Home Engineering Behavioral Intervention Research: Designing, Evaluating, and Implementing
With the increased technical capabilities and adoption of mobile devices, mobile technologies, which typically refer to cell phones, smartphones, and tablet technologies, are increasingly being used as a format for intervention delivery. Mobile technologies can be used to send prompts and reminders to users via text, pop-up notifications, or audio/visual messages; to deliver educational programs and counseling; as a means for users to come in direct contact with medical personnel if needed; and as a way for interventionists/health care providers to provide suggestions for behavior modifications on the basis of real-time user-provided information.
In 2014, 64% of Americans owned a smartphone, 90% owned a cell phone, and 42% owned a tablet computer. Many people are dependent on smartphones for online access. This is especially true for those with lower education and ethnic minorities (Smith, 2015). Mobile phone penetration has also rapidly increased in less developed countries (Wilke & Oates, 2014) that often face considerable public health disparities and higher burdens of disease. Thus, mobile technologies present an opportunity for delivering health information and services to populations who frequently confront problems with access. Clearly, the use of “apps” as a means of delivering mobile health interventions is exciting as mobile technologies offer the potential for providing individualized support to large numbers of individuals.
Given the recent emphasis on health-related “apps” (applications), the term “mHealth” has emerged, which is an abbreviation for “mobile health,” that is, the practice of medicine and public health supported by mobile devices (Adibi, 2015). The field has grown so tremendously that there is now an interactional conference that focuses on mHealth (mHealth Summit). mHealth represents a subsegment of eHealth that refers to the use of information and communication technologies, such as Internet-connected computers, for the delivery of health services and information.
Tran, Tran, and White (2012) conducted a review of apps targeted for the management of diabetes and found that individuals can successfully use “apps” such as Diabetes Buddy, Diabetes Log, and Diabetes Pilot (among others) to self-monitor blood glucose levels. Use of these “apps” can also facilitate a provider’s access to a patient’s data and his or her ability to provide feedback with regards to selfmanagement practices. Mobile applications have also been shown to have a positive impact on individuals suffering from anxiety, bipolar disorders, and schizophrenia (Depp et al., 2010; Granholm, Ben-Zeev, Link, Bradshaw, & Holden, 2012; Heron & Smyth, 2010). With regards to diet and exercise, however (for which there are many applications currently on the market), the use of mobile apps has found mixed results. Studies have shown that, although individuals using mobile apps for weight loss can more successfully self-monitor and assess their diets and caloric intake, the weight-loss trajectories of app users tend not to be significantly different from those who do not use mobile technologies (e.g., Laing et al., 2014; Wharton, Johnston, Cunningham, & Sterner, 2014).
Social media-based interventions are also typically included in discussions of mobile technologies, as they are often accessed using mobile devices. Popular social media sites include Facebook and Twitter. Online support groups also represent a form of social media. Findings regarding the use of social media to deliver health interventions are mixed. For example, Bull and colleagues (Bull, Levine, Black, Schmiege, & Santelli, 2012) found that a social media-delivered sexual health intervention increased safe sex practices among young adults. In contrast, Cavallo and colleagues (2012) evaluated a social media-based physical activity intervention. They found that use of an online social networking group plus self-monitoring did not produce greater perceptions of social support or physical activity as compared to an education-only control intervention. Mohr et al. (2013) argue that many social media spaces remain unregulated by a moderator, such as a health care professional, and thus lack a driving force that is able to “steer” individuals in the right direction with regards to behavior change. Because social media has become pervasive and engrained in the fabric of popular culture, more research is needed to determine how to effectively use social media in behavioral intervention research.
In summary, mobile technologies are technologies that individuals can hypothetically have with them at all times (and always turned on), and these technologies have also become a primary means of communication in the United States and world population. Thus, mobile devices can provide access to therapies and interventions to a large number of people. However, behavioral intervention research in this area is still emerging. There is a need for more systematic evaluation of using mobile technologies to deliver interventions to establish stronger evidence of the efficacy and effectiveness of this approach and to establish guidelines for best practices with respect to implementation and evaluation.
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