persuasive technology and adherence in a web-based ...impressie interventie link naar voluit leven...
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Persuasive technology and adherence in a
web-based (mindfulness) intervention for the
prevention of depression
Saskia Kelders, Wendy Pots, Martine Fledderus, Lisette van
Gemert-Pijnen, Ernst Bohlmeijer.
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1.
Context
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Persuasive technology and adherence in a web-based
intervention for the prevention of depression
Prevention and early intervention
Living to the full (Voluit Leven)
ACT & Mindfulness
Ernst Bohlmeijer & Monique Hulsbergen
Effective as group-course and as self-help with
e-mail support (Bohlmeijer 2011, Fledderus
2010, Fledderus 2011)
Transformed into a web-based intervention
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Mindfulness
Waarden
Toegewijde actie
Zelf als context
Aanvaarding
Cognitieve
defusie
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Mindfulness meditation exercises
Body-scan (18 m)
Observing breath
Making room and allowing what is
Observing thinking
3-minute meditation for in daily life
Routine-activity with attention
All in one exercise
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Results Depression (CES-D: 0-60)
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Voor 3 weken 6 weken Na (9 weken)
Follow-up (3 mnd)
De
pre
ssie
(C
ES
-D) Intensieve begeleiding
Proces begeleiding
Wachtlijst
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Person focused approach in care
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2.
Development of online interventions
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Development (van Gemert, 2011; JMIR)
HIER ROADMAP
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Design VL online (Kelders et al., under review)
Contextual inquiry – review of literature + discussion project team
Value specification – interviews target group + rapid prototyping
Design – users tests + expert inspection method
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Impressie interventie
Link naar Voluit Leven online
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3.
Adherence and the role of persuasive technology
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Persuasive technology and adherence in a web-based
intervention for the prevention of depression
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Meyer et al, 2009 (JMIR, 11(2); 15)
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Motivation through
technology?
Christensen et al, 2009 (JMIR 11(2):13)
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Persuasive technology and adherence in a web-based
intervention for the prevention of depression
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BJ Fogg: Persuasive Technology
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Persuasive technology and adherence in a web-based
intervention for the prevention of depression
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Primary task
support
Dialogue
support
System credibility
support
Social support
Reduction Praise Trustworthiness Social learning
Tunneling Rewards Expertise Social comparison
Tailoring Reminders Surface credibility Normative influence
Personalisation Suggestion Real-world feel Social facilitation
Self-monitoring Similarity Authority Cooperation
Simulation Liking Third-party Competition
Rehearsal Social role Verifiability Recognition
Oinas-Kukkonen 2008 (Persuasive 2008)
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Does persuasive technology influence adherence of a web-based intervention?
Does persuasive technology influence the effect of a web-based intervention?
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Potential factors to influence adherence
Feedback
Cues
Experience through technology
Similarity
Personalisation
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Feedback
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Cues
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Experience through technology
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Similarity
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Personalisation
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Studying the effects of different factors on attrition and clinical outcomes of online intervention
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Methods
Goal: tot test whether these factors influence adherence (and effect)
MOST method (Collins 2005, Collins 2007, Norman 2008)
Experimental RCT
Insight in effect of elements of an intervention
‘Balanced Fractional Factorial Design’
One intervention
5 experimental factors with 2 levels each
8 combinations of factors (conditions)
Analyses compare between levels of experimental factors
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Methods
Condition Feedback Cues Experience Similarity Personalisation
1 Automated Yes Elaborate High High
2 Automated Yes Basic Low Low
3 Automated No Elaborate Low Low
4 Automated No Basic High High
5 Counselor Yes Elaborate Low High
6 Counselor Yes Basic High Low
7 Counselor No Elaborate High Low
8 Counselor No Basic Low High
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Methods
Condition Feedback Cues Experience Similarity Personalisation
1 Automated Yes Elaborate High High
2 Automated Yes Basic Low Low
3 Automated No Elaborate Low Low
4 Automated No Basic High High
5 Counselor Yes Elaborate Low High
6 Counselor Yes Basic High Low
7 Counselor No Elaborate High Low
8 Counselor No Basic Low High
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Methods
Baseline measures (demographics, CES-D)
Inclusion: light to moderate depressive symptoms (CES-D: 10 – 38)
Respondents randomized into conditions
12 weeks access to ‘Living to the full’-online
Log-file data of usage
After 12 weeks: T1 (CES-D)
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Results
239 respondents
71% female
Mean age: 45 (range 19-78)
66% higher educated
Mean CES-D 25,0 (range 10-38)
54% response T1 (after 12 weeks)
Randomization not completely successful:
Cues: more women received cues
Experience: more women received elaborate experience
Similarity: less women received high similarity
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Effects feedback (human - automated) on depressive
symptoms
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Baseline Post intervention
Follow-up
CE
S-D
sco
re
Human
Automated
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Effects feedback (human – automated) on anxiety
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6,5
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7,5
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8,5
9
9,5
10
10,5
Baseline Post intervention
Follow-up
HA
DS
-A s
co
re
Human
Automated
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Conclusions
Online self-help intervention based on ACT and mindfulness is effective
(but specific groups make use of it)
There substantial attrition (50%); (= not completing 9 sessions)
Attrition is not larger for automated support group
Automated support intervention is not significant less effective as guided
support intervention
None of the five persuasive technology factors had a significant effect on
adherence or effectiveness
It is seemingly worthwhile to use/explore all ICT-possibilities and use a
holistic framework such as the Roadmap
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Health-e-lab als partner?
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Thank you Questions?
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www.health-e-lab.nl
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