ObjectiveTo determine the incentivization strategy that maximizes patient adherence to report symptoms and activity via ecological momentary assessment (EMA) following pediatric concussion.BackgroundConcussion is a common pediatric injury. Traditionally, outcome assessment has occurred at discrete points-in-time, days or weeks apart, relying on patient's subjective recall of symptoms and activity. EMA is a behavioral measurement approach that allows for reporting of real-time symptoms and behaviors in real-life settings. While feasible in adolescents, the ideal strategy to maximize responsiveness from the emergency department (ED) setting is unknown.Design/MethodsThis was a randomized controlled trial of patients age 13–18 with concussion presenting to an urban, academic pediatric ED within 5 days of injury. Patients were randomized to one of 4 incentive-based arms: 2 dynamic (loss-based and streak) and 2 flat-rate (monetary and electronic device). Through the ReCoUPS app, patients reported symptoms 3 times per day and cognitive activity once each evening for 3 weeks. Physical activity (step count) and sleep were monitored using a FitBit (which was kept by the participant in the electronic device flat-rate arm). The primary outcome was proportion of prompts to which patients responded. Secondary outcomes included daily symptom change and time to symptom resolution.ResultsThirty participants were enrolled, median age 15.5 years, 60% female. Median proportion completed was 81% in the loss-based arm, 59% in the streak accrual arm, 50% in the FitBit-received arm, and 57% monetary flat rate arm. Retention was higher in the dynamic compared to the flat arms (68% v. 54%, p = 0.065). There was no significant difference between morning, afternoon, and evening symptoms. Sixty-four percent of participants had symptom resolution during the 3-week follow-up.ConclusionsDynamic incentivization showed higher rates of response to tri-daily symptom prompts compared with flat-fee incentivization. This data shows tracking concussed youth using EMA from ED is feasible using a dynamic incentivization strategy.
The aims of this study were to determine the incentivization strategy that maximizes patient adherence to report symptoms and activity via ecological momentary assessment (EMA) after pediatric concussion, and assess the feasibility of tracking concussed youth using EMA from the emergency department (ED) setting. Methods:This study was a randomized controlled trial of participants ages 13 to 18 years with concussion presenting to an urban, academic pediatric ED within 5 days of injury. Participants were randomized to 1 of 4 incentive arms: 2 dynamic (loss-based and streak) and 2 control flat-rate (monetary and electronic device). Participants reported symptoms 3 times per day and cognitive activity once each evening for 3 weeks. Physical activity (step count) and sleep were monitored using a Fitbit (kept by participants in the device flat-rate arm). The primary outcome was proportion of prompts to which participants responded. Secondary outcomes included differential response rates by demographics, and comparison of outcome determination between EMA and subsequent clinical visits.Results: Thirty participants were enrolled, with a median age of 15.5 years and 60% female. Median cumulative proportion of prompts responded to was 68.3% (interquartile range, 47.6%-82.5%) in the dynamic arms versus 54.0% (interquartile range. 20.6%-68.3%) in the flat-rate arms, P = 0.065. There were nonsignificant differences in median response by sex (65.9% for female vs 40.0% for male, P = 0.072), race/ethnicity (61.9% for non-Hispanic White vs 43.7% for non-Hispanic Black participants, P = 0.097), and insurance (61.9% for private insurance vs 47.6% for public insurance, P = 0.305). Recovery at 3 weeks was discernible for all but 2 participants (93.3%) using EMA data, compared with only 9 participants (30.0%) (P < 0.001) from clinical visits. Conclusions: Dynamic incentivization showed higher rates of response to tridaily symptom prompts compared with flat-rate incentivization. These data show tracking concussed youth using EMA from the ED is feasible using a dynamic incentivization strategy, with improved ability to discern outcomes compared with prospective monitoring using follow-up clinical visits.
Structural determinants of health like neighborhood are often overlooked in the context of understanding public awareness of health topics and health information seeking behaviors. Seeking health information is particularly relevant given that some communities have higher prevalence of disease than others. Using the Structural Influence Model of Health Communication (SIMHC), this paper examines how both individual and neighborhood level characteristics contribute to health communication outcomes such as being aware of health topics like cancer, obesity, and HIV, and whether or not individual seeking health-related information or coming across information in the course of their general media use. Respondents to the Southeastern Pennsylvania Household Health Survey (SEPa HHS), a county-stratified random sample of adults ages 18-75 years old, who completed the survey in 2015, were recontacted for participation in 2017. Over one-thousand respondents (n=1,005) completed the survey, and the final sample size for this analysis was 887. Individual level correlates included demographic factors and relevant lifestyle behaviors (e.g., smoking); neighborhood level variables- determined by ZIP Code- included such socioeconomic status (SES) measures as percent unemployed, percent with a high school education, and percent living in poverty. Multilevel modeling was used to determine whether there were random effects on the health communication outcomes of interest. Analyses showed our outcomes of interest did not vary across neighborhoods, whether they were treated as random or fixed effects. Different characterizations of neighborhood (e.g., census block group) and different indicators of neighborhood media environments may be more likely to demonstrate macro level effects on health communication outcomes.
half of the sample (44.5%) reported involvement in at least one MVC as a driver. The majority also reported engaging in cell phone calls while driving (73.2%, n=281) and texting while driving (61.7%, n=237). A 2-factor structure was confirmed, revealing that cell phone use loaded highly on a latent factor largely consisting of intentional driving violations. A binary logistic regression revealed a significant association between the probability of reporting a crash and this reckless driving factor (Wald=4.058, p=0.044) as well as impulsivity (Wald=8.602, p=0.003). Conclusions These findings suggest that cell phone use does not represent a unique source of reckless driving behavior associated with crashes. Significance and Contributions Interventions for improving driver safety should adopt a holistic approach addressing patterns of risk-taking in young drivers.
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