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The role of mobile sensing in behaviour change – Q Sense; a context aware smoking
cessation app
Felix Naughton Behavioural Science Group
University of Cambridge
[email protected] @FelixNaughton
Collaborators Neal Lathia Sarah Hopewell Chloë Brown Jo Emery Rik Schalbroeck Cecilia Mascolo Andy McEwen Stephen Sutton
What is tailoring?
What is tailoring?
• Tailoring: support customised to individual using information about them
What is tailoring?
• Tailoring: support customised to individual using information about them
• Targeting: support customised to group based on shared characteristics
What is tailoring?
• Tailoring: support customised to individual using information about them
• Targeting: support customised to group based on shared characteristics
• Generic: one-size-fits-all
Generic leaflet (n=105)
Tailored leaflet (n=102)
Does tailoring increase effectiveness?
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Reported receiving leaflet Read at least once
Generic
Tailored
* p<0.05 ** p<0.01
*
**
Naughton et al, 2012 Nicotine & Tobacco Research
Does tailoring increase effectiveness?
0
1
2
3
4
Leaflet provided new info Written for me
Generic
Tailored
** **
* p<0.05 ** p<0.01
5-point rating scale
Naughton et al, 2012 Nicotine & Tobacco Research
Existing cessation apps
Existing cessation apps
97.3%
2.7%
No tailoring
Tailoring
Hoeppner et al, 2015 Nicotine & Tobacco Research
% of cessation apps (N=225) that 'remembers' user input to tailor interactions
Existing cessation apps
Hoeppner et al, 2015 Nicotine & Tobacco Research
Existing cessation apps
Hoeppner et al, 2015 Nicotine & Tobacco Research
Examples of tailoring variables
• Demographics/social characteristics
• Clinical characteristics/symptoms
• Past behaviour
• Beliefs
Examples of tailoring variables
• Demographics/social characteristics
• Clinical characteristics/symptoms
• Past behaviour
• Beliefs
Relatively stable over short periods
Examples of tailoring variables
• Demographics/social characteristics
• Clinical characteristics/symptoms
• Past behaviour
• Beliefs
• What they are currently doing
• What is in their current environment
• How they are currently feeling
Relatively stable over short periods
Examples of tailoring variables
• Demographics/social characteristics
• Clinical characteristics/symptoms
• Past behaviour
• Beliefs
• What they are currently doing
• What is in their current environment
• How they are currently feeling
Transitory and ever-changing
Relatively stable over short periods
Examples of tailoring variables
• Demographics/social characteristics
• Clinical characteristics/symptoms
• Past behaviour
• Beliefs
• What they are currently doing
• What is in their current environment
• How they are currently feeling
characteristic tailoring
context tailoring
Impact of early lapse on relapse
Lapse in first week of quit
attempt (FU 6 months)
Impact of early lapse on relapse
Lapse in first week of quit
attempt (FU 6 months)
x5
Ashare et al, 2013, Journal of Addiction Medicine
Impact of early lapse on relapse
Lapse in first week of quit
attempt (FU 6 months)
x5
Ashare et al, 2013, Journal of Addiction Medicine
Induced lapse in first week
of quit attempt (FU 14 days)
Impact of early lapse on relapse
Lapse in first week of quit
attempt (FU 6 months)
x5
Ashare et al, 2013, Journal of Addiction Medicine
Induced lapse in first week
of quit attempt (FU 14 days)
x2
Shadel et al, 2011, Health Psychology
Episodic craving (cue induced craving)
Major cause of lapse
Shiffman et al, 1996 Journal of Consulting & Clinical Psychology; Ferguson & Shiffman , 2009, J Subst Abuse Treat
Episodic craving (cue induced craving)
Major cause of lapse
Shiffman et al, 1996 Journal of Consulting & Clinical Psychology; Ferguson & Shiffman , 2009, J Subst Abuse Treat
Episodic craving (cue induced craving)
Implicated in 44% of lapses
Shiffman et al (1996)
Major cause of lapse
Shiffman et al, 1996 Journal of Consulting & Clinical Psychology; Ferguson & Shiffman , 2009, J Subst Abuse Treat
Episodic craving (cue induced craving)
Implicated in 44% of lapses
Shiffman et al (1996)
Major cause of lapse
Half of lapses occur within 11 minutes of
episodic craving
Shiffman et al, 1996 Journal of Consulting & Clinical Psychology; Ferguson & Shiffman , 2009, J Subst Abuse Treat
Sense
Sense
SET QUIT
DATE
Sense
SET QUIT
DATE
Sense
SET QUIT
DATE
IF REPORTS > THRESHOLD THEN ACTIVE GEOFENCE
CREATED
Sense
SET QUIT
DATE
IF REPORTS > THRESHOLD THEN ACTIVE GEOFENCE
CREATED
Sense
AFTER QUIT
DATE
Sense
AFTER QUIT
DATE
MRC
framework
phase
Phase 0 Phase 1 Phase 2 Phase 3 Phase 4
Acceptability study
Intervention refinement
Theory and evidence generation
Intervention targets, modelling & barriers
Feasibility, acceptability & trial parameters
Definitive RCT Examine implementation in practice
Pilot/exploratory RCT
Q Sense development
Intervention development
Feasibility study
Effectiveness RCT
Theory
&
literature
MRC
framework
phase
Phase 0 Phase 1 Phase 2 Phase 3 Phase 4
Acceptability study
Intervention refinement
Theory and evidence generation
Intervention targets, modelling & barriers
Feasibility, acceptability & trial parameters
Definitive RCT Examine implementation in practice
Pilot/exploratory RCT
Q Sense development
Intervention development
Feasibility study
Effectiveness RCT
Theory
&
literature
Feasibility study
• Median time to report smoking 13 secs
• Underreporting on around half of days
• Reporting barriers – Forgetting
– Not wanting to appear rude
– Driving
– Relapse
Naughton et al, in press, JMIR mHealth uHealth
MRC
framework
phase
Phase 0 Phase 1 Phase 2 Phase 3 Phase 4
Acceptability study
Intervention refinement
Theory and evidence generation
Intervention targets, modelling & barriers
Feasibility, acceptability & trial parameters
Definitive RCT Examine implementation in practice
Pilot/exploratory RCT
Q Sense development
Intervention development
Feasibility study
Effectiveness RCT
Theory
&
literature
Acceptability study
• Objectives 1. Assess acceptability of Q Sense among target population 2. Estimate speed of engagement with geofence support 3. Estimate disengagement from app
• Design & methods • Mixed methods design (app data, follow-up survey & 1-to-1 interviews) • Smokers, receiving/motivated to receive cessation support (N=42)
– 55% female – 50% were over 35 years old – 74% smoked first cigarette after waking within 30 minutes
• Used app prequit (~7 days) and postquit up to 28 days • Follow up survey at 28 days post quit date (n=30 out of 42; 71%) • Purposive sample invited to interview (n=9)
% receiving geofence-triggered support
• 70% of those eligible (16/23)
1. Acceptability
17%
23%
76%
0% 20% 40% 60% 80% 100%
Negative reminder*
Privacy concerns
Use app again
Agree
Neutral
Disagree
* Subsample followed up who received geofence triggered support
1. Acceptability
“When [the messages] actually came through it was as if
the programme was written for me. Seriously that is what I did feel...because it was coming through at the times when I felt that I would have smoked and that’s when the support was there.” (ppt 1)
1. Acceptability
“When [the messages] actually came through it was as if
the programme was written for me. Seriously that is what I did feel...because it was coming through at the times when I felt that I would have smoked and that’s when the support was there.” (ppt 1)
“Some of [the messages] were useful and some of them seemed very daft. Yes. Some were very irrelevant to me personally, I thought.” (ppt 21)
Self-monitoring
Self-monitoring
“…inputting it I’d think, “Am I really that stressed? Am I
really that anxious?” (ppt 42)
Self-monitoring
“…inputting it I’d think, “Am I really that stressed? Am I
really that anxious?” (ppt 42)
“And that was the most important thing to start off with, is realising where in your day the pinch points were going to be and to sort of see a pattern of how much you were smoking and when you were smoking.” (ppt 24)
(more) self-monitoring
“Have a button, ‘I’m not smoking’…” (ppt 7)
“…it almost like solidifies your decision to not smoke whereas you might, if you didn’t have a button as it currently is, five minutes later you think, “Oh I still do want one” (ppt 24)
2. Engagement
• 2,879 interaction episodes (> 1 minute apart)
– Mean of 70 (SD 75) per participant
• Of 3,090 notifications, 1,483 (48%) engaged with
• Of 769 GF notifications, 432 (56%) engaged with
2. (Speed of) engagement
2. (Speed of) engagement
geofence
Geofence messages
Median time to response after geofence message notification (n=15) = 4.5 mins
79% viewed within 30 minutes
Median = 4.5 minutes
2. (Speed of) engagement
daily support geofence
Geofence messages Daily support messages
Median time to response after geofence message notification (n=15) = 4.5 mins
79% viewed within 30 minutes 54% viewed within 30 minutes
p<0.001
Median = 4.5 minutes Median = 24.2 minutes
2. (Speed of) engagement
MLM - Response time (DV), n=15 Estimate F p value
Time 0.02 4.83 0.029
AR1 rho (serial correlation) 0.217 Wald Z = 1.84
0.066
Fixed effect: GF situation (home vs. work) -0.92 0.02 0.882
Fixed effect: GF event (entry vs. dwell) -2.61 0.38 0.536
Fixed effect: Situational craving (low vs. high) 0.25 0.002 0.968
Fixed effect: Time of day -9.51 0.50 0.481
Response time Mean (SD) = 22.4 (37.3) mins Median = 4.9 mins
Response time Mean (SD) = 17.7 (33.7) mins Median = 3.8 mins
Home Work
3. Disengagement
• Last completion of an app survey or rating a message
3. Disengagement
Approx. end of automated support (38 days)
Median 25 days (IQR 7-41)
• Last completion of an app survey or rating a message
3. Disengagement
• Last completion of an app survey or rating a message
Shiffman et al, 2007 Drug & Alcohol Dependence
Summary
Summary
¾ would use Q Sense again
Summary
¾ would use Q Sense again
Over half of geofence messages engaged with, most
viewed within 5 mins
Summary
¾ would use Q Sense again
Over half of geofence messages engaged with, most
viewed within 5 mins
Desire for more self-monitoring
Summary 2
~ ½ of interaction episodes driven by
notifications
But only 10% of smoking cessation apps include any type of proactive notifications Hoeppner et al (2016) Nic Tob Res
Future steps
Future steps
“You can vote the messages can’t you? So that’s great as well because it means the very best and most popular ones come up first and foremost.” (study 2, ppt 24)
Future steps
“You can vote the messages can’t you? So that’s great as well because it means the very best and most popular ones come up first and foremost.” (study 2, ppt 24)
Future steps
“You can vote the messages can’t you? So that’s great as well because it means the very best and most popular ones come up first and foremost.” (study 2, ppt 24)
Future steps
AIRO wristband
Scholl & Van Laerhoven, 2012
Source: Qualcomm
http://somatixinc.com/smokebeat/
Thank you
Felix Naughton
Behavioural Science Group
University of Cambridge
[email protected] @FelixNaughton
Collaborators Neal Lathia Sarah Hopewell Chloë Brown Jo Emery Rik Schalbroeck Cecilia Mascolo Andy McEwen Stephen Sutton