.04) Mean Weekly App Usage Usage Post-Program Feedback

11 Results: App Usage Points Goals Raw Present Not Present Transformed Effect B P Intercept 2.72 <.01 Time -.04 <.01 Points Goals.36.02

12 Results: Key Feedback WITH GOAL SETTING 77% found goal setting fairly to very easy +Progressive structure +Easy of entry/editing +General motivation WITHOUT GOAL SETTING 47% found goal setting fairly to very easy Handbook was practical Most did not use Found it easy to misplace

13 Results: Feedback POINTS +Motivation for increased activity +Feeling of progress related to badges/levels +Informative feedback on progress FAVORITE FEATURE Tailored Bi-Weekly Feedback Sense of accountability Desired more frequent contacts -Desire specific information on point values -More frequent badge and level delivery

14 Discussion Points-based systems can be effective for promoting engagement and highlighting mastery experiences In-app goal setting fosters structured goal-setting practice Additional research implementing a more conservative base app over a longer follow-up period is needed

15 Thank You Jason Fanning, PhD

16 Supplement

17 Social Cognitive Theory Used to study and influence a wide number of health behaviors Sexual health Bandura, 1994 Nutrition Hebert et al., 2001 Physical activity White, Wojcicki, McAuley, 2012; Gothe et al., 2015; Fanning, 2016 Mastery Experiences Vicarious Experiences Social/Verbal Persuasion Perceptions of Physical and Psychological Responses Self-Efficacy Outcome Expectations Sociostructural Factors Goals Behavior Bandura, 1986, 2007, 2004

18 Full Model

19 Design Web app Built using Perl, PHP, HTML, CSS, and JavaScript Housed on a commercial server Text-messages delivered via Twilio SMS Server Web Server Participant Device

20 Results: Physical Activity Points Goals

21 Results: Barriers Self-Efficacy Points Goals

22 Results: Exercise Self-Efficacy Baseline Follow-Up Points (+) Points (-) Points Goals Goals*Points Effect F η 2 P Time Points Goals Time*Points Time*Goals Points*Goals Time*Points*Goals *adjusted for gender

23 Results: Lifestyle Self-Efficacy Points Goals Effect F η 2 P Time <.01 Points Goals Time*Points Time*Goals Points*Goals Time*Points*Goals

24 Results: Barriers Points Goals Effect F η 2 P Time <.01 Points Goals Time*Points Time*Goals Points*Goals Time*Points*Goals *adjusted for gender

25 Results: Exercise Goal Setting Points Goals Effect F η 2 P Time <.01 Points Goals Time*Points Time*Goals Points*Goals Time*Points*Goals *adjusted for race

26 Results: Physical Outcome Expectations Points Goals Effect F η 2 P Time Points Goals Time*Points Time*Goals Points*Goals Time*Points*Goals

27 Results: Self-Evaluative Outcome Expectations Points Goals Effect F η 2 P Time Points Goals Time*Points Time*Goals Points*Goals Time*Points*Goals

28 Results: Social Outcome Expectations Points Goals Effect F η 2 P Time Points Goals Time*Points Time*Goals Points*Goals Time*Points*Goals *adjusted for gender and income

29 Analyses Multiple imputation used for missing values Windsorized when necessary Aim 1 and Aim 2: Repeated-measures factorial ANOVA Linear regression to identify covariates Points & goals entered as fixed factors Bonferroni-corrected posthoc analyses Aim 3: Hierarchical linear modeling Forward stepping Model fit assessed via -2LL, AIC, BIC Predictors retained at p.10 Significance at p.05 Aim 3: Feedback coded by theme Descriptive statistics

30 Results: App Usage Un-transformed Points Goals Effect B SE t P Intercept <.01 Time Points Goals

31 Results: App Usage Transformed Points Goals Effect B SE t P Intercept <.01 Time <.01 Points Goals