Kristell M. Penfornis
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11 records found
1
Background: Mobile health (mHealth) interventions with virtual coaches offer scalable and potentially cost-effective solutions for health behavior change. However, these interventions commonly present challenges, such as limited personalization and insufficient grounding in evidence-based strategies. Perfect Fit (PF; Perfect Fit consortium), a personalized mHealth intervention with a text-based virtual coach, supports adults in quitting smoking and becoming more physically active. By combining innovative techniques, including sensor technology, end user involvement, and evidence-based strategies, PF aims to address common challenges faced by mHealth interventions, including those with virtual coaches. Objective: The study primarily investigated the feasibility and acceptability of PF. The secondary aim was to explore associations between sociodemographic, smoking-, and physical activity–related characteristics and the feasibility and acceptability outcomes. The third aim was to evaluate the feasibility of conducting the research study. Methods: A single-arm, pre-post, mixed methods study was conducted in the Netherlands with 100 adults who smoked. The intervention lasted approximately 16 weeks. Data were collected at baseline, during the intervention, and postintervention (4 months). Quantitative data included usage data and self-report questionnaires on feasibility, acceptability, and baseline characteristics. Qualitative data were gathered through postintervention semistructured interviews. Analyses included descriptive and inferential analyses, as well as the framework approach for the qualitative data. Results: PF usage varied considerably across participants (n=87). The mean satisfaction rating was 2.79 (SD 0.73; scale range 1‐4), and perceived usability had a median score of 67.50 (range 12.50‐87.50; scoring range 0‐100), indicating OK-to-good usability. The mean virtual coach acceptance rating was –0.27 (SD 1.30; scale range −3 to 3; n=77). Higher PF usage was associated with greater satisfaction, usability, and coach acceptance (all P≤.004). Frequent connection issues with the smartwatch were a disruptive factor. Qualitative findings (n=12) provided in-depth insights into PF’s feasibility and acceptability, encompassing both positive and negative experiences. For instance, some participants valued the virtual coach for its anonymity, low-threshold access, and the sense of control it offered, while others preferred a human coach for greater accountability. Suggested improvements included more varied content and enhanced adaptability of the coach to users’ input and personal situations. Exploratory analyses suggested that high PF users were older than moderate (P=.01) and low PF users (P=.05). Importantly, PF was perceived as similarly feasible and acceptable across socioeconomic groups (P>.05), aligning with one of the project’s goals. Finally, research procedures and recruitment strategies proved feasible. Conclusions: PF shows potential as an accessible and inclusive strategy for multiple health behavior changes, contributing to public health. Findings highlight areas for improvement and can guide the future development of virtual coach interventions.
Background: Smoking and physical inactivity compromise health, especially in combination. Interventions to promote smoking cessation and increased physical activity (PA) often lack impact, especially in the long term. Digital future-self interventions (FSIs), which prompt individuals to imagine who they do and do not want to become (ie, their desired and undesired future selves), show promise in encouraging sustainable changes in both behaviors. However, knowledge of user experiences with digital FSIs is limited. A deeper understanding of these experiences could help optimize FSIs, enhancing their efficacy in supporting smoking cessation and increased PA sustainably. Objective: This study examined behavioral, cognitive, and affective experiences with digital FSIs focused on smoking, PA, or both. Potential differences in user experiences based on behavior (smoking vs PA), polarity (desired vs undesired future self), and modality (verbal vs visual description of future selves) were explored. Methods: Secondary analyses of quantitative and qualitative survey data from 3 studies using digital FSIs as a means to encourage smoking cessation or increase PA were conducted. In study 1, participants (N=144) thought about how it would be to complete the FSI. In studies 2 (N=447) and 3 (N=87), they completed an FSI. Each study highlighted different aspects of user experiences with FSIs, namely, behavioral (eg, time spent), cognitive (eg, mental effort exerted), or affective (eg, emotions) experiences. Quantitative and qualitative findings were integrated for a comprehensive interpretation. Results: Regarding behavioral experiences, participants completed future-self tasks promptly (mean 6.64, SD 8.30 minutes), spent less time completing the desired- versus undesired-future-self (P<.001; η p 2=0.227) and verbal versus visual (P=.03; η p 2=0.060; quantitative) tasks, and integrated the tasks into their lives (qualitative). Despite tasks being preparatory and not actively encouraging behavior change, multiple participants reported implementing changes in their smoking or PA (qualitative). Regarding cognitive experiences, moderate effort (mean 5.85/10, SD 2.56) was exerted on the tasks regardless of behavior (P=.69; η p 2=0.002), modality (P=.45; η p 2=0.004), or polarity (P=.69; η p 2=0.002; quantitative). Experiences of task difficulty were inconsistent across studies, individuals, and tasks, although mental visualization and describing one’s future self using images were consistently reported as challenging (quantitative and qualitative). Future-self tasks were reported to prompt cognitive processes such as contemplating consequences of smoking and PA behavior (qualitative). Regarding affective experiences, desired- and undesired-future-self tasks elicited different emotions (P<.001; η p 2=0.630; quantitative). Desired-future-self tasks were perceived as enjoyable and happiness inducing, whereas undesired-future-self tasks were perceived as confronting and unpleasant, evoking feelings of sadness, fear, and anger (quantitative and qualitative). Conclusions: Digital FSIs appeared to be a time-efficient, feasible, and acceptable way of strengthening identities as a means to encourage smoking cessation and PA. Findings support continued implementation of digital FSIs, although further research is required to optimize their operationalization. Avenues in that regard are proposed and discussed.
Adopting healthy behavior is vital for preventing chronic diseases. Mobile health (mHealth) interventions utilizing virtual coaches (i.e., artificial intelligence conversational agents) can offer scalable and cost-effective solutions. Additionally, targeting multiple unhealthy behaviors, like low physical activity and smoking, simultaneously seems beneficial. We developed Perfect Fit, an mHealth intervention with a virtual coach providing personalized feedback to simultaneously promote smoking cessation and physical activity. Through innovative methods (e.g., sensor technology) and iterative development involving end-users, we strive to overcome challenges encountered by mHealth interventions, such as shortage of evidence-based interventions and insufficient personalization. This paper outlines the content of Perfect Fit and the protocol for evaluating its feasibility, acceptability, and preliminary effectiveness, the role of participant characteristics, and the study's feasibility.
Methods
A single-arm, mixed-method, real-world evaluation study will be conducted in the Netherlands. We aim to recruit 100 adult daily smokers intending to quit within 6 weeks. The personalized intervention will last approximately 16 weeks. Primary outcomes include Perfect Fit's feasibility and acceptability. Secondary outcomes are preliminary effectiveness and study feasibility, and we will measure participant characteristics. Quantitative data will be collected through questionnaires administered at baseline, post-intervention and 2, 6, and 12 months post-intervention. Qualitative data will be gathered via semi-structured interviews post-intervention. Data analysis will involve descriptive analyses, generalized linear mixed models (quantitative) and the Framework Approach (qualitative), integrating quantitative and qualitative data during interpretation.
Conclusions
This study will provide novel insight into the potential of interventions like Perfect Fit, as a multiple health behavior change strategy. Findings will inform further intervention development and help identify methods to foster feasibility and acceptability. Successful mHealth interventions with virtual coaches will prevent chronic diseases and promote public health. ...
Adopting healthy behavior is vital for preventing chronic diseases. Mobile health (mHealth) interventions utilizing virtual coaches (i.e., artificial intelligence conversational agents) can offer scalable and cost-effective solutions. Additionally, targeting multiple unhealthy behaviors, like low physical activity and smoking, simultaneously seems beneficial. We developed Perfect Fit, an mHealth intervention with a virtual coach providing personalized feedback to simultaneously promote smoking cessation and physical activity. Through innovative methods (e.g., sensor technology) and iterative development involving end-users, we strive to overcome challenges encountered by mHealth interventions, such as shortage of evidence-based interventions and insufficient personalization. This paper outlines the content of Perfect Fit and the protocol for evaluating its feasibility, acceptability, and preliminary effectiveness, the role of participant characteristics, and the study's feasibility.
Methods
A single-arm, mixed-method, real-world evaluation study will be conducted in the Netherlands. We aim to recruit 100 adult daily smokers intending to quit within 6 weeks. The personalized intervention will last approximately 16 weeks. Primary outcomes include Perfect Fit's feasibility and acceptability. Secondary outcomes are preliminary effectiveness and study feasibility, and we will measure participant characteristics. Quantitative data will be collected through questionnaires administered at baseline, post-intervention and 2, 6, and 12 months post-intervention. Qualitative data will be gathered via semi-structured interviews post-intervention. Data analysis will involve descriptive analyses, generalized linear mixed models (quantitative) and the Framework Approach (qualitative), integrating quantitative and qualitative data during interpretation.
Conclusions
This study will provide novel insight into the potential of interventions like Perfect Fit, as a multiple health behavior change strategy. Findings will inform further intervention development and help identify methods to foster feasibility and acceptability. Successful mHealth interventions with virtual coaches will prevent chronic diseases and promote public health.
Users’ needs for a digital smoking cessation application and how to address them
A mixed-methods study
Despite their increasing prevalence and potential, eHealth applications for behavior change suffer from a lack of adherence and from dropout. Advances in virtual coach technology provide new opportunities to improve this. However, these applications still do not always offer what people need. We, therefore, need a better understanding of people’s needs and how to address these, based on both actual experiences of users and their reflections on envisioned scenarios.
Methods
We conducted a longitudinal study in which 671 smokers interacted with a virtual coach in five sessions. The virtual coach assigned them a new preparatory activity for quitting smoking or increasing physical activity in each session. Participants provided feedback on the activity in the next session. After the five sessions, participants were asked to describe barriers and motivators for doing their activities. In addition, they provided their views on videos of scenarios such as receiving motivational messages. To understand users’ needs, we took a mixed-methods approach. This approach triangulated findings from qualitative data, quantitative data, and the literature.
Results
We identified 14 main themes that describe people’s views of their current and future behaviors concerning an eHealth application. These themes relate to the behaviors themselves, the users, other parties involved in a behavior, and the environment. The most prevalent theme was the perceived usefulness of behaviors, especially whether they were informative, helpful, motivating, or encouraging. The timing and intensity of behaviors also mattered. With regards to the users, their perceived importance of and motivation to change, autonomy, and personal characteristics were major themes. Another important role was played by other parties that may be involved in a behavior, such as general practitioners or virtual coaches. Here, the themes of companionableness, accountability, and nature of the other party (i.e., human vs AI) were relevant. The last set of main themes was related to the environment in which a behavior is performed. Prevalent themes were the availability of sufficient time, the presence of prompts and triggers, support from one’s social environment, and the diversity of other environmental factors. We provide recommendations for addressing each theme.
Conclusions
The integrated method of experience-based and envisioning-based needs acquisition with a triangulate analysis provided a comprehensive needs classification (empirically and theoretically grounded). We expect that our themes and recommendations for addressing them will be helpful for designing applications for health behavior change that meet people’s needs. Designers should especially focus on the perceived usefulness of application components. To aid future work, we publish our dataset with user characteristics and 5,074 free-text responses from 671 people. ...
Despite their increasing prevalence and potential, eHealth applications for behavior change suffer from a lack of adherence and from dropout. Advances in virtual coach technology provide new opportunities to improve this. However, these applications still do not always offer what people need. We, therefore, need a better understanding of people’s needs and how to address these, based on both actual experiences of users and their reflections on envisioned scenarios.
Methods
We conducted a longitudinal study in which 671 smokers interacted with a virtual coach in five sessions. The virtual coach assigned them a new preparatory activity for quitting smoking or increasing physical activity in each session. Participants provided feedback on the activity in the next session. After the five sessions, participants were asked to describe barriers and motivators for doing their activities. In addition, they provided their views on videos of scenarios such as receiving motivational messages. To understand users’ needs, we took a mixed-methods approach. This approach triangulated findings from qualitative data, quantitative data, and the literature.
Results
We identified 14 main themes that describe people’s views of their current and future behaviors concerning an eHealth application. These themes relate to the behaviors themselves, the users, other parties involved in a behavior, and the environment. The most prevalent theme was the perceived usefulness of behaviors, especially whether they were informative, helpful, motivating, or encouraging. The timing and intensity of behaviors also mattered. With regards to the users, their perceived importance of and motivation to change, autonomy, and personal characteristics were major themes. Another important role was played by other parties that may be involved in a behavior, such as general practitioners or virtual coaches. Here, the themes of companionableness, accountability, and nature of the other party (i.e., human vs AI) were relevant. The last set of main themes was related to the environment in which a behavior is performed. Prevalent themes were the availability of sufficient time, the presence of prompts and triggers, support from one’s social environment, and the diversity of other environmental factors. We provide recommendations for addressing each theme.
Conclusions
The integrated method of experience-based and envisioning-based needs acquisition with a triangulate analysis provided a comprehensive needs classification (empirically and theoretically grounded). We expect that our themes and recommendations for addressing them will be helpful for designing applications for health behavior change that meet people’s needs. Designers should especially focus on the perceived usefulness of application components. To aid future work, we publish our dataset with user characteristics and 5,074 free-text responses from 671 people.