Innovation in Technology to Improve Adherence Promoting Activity - - PDF document

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Innovation in Technology to Improve Adherence Promoting Activity - - PDF document

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Innovation in Technology to Improve Adherence Promoting Activity and Participation Among Persons with Arthritis Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Kristin Baker, PhD Boston University Promoting

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Promoting Activity and Participation Among Persons with Arthritis

Innovation in Technology to Improve Adherence

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Promoting Activity and Participation Among Persons with Arthritis

Kristin Baker, PhD Boston University

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Outline

  • Potential of technology to change/sustain behavior
  • Capabilities of technology
  • Access to technology
  • Behavioral insights
  • Studies utilizing technology to improve adherence
  • Summary and future directions
  • Key references

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Goals

  • Why Technology?
  • Capabilities of technology
  • Access to technology
  • Behavioral insights
  • What Technology?
  • Overview of technologies
  • Specific examples
  • How Technology?
  • Studies and data
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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Why Technology – Why Not?

  • History of human race can be mapped using its

technological innovations

  • Extend our capabilities further into the world
  • Address limitations of the human condition—both physically,

cognitively and emotionally

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Access to Technology

  • Access to, and utilization of technology creates
  • pportunities to Encourage, Enable and Empower

more sustainable behaviors

  • Internet within easy reach
  • Quantified self walking around
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Global Explosion of Technology Across all Populations

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

The Quantified Self

  • The Monitored Man

The New York Times 3/10/2014

  • Wearable Devices: Selfies

For Health Nuts?

Forbes 3/18/2014

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Can Technology Change Behavior?

  • Behavior change through a technological lens - YES

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

However

  • The potential of technology to change behavior does

not lie in simply digitizing current strategies or creating another communication channel

  • Technology must look through a behavior lens
  • Technology - Insight led and Human centered
  • Behavior Change - Sustainable and empowering
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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Adherence of Wearable Trackers

Data via Endeavor Partners, LLC, September 2013. Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Sustaining behavior is hard

  • Aerobic physical activity through leisure- time activity
  • 45-64 - <50%
  • 65-74 - 37%
  • 75+ - 24%
  • American adults >50 more functional disability than any
  • ther developed country

CDC/NCHS, National Health Interview Survey, 2008–2010 Crimmins, EM et al., The National Academic Press;2011

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Behavioral Insights to Adherence

  • Overcoming human limitations
  • Maintaining momentum
  • Intention/action gap
  • Inaccurate recall (lying to our selves)

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Information Technology

1st Generation 1st Generation

2nd Generation pre-programed reasoning 2nd Generation pre-programed reasoning 3rd Generation recognition and inference 3rd Generation recognition and inference

Quantified Self or Ecological Momentary Assessment SenseCam Trackers (Fit Bit, Jawbone Up, Nike Fuelband) Smart Phone Apps (MapMyFitness)

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Promoting Activity and Participation Among Persons with Arthritis

Research

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Telephone-Linked Communication (TLC)

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Data on TLC

  • Participants receiving TLC intervention > 6

months

  • 50% have connected all possible TLC calls
  • 50% range 31-85% of possible TLC calls
  • Majority of calls are complete
  • Average time on call 6:43
  • Incomplete calls average 3:25
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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Exercise advice by humans versus computers: Maintenance effects at 18 months

King AC, et al., Health Psychol. 2014 Feb;33(2):192-6

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Exercise advice by humans versus computers: Maintenance effects at 18 months

King AC, et al., Health Psychol. 2014 Feb;33(2):192-6

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Mobile Phones to Promote Daily Physical Activity

King et al., PLoS One. 2013 Apr 25;8(4)

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Join2Move – Web-Based Physical Activity for Knee and Hip Osteoarthritis

Bossen, D. et al., J Med Internet Res. 2013 Nov 22;15(11):e257.

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Relational Agent http://www.relationalagents.com/demos/ind ex.html - RAISE PROJECT VIDEO 1

Bickmore, T. et al., Journal of the American Geriatrics Society, 2013; 61:1676–1683 Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Parkinson’s Disease Virtual Exercise Coach

Ellis, et al., Am J PhysMed Rehabil. 2013 Jun;92(6):472-81

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Primary Aim: to develop a community-based Virtual Exercise Coach for people with

Parkinson’s Disease to support long-term self-management of their exercise training to optimize quality of life and participation.

Further Development of the Virtual PD Exercise COACH

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Mobile Health Technology

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Research Conclusions

  • Interventions are largely 2nd generation moving

towards 3rd generation

  • Platforms are phone and computer, increasingly into tablets

and mobile phones

  • The “Quantified self” increases the objective data utilized by

the platforms

  • Becoming more tailored and individual
  • Evidence emerging for varied approaches for varied

populations

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014 Promoting Activity and Participation Among Persons with Arthritis

Last Thoughts

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Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Conclusions and Moving Forward

  • Potential
  • Global explosion of technology across all population sectors

provides huge potential for infusing behavioral medicine into interventions and research

  • Applying evidence based behavior science to technology can

address the “whiches conundrum” which programs for which people under which circumstances (King, AC et al., Ann Behav Med.

2008;35:251)

  • However
  • Technology must look through a behavior lens
  • Problem driven not solution driven
  • Interdisciplinary

Arthritis State of the Science Meeting Pentagon City, Virginia | April 7, 2014

Acknowledgements:

NIDRR PR/Award #H133B100003

Julie Keysor, PhD, PT David Felson, MD, MPH Robert Friedman, MD Faye Cochrane, BS Aileen Ledingham, MS PT InbarHanouna, MS Michael LaValley, PhD John Dibello, RA

Arthritis Foundation, Arthritis Investigator Award