Behaviour Change & Technology

In an age of behaviour change researchers in the field and experts in digital media and the entertainment industry have capitalised on the sophistication and innovation of today’s digital media technology to deliver interventions to improve the population’s health. Can more collaboration between these disciplines be a step forward in providing more effective digital interventions to change health behaviour?

Advances in digital and interactive technology has revolutionised and increased the impact of health promotion worldwide. Researchers in the field have taken advantage of this new technology which has led to a growing number of interventions promoting health behaviour change. However, until a recent systematic review, there was little known about which specific components of interventions have the most effect on behaviour. In a meta-analysis of various health internet interventions (85 studies, 43,236 participants), Webb, Joseph, Yardley & Michie (2010) used coding frames (taxonomy of behaviour change techniques) to assess the use of theory and behaviour change techniques to investigate which characteristics of the internet based interventions best promoted behaviour change. They also developed a new coding system to assess modes of delivery (such as video, sms, social networking) and linked this to how different modes produced different effects.

What were the main findings?
They reported that on average interventions had small yet statistically significantly positive effects on health related behaviour. In particular, studies using more extensive theory to underpin their intervention showed an increase in effect size compared to studies that did not. Also studies using more behaviour change techniques (BCTs) tended to have larger effects than studies using less. In regards to mode of delivery, supplementary modes (additional ways of interacting with people) tended to produce the largest effect on behaviour change, especially text messages. In regards to BCTs, the one’s that led to the greatest changes in behaviour were stress-management and communication skills training, however these techniques appeared in a small number of studies so it is difficult to generalize. Other BCTs such as modeling and providing normative information about other’s behaviour also had significant positive effects on behaviour.

Overall, Webb et al., (2010) found considerable variation in the effects of interventions with some having a large effect and others a small or negative effect. This highlights the importance of identifying which components of the intervention effect behaviour, and the size of this effect. However, another recent review that specifically looked at the area of adolescent obesity prevention and treatment showed that the majority of studies are failing to achieve this. Nguyen, Korman & Baur (2010) reviewed 24 studies and found that interventions involving parents led to positive outcomes as ‘parental variables relating to family and life satisfaction were the strongest mediators of adolescent weight loss’ (Nguyen et al., 2010:312). They suggest that further research is needed to see how different levels of parental involvement affects and sustains adolescent behaviour to prevent obesity. Unfortunately, the authors found it difficult to draw many other findings in light of the poor quality of the majority of studies. They recommend that future research should ensure high quality studies, especially relating to the prevention of obesity, studies delivered using innovative methods such as social networking platforms, studies involving parents, studies isolating intervention components, and studies assessing programme participation and ‘the relationship between intervention dose and outcomes’ (Nygen, 2010:312).

An earlier study also looking into online adolescent obesity prevention and treatment, gathered data and conducted a formative evaluation involving a systematic review of the literature, questionnaires and meetings with a panel of experts. The findings indicated some critical implications for future research in this area, including the importance of; I) integrating interventions into young people’s everyday lives; II) being culturally competent; III) collaboration with the entertainment industry, who are experts in developing fun and engaging ‘ehealth’ applications for young people (Ahern, Phalen, Le, Goldman, 2007). It seems a shame that few of these recommendations have been taken on board so far in recent interventions in this area and perhaps this is a reflection of the lack of collaboration between disciplines.

Why are digital media experts and the entertainment industry important?
Serious Games is now a fast growing area with virtual environments applied to preventive health in areas such as childhood obesity, sexual health, and helping parents to communicate better with their children (see the Serious Games Institute). In addition, existing social networking platforms may have a potential for effective and wide reaching health promotion. A recent study found that the advanced social networking site ‘Second Life’ may increase people’s confidence in their ability to exercise in the real world. Johnston (2011) allocated participants to either a virtual weight-loss programme where they could interact with one another in virtual training club or participants were allocated to group sessions in a traditional fitness club. While there were no differences in weight loss, the virtual group reported more healthy eating behaviour and confidence in their ability to carry out exercise even when barriers such as bad weather arose. However, until the final paper is published, it is not clear how participants were allocated to groups and how much the study was relying on self-reports compared to objective measures.

Nevertheless, this study demonstrates how researchers can start to test the ability of existing digital media platforms to provide innovative and effective interventions related to health behaviour change. Other products such as Nintendo Wii, Microsoft Kinect, Dance Dance Revolution further demonstrate the expertise of the entertainment industry in creating highly innovative and engaging virtual environments that are being used by both adults and young people worldwide. However, there is a lack of research evaluating the efficacy of such technology in the promotion of health. This may in part reflect the lifecycle of IT and the lifecycle of research. In addressing the challenge of adolescent obesity prevention, researchers may be able to harness the highly interactive, ubiquitous, state of the art technology that adolescents are engaging with today. However, sound psychological theory should not become secondary to the technology. It is important that interventions are underpinned by strong evidence to ensure their effectiveness and ability to produce long term behaviour change. Constant advances in digital media technology mean that the technology we are using today will not last forever but we hope that the theories (allowing for modifications) that underpin them will.

Conclusion
Webb et al., (2010) conducted their research under the premise that three factors of an intervention are associated with the effect on behaviour: theoretical basis; behaviour change techniques employed; and mode of delivery. Thus, if we agree with the authors then it seems logical that digital health behaviour change interventions utilise the expertise of health psychologists, public health researchers, and other health professionals who specialise in behaviour change to inform the first two characteristics of the intervention while experts in digital media and the entertainment industry should be used to deliver them in a highly engaging and innovative way.

Key reading(s):
Webb, T. L., Joseph, J., Yardley, L., & Michie, S. (2010). Using the internet to promote health behaviour change: A systematic review and meta-analysis of the impact of theoretical basis, use of behaviour change techniques, and mode of delivery on efficacy. Journal of Medical Internet Research, 12

References:
Ahern, D.K.; Phalen, J.M.; Le, L.X.; Goldman, R. (2007) Childhood Obesity Prevention and Reduction: Role of eHealth, Exploring the role that technology can play in reducing the incidence and prevalence of childhood obesity, Health e-Technologies Initiative.

Nguyen, B., Kornman.K.P., Baur. L.A., (2010) A Review of electronic interventions for preventions and treatment of overweight and obesity in young people, Obesity reviews, 12, 298-314

Johnston (2011) cited in Pappas, S., (2011) Health App Downloads Soar, But Do They Work? http://www.livescience.com/13328-health-smartphone-apps-weight-loss-quit-smoking.html

Webb, T. L., Joseph, J., Yardley, L., & Michie, S. (2010). Using the internet to promote health behaviour change: A systematic review and meta-analysis of the impact of theoretical basis, use of behaviour change techniques, and mode of delivery on efficacy. Journal of Medical Internet Research, 12

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