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Automated Smoking Cessation Intervention for Improved Health Psychology: Implications of IT Advances

Explore the innovative Happy Ending Experience's fully automated smoking cessation program leveraging IT advancements. Learn about the program's distinct phases and tailored interventions. Discover the significance of automatization and flexibility in successful interventions. Dive into the intersection of technology and health psychology for effective outcomes. Discuss the future implications and possibilities for health interventions in the digital age.

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Automated Smoking Cessation Intervention for Improved Health Psychology: Implications of IT Advances

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  1. The Implications of Advances in Information Technology (IT) The Happy Ending Experience

  2. Fundamentals of Happy Ending • Fully automated smoking cessation intervention • Internet & cell-phone • Target group: smokers motivated to quit • Core idea: The quitter needs different help at different times • tunnelling

  3. Three distinct phases • Three distinct phases 2 weeks + 4 weeks + 11 months

  4. The information architecture of HE • This figure shows a sample week from each phase, where each cell represents a unique contact point between client and program that particular day

  5. The information architecture of HE • A new unique web-page (□) • Each day, week 1 through week 6 • Todays assignment – interactive diary

  6. The information architecture of HE Legend: ─ one text-message (SMS) a day = two text-messages a day ≡ three text-messages a day

  7. “today, your blood pressure has been reduced to that of a non-smoker.” The information architecture of HE • Motivational conflict: • short-term positive consequences of starting to smoke again - inflated • value of the long term positive consequences of abstinence - deflated • Psycho-educative approach • Quitting-chronology requires tunnelling

  8. The information architecture of HE Choices: (1) reduce stress; (2) regulate negative affect; or (3) fuel motivation Available 24 hours a day for one year No human contact – pre-recorded messages only

  9. The information architecture of HE Relapse prevention system

  10. RCT design • Data collection: web based surveys • Initiating mail + 2 reminders • then telephone interview with non-responders

  11. Abstinence

  12. Abstinence

  13. Abstinence

  14. THE implication: AUTOMATIZATION of interventions THE implication of acvances in IT Σ technological development FLEXIBILITY fitting interventions to users Todays assignment: What are the implications of advances in information technology (IT) for the future of health psychology interventions?

  15. THE implication: AUTOMATIZATION of interventions THE implication of acvances in IT high reach low cost provided that high reach low cost if EFFICACY then SUCCESS Σ technological development FLEXIBILITY fitting the information to users when Sequencing (timing) e.g. tunneling, 24/7 availability what Selection e.g. tailoring how Signal mode web, email, SMS, IVR re-active & pro-active

  16. THE implication: AUTOMATIZATION of interventions THE implication of acvances in IT provided that high reach low cost if EFFICACY then SUCCESS Σ technological development FLEXIBILITY fitting the information to users when Sequencing (timing) e.g. tunneling, 24/7 availability what Selection e.g. tailoring how Signal mode web, email, SMS, IVR re-active & pro-active

  17. Flexibility – state of the artFitting interventions to users SEQUENCING SELECTION tunneling tailoring just-in-time therapy iterative tailoring DIALOG/ RELATION

  18. past ... ... future ONE SIZE FITS ALL Timeline SEQUENCING SELECTION Stop-Tabac (Etter et. al.) Proschasca’s Expert system Happy Ending mature digital therapy tunneling tailoring just-in-time therapy iterative tailoring DIALOG/ RELATION

  19. Therapy model Innsight Alliance Change

  20. Arguments for tunnelling • Required by the therapeutical model • tunnelling affords a relationship to the user • relationship is a possibility condition for dialog and therapy • Different help at different times • because the psychological processes are different • Keep up the interest

  21. Implication – summary • Automatization + flexibility = success • Automatization of interventions • stick to it! • to preserve the high-reach-low-cost feature of mass media • Exploit the flexibility! • flexibility is the key to efficacy • Learn from clinical psychology • take advantage of the therapeutical processes we know from clinical psychology • from sequencing and selection towards dialog and relation • do not forget sequencing strategies (like tunnelling) on the way

  22. Questions • Intervention / RCT-results / implications of advances in IT • Other dimensions of flexibility? • The role of chat rooms and discussion forums for e-health interventions? • some of you may be more optimistic than I am...

  23. Trial 1 Nicotine Replacement Therapy (NRT) • Proportion of NRT users: • 93% in treatment vs. 87% in control (N.S.) • Higher NRT-adherence in treatment: • Days/week of NRT use, mean: 4.5 vs. 3.6; SD = 2.9; t(382) = 3.11, p = .002 • Weeks of use, mean: 8.3 vs. 7.0; SD = 4.9; t(316) = 2.22, p = .03 • NRT-adherence did NOT mediate 1yr. sustained abstinence!

  24. Program adherence and abstinence • 65% ADHERENCE • Adherence to various components are highly correlated. Using a backward conditional procedure, answering the log-off call, came out as the only significant predictor – adding the other variables did not increase explained variance. • When tested alone, however, log-on and reading web-pages did also sig. predict abstinence (helpline-calls did not). Adherence – each component tested alone: • log-off: R² = 25% • log-on: R² = 16% • web-pages: R² = 8% • help-line: N.S.

  25. Baseline sample characteristics Trial 1 Trial 2 ———————— ———————— Treatment Control Treatment Control —————————————————————————N 197 199 144 146 Male 49.2 % 50.3 % 50.0 % 50.0 % College degree 42.1 % 39.7 % 48.6 % 52.1 % Age 35.9 (10.0) 36.4 (10.5) 39.5 (11.0) 39.7 (10.8) FTND 4.8 (2.2) 4.9 (2.2) 4.5 (2.3) 4.6 (2.2) self-efficacy 4.9 (1.3) 5.1 (1.3) 5.1 (1.4) 5.1 (1.3) ————————————————————————— Note. Numbers represent mean ± standard deviation for continuous variables and percentages of subjects for dichotomous variables.

  26. Response rates (%) Trial 1 Trial 2 ——————— ——————— Treatment Control Treatment Control —————————————————————— preparation N.A. N.A. 91.7 89.7 1 month 98.5 97.0 96.5 87.0 3 months 93.4 91.0 93.8 89.7 6 months 95.4 94.0 86.1 82.2 12 months 95.9 91.5 91.0 83.3 —————————————————————— Note. No significant differences in trial one. Response rates at 1 month in trial 2 was significantly lower in control condition (highlighted with red boldface).

  27. HE compared to other psycho-social interventions – Cohrane reviews

  28. HE compared to medicational treatments – Cohrane reviews

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