What is the future of digital interventions for health behaviour change?
The digital environment (e.g. Internet, mobile phones, smart phones) that is now an integral part of our daily lives is becoming an increasingly important means of sustaining the health of people worldwide, whether by providing access to a wealth of information, by linking geographically dispersed communities of peers and professionals, or by supporting self-management of health and illness. The Internet is therefore rapidly becoming both a medium and a focus for health psychology research.
The Internet can be used as a source of naturally occurring observations and data, as in the qualitative study by Rodham, McCabe, and Blake (2009) of Internet communication between people with Complex Regional Pain Syndrome. It can also be used to give people personalized feedback about their health risks, as in the study of predictors of online diabetes risk test taking by van Koningsbruggen and Das (2009). Perhaps most significantly, it provides a cost-effective means of making automated behavior change interventions widely available, such as the stress and alcohol reduction programmes deployed in two papers in a recent issue of Psychology & Health (Crutzen et al., 2009; Fridici, Lohaus, & Glaß, 2009).
A meta-analysis of 75 randomized controlled trials has provided support for the effectiveness of digital interventions (Internet, mobile phones, etc.) in the health promotion area (Portnoy, Scott-Sheldon, Johnson & Carey, 2008). But how and why can digital interventions be effective in promoting sustained behaviour change? And can different digital tools serve different purposes?
In Eysenbach’s (2001) definition of the ‘10 E’s’ integral to e-health, three of the key ingredients are encouragement of a new relationship with the patient which focuses on empowering and educating them. Digital interventions can provide new forms of access to self-care, video and audio delivery for those with reading difficulties and anonymous social support for those who are unable or unwilling to consult health professionals in person. While there is concern that the ‘digital divide’ could limit the extent to which those from more socioeconomically deprived backgrounds may benefit from digital interventions (Murray, Burns, See, Lai, & Nazareth, 2005), this problem may diminish as the Internet grows more ubiquitous; for example, young people already routinely use the Internet daily, with minimal differences in access due to socioeconomic background.
Another key problem is the finding that high attrition rates seem to pose a potential short-coming of digital health interventions (see for example Matano, Koopman, Wanat, Winzelberg, Whitsell, Westrup, Futa, Clayton, Mussman & Taylor, 2007). Clearly, we need research into how digital interventions can best be designed to hold the interest of the user. While the main motivation for initial use is the expected utility of use, continued use is probably heavily influenced by experienced utility (which in turn fuels expected future utility). This may be increased by offering the client relevant, individually tailored material and feedback, which has been shown to increase program use and engagement (see e.g. Strecher, McClure, Alexander, Chakraborty, Nair, Konkel, Greene, Couper, Carlier, Wiese, Little, Pomerleau & Pomerleau, 2008). Specifically, individuals must be able to gauge their progress against some frame of reference, which might include their own change plan (compared with their own prior history), the behavioral progress of others who are in a similar situation to themselves, or a regimen from a trustworthy source (for overview see Kraft, Drozd & Olsen, 2009). In other words, efforts to change are likely to be successful when individuals receive timely monitoring and feedback on their progress (see e.g. Brendryen, Drozd & Kraft, 2008). With such feedback, individuals can be motivated by their own achievements. They can modify their strategies and gauge the proximity of their goals. For example, Internet weight loss programs are likely to be most effective when they require participants to keep regular records of their food intake and physical activity, and the program provides feedback on their performance (Tate, Jackovny & Wing, 2003).
Additionally, more elaborate interventions can be more effective. For example, a review of 15 Internet-delivered interventions to promote increased physical activity (Vandelanotte, Spathoris, Eakin, & Owen, 2007) found that interventions were more successful if they required participants to engage more with the intervention (using techniques such as email, weekly modules, or online coaching or chat sessions). Generally, increased interactivity seems to improve the emotional quality of an intervention (i.e. how it makes you feel) (Norman, 2003). Hence, the extent that interactivity can increase user involvement must be considered a critical characteristic of a digital intervention.
It is pretty obvious that we are just at the start of the development of digital health care. Rapid technological change means that this field is already posing new questions and challenges for digital interventions and research. For example, many future interventions can be expected to be delivered through mobile phones, which will offer new opportunities for tracking people’s activities and health status and offering timely advice. At the same time, a more focused and tailored approach to intervention design may be needed that is compatible with the restrictions of interacting via a smaller interface. Given the exciting scope for innovation and the demand for technological solutions to health problems, it is certain that research into digital interventions is set to grow substantially in the foreseeable future.
References
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A full version of this article can be found here:
Kraft, P. & Yardley, L. (2009). Current issues and new directions in psychology and health: What is the future of digital interventions for health behaviour change? Psychology & Health, 24, 615–618.