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The Implications of Advances in Information Technology (IT)

The Implications of Advances in Information Technology (IT). The Happy Ending Experience. Fundamentals of Happy Ending. Fully automated smoking cessation intervention Internet & cell-phone Target group: smokers motivated to quit

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The Implications of Advances in Information Technology (IT)

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  1. The Implications of Advances in Information Technology (IT) The Happy Ending Experience

  2. Fundamentals of Happy Ending • Fully automated smoking cessation intervention • Internet & cell-phone • Target group: smokers motivated to quit • Core idea: The quitter needs different help at different times • tunnelling

  3. Three distinct phases • Three distinct phases 2 weeks + 4 weeks + 11 months

  4. The information architecture of HE • This figure shows a sample week from each phase, where each cell represents a unique contact point between client and program that particular day

  5. The information architecture of HE • A new unique web-page (□) • Each day, week 1 through week 6 • Todays assignment – interactive diary

  6. The information architecture of HE Legend: ─ one text-message (SMS) a day = two text-messages a day ≡ three text-messages a day

  7. “today, your blood pressure has been reduced to that of a non-smoker.” The information architecture of HE • Motivational conflict: • short-term positive consequences of starting to smoke again - inflated • value of the long term positive consequences of abstinence - deflated • Psycho-educative approach • Quitting-chronology requires tunnelling

  8. The information architecture of HE Choices: (1) reduce stress; (2) regulate negative affect; or (3) fuel motivation Available 24 hours a day for one year No human contact – pre-recorded messages only

  9. The information architecture of HE Relapse prevention system

  10. RCT design • Data collection: web based surveys • Initiating mail + 2 reminders • then telephone interview with non-responders

  11. Abstinence

  12. Abstinence

  13. Abstinence

  14. THE implication: AUTOMATIZATION of interventions THE implication of acvances in IT Σ technological development FLEXIBILITY fitting interventions to users Todays assignment: What are the implications of advances in information technology (IT) for the future of health psychology interventions?

  15. THE implication: AUTOMATIZATION of interventions THE implication of acvances in IT high reach low cost provided that high reach low cost if EFFICACY then SUCCESS Σ technological development FLEXIBILITY fitting the information to users when Sequencing (timing) e.g. tunneling, 24/7 availability what Selection e.g. tailoring how Signal mode web, email, SMS, IVR re-active & pro-active

  16. THE implication: AUTOMATIZATION of interventions THE implication of acvances in IT provided that high reach low cost if EFFICACY then SUCCESS Σ technological development FLEXIBILITY fitting the information to users when Sequencing (timing) e.g. tunneling, 24/7 availability what Selection e.g. tailoring how Signal mode web, email, SMS, IVR re-active & pro-active

  17. Flexibility – state of the artFitting interventions to users SEQUENCING SELECTION tunneling tailoring just-in-time therapy iterative tailoring DIALOG/ RELATION

  18. past ... ... future ONE SIZE FITS ALL Timeline SEQUENCING SELECTION Stop-Tabac (Etter et. al.) Proschasca’s Expert system Happy Ending mature digital therapy tunneling tailoring just-in-time therapy iterative tailoring DIALOG/ RELATION

  19. Therapy model Innsight Alliance Change

  20. Arguments for tunnelling • Required by the therapeutical model • tunnelling affords a relationship to the user • relationship is a possibility condition for dialog and therapy • Different help at different times • because the psychological processes are different • Keep up the interest

  21. Implication – summary • Automatization + flexibility = success • Automatization of interventions • stick to it! • to preserve the high-reach-low-cost feature of mass media • Exploit the flexibility! • flexibility is the key to efficacy • Learn from clinical psychology • take advantage of the therapeutical processes we know from clinical psychology • from sequencing and selection towards dialog and relation • do not forget sequencing strategies (like tunnelling) on the way

  22. Questions • Intervention / RCT-results / implications of advances in IT • Other dimensions of flexibility? • The role of chat rooms and discussion forums for e-health interventions? • some of you may be more optimistic than I am...

  23. Trial 1 Nicotine Replacement Therapy (NRT) • Proportion of NRT users: • 93% in treatment vs. 87% in control (N.S.) • Higher NRT-adherence in treatment: • Days/week of NRT use, mean: 4.5 vs. 3.6; SD = 2.9; t(382) = 3.11, p = .002 • Weeks of use, mean: 8.3 vs. 7.0; SD = 4.9; t(316) = 2.22, p = .03 • NRT-adherence did NOT mediate 1yr. sustained abstinence!

  24. Program adherence and abstinence • 65% ADHERENCE • Adherence to various components are highly correlated. Using a backward conditional procedure, answering the log-off call, came out as the only significant predictor – adding the other variables did not increase explained variance. • When tested alone, however, log-on and reading web-pages did also sig. predict abstinence (helpline-calls did not). Adherence – each component tested alone: • log-off: R² = 25% • log-on: R² = 16% • web-pages: R² = 8% • help-line: N.S.

  25. Baseline sample characteristics Trial 1 Trial 2 ———————— ———————— Treatment Control Treatment Control —————————————————————————N 197 199 144 146 Male 49.2 % 50.3 % 50.0 % 50.0 % College degree 42.1 % 39.7 % 48.6 % 52.1 % Age 35.9 (10.0) 36.4 (10.5) 39.5 (11.0) 39.7 (10.8) FTND 4.8 (2.2) 4.9 (2.2) 4.5 (2.3) 4.6 (2.2) self-efficacy 4.9 (1.3) 5.1 (1.3) 5.1 (1.4) 5.1 (1.3) ————————————————————————— Note. Numbers represent mean ± standard deviation for continuous variables and percentages of subjects for dichotomous variables.

  26. Response rates (%) Trial 1 Trial 2 ——————— ——————— Treatment Control Treatment Control —————————————————————— preparation N.A. N.A. 91.7 89.7 1 month 98.5 97.0 96.5 87.0 3 months 93.4 91.0 93.8 89.7 6 months 95.4 94.0 86.1 82.2 12 months 95.9 91.5 91.0 83.3 —————————————————————— Note. No significant differences in trial one. Response rates at 1 month in trial 2 was significantly lower in control condition (highlighted with red boldface).

  27. HE compared to other psycho-social interventions – Cohrane reviews

  28. HE compared to medicational treatments – Cohrane reviews

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