Persuasive technology and adherence in a web-based (mindfulness) intervention for the prevention of depression

Transcription

1 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. 14/06/2012 Title: to modify choose 'View' then 'Heater and footer' 1 1

2 1. Context 2

3 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 support (Bohlmeijer 2011, Fledderus 2010, Fledderus 2011) Transformed into a web-based intervention 3

4 Mindfulness Aanvaarding Waarden Cognitieve defusie Toegewijde actie Zelf als context 4

5 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 5

6 Depressie (CES-D) Results Depression (CES-D: 0-60) Voor 3 weken 6 weken Na (9 weken) Follow-up (3 mnd) Intensieve begeleiding Proces begeleiding Wachtlijst 6

7 Person focused approach in care 7

8 2. Development of online interventions 8

9 Development (van Gemert, 2011; JMIR) HIER ROADMAP 9

10 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 10

11 Impressie interventie Link naar Voluit Leven online 11

12 3. Adherence and the role of persuasive technology 12

13 Persuasive technology and adherence in a web-based intervention for the prevention of depression Meyer et al, 2009 (JMIR, 11(2); 15) 13

14 Motivation through technology? Christensen et al, 2009 (JMIR 11(2):13) 14

15 Persuasive technology and adherence in a web-based intervention for the prevention of depression BJ Fogg: Persuasive Technology 15

16 Persuasive technology and adherence in a web-based intervention for the prevention of depression 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) 16

17 Does persuasive technology influence adherence of a web-based intervention? Does persuasive technology influence the effect of a web-based intervention? 17

18 Potential factors to influence adherence Feedback Cues Experience through technology Similarity Personalisation 18

19 Feedback 19

20 Cues 20

21 Experience through technology 21

22 Similarity 22

23 Personalisation 23

24 4. Studying the effects of different factors on attrition and clinical outcomes of online intervention 24

25 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 25

26 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 26

27 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 27

28 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) 28

29 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 29

30 CES-D score Effects feedback (human - automated) on depressive symptoms Human Automated Baseline Post intervention Follow-up 30

31 HADS-A score Effects feedback (human automated) on anxiety 10,5 10 9,5 9 8,5 8 7,5 Human Automated 7 6,5 6 Baseline Post intervention Follow-up 31

32 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 32

33 Health-e-lab als partner? 33

34 Thank you Questions?