Abstract Background The just-in-time adaptive intervention (JITAI) is an intervention design aiming to provide the right type/amount of support, at the right time, by adapting to an individual’s changing internal and contextual state. The availability of increasingly powerful mobile and sensing technologies underpins the use of JITAIs to support health behavior, as in such a setting an individual’s state can change rapidly, unexpectedly, and in his/her natural environment. Purpose Despite the increasing use and appeal of JITAIs, a major gap exists between the growing technological capabilities for delivering JITAIs and research on the development and evaluation of these interventions. Many JITAIs have been developed with minimal use of empirical evidence, theory, or accepted treatment guidelines. Here, we take an essential first step towards bridging this gap. Methods Building on health behavior theories and the extant literature on JITAIs, we clarify the scientific motivation for JITAIs, define their fundamental components, and highlight design principles related to these components. Examples of JITAIs from various domains of health behavior research are used for illustration. Conclusions As we enter a new era of technological capacity for delivering JITAIs, it is critical that researchers develop sophisticated and nuanced health behavior theories capable of guiding the construction of such interventions. Particular attention has to be given to better understanding the implications of providing timely and ecologically sound support for intervention adherence and retention

Sexuality research focuses almost exclusively on individuals rather than couples, though ongoing relationships are very important for most people and cultures. The present study was the first to examine sexual and relationship parameters of middle-aged and older couples in committed relationships of 1-51 years duration. Survey research was conducted in Brazil, Germany, Japan, Spain, and the U.S. targeting 200 men aged 40-70 and their female partners in each country, with 1,009 couples in the final sample. Key demographic, health, physical intimacy, sexual behavior, sexual function, and sexual history variables were used to model relationship happiness and sexual satisfaction. The median ages were 55 for men and 52 for women; median relationship duration was 25 years. Relationship satisfaction in men depended on health, physical intimacy, and sexual functioning, while in women only sexual functioning predicted relationship satisfaction. Models predicting sexual satisfaction included significant physical intimacy and sexual functioning for both genders and, for men, more frequent recent sexual activity and fewer lifetime partners. Longer relationship duration predicted greater relationship happiness and sexual satisfaction for men. However, women in relationships of 20 to 40 years were significantly less likely than men to report relationship happiness. Compared to men, women showed lower sexual satisfaction early in the relationship and greater sexual satisfaction later. Within the long-term committed relationship context, there were significant gender differences in correlates of sexual and relationship satisfaction, with sexual functioning a common predictor of both types of satisfaction and physical intimacy a more consistent and salient predictor for men.

This study was registered on ClinicalTrials.gov number NCT03225521.

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BACKGROUND: Readmission rates after pneumonia, heart failure, and acute myocardial infarction hospitalizations are risk-adjusted for age, gender, and medical comorbidities and used to penalize hospitals. OBJECTIVE: To assess the impact of disability and social d e t e r m i n an t s o f h ea l t h o n c o n d i t i o n-s p e c i f i c readmissions beyond current risk adjustment. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of Medicare patients using 1) linked Health and Retirement Study-Medicare claims data (HRS-CMS) and 2) Healthcare Cost and Utilization Project State Inpatient Databases (Florida, Washington) linked with ZIP Code-level measures from the Census American Community Survey (ACS-HCUP). Multilevel logistic regression models assessed the impact of disability and selected social determinants of health on readmission beyond current risk adjustment. M A I N M E A S U R E S : O u t c o m e s m e a s u r e d w e r e readmissions ≤30 days after hospitalizations for pneumonia, heart failure, or acute myocardial infarction. HRS-CMS models included disability measures (activities of daily living [ADL] limitations, cognitive impairment, nursing home residence, home healthcare use) and social determinants of health (spouse, children, wealth, Medicaid, race). ACS-HCUP model measures were ZIP Codepercentage of residents ≥65 years of age with ADL difficulty, spouse, income, Medicaid, and patient-level and hospital-level race. KEY RESULTS: For pneumonia, ≥3 ADL difficulties (OR 1.61, CI 1.079-2.391) and prior home healthcare needs (OR 1.68, CI 1.204-2.355) increased readmission in HRS-CMS models (N = 1631); ADL difficulties (OR 1.20, CI 1.063-1.352) and 'other' race (OR 1.14, CI 1.001-1.301) increased readmission in ACS-HCUP models (N = 27,297). For heart failure, children (OR 0.66,) and wealth (OR 0.53, CI 0.349-0.787) lowered readmission in HRS-CMS models (N = 2068), while black (OR 1.17, CI 1.056-1.292)

Background The Assistant to Lift your Level of activitY (Ally) app is a smartphone application that combines financial incentives with chatbot-guided interventions to encourage users to reach personalized daily step goals. Purpose To evaluate the effects of incentives, weekly planning, and daily self-monitoring prompts that were used as intervention components as part of the Ally app. Methods We conducted an 8 week optimization trial with n = 274 insurees of a health insurance company in Switzerland. At baseline, participants were randomized to different incentive conditions (cash incentives vs. charity incentives vs. no incentives). Over the course of the study, participants were randomized weekly to different planning conditions (action planning vs. coping planning vs. no planning) and daily to receiving or not receiving a self-monitoring prompt. Primary outcome was the achievement of personalized daily step goals. Results Study participants were more active and healthier than the general Swiss population. Daily cash incentives increased step-goal achievement by 8.1%, 95% confidence interval (CI): [2.1, 14.1] and, only in the no-incentive control group, action planning increased step-goal achievement by 5.8%, 95% CI: [1.2, 10.4]. Charity incentives, self-monitoring prompts, and coping planning did not affect physical activity. Engagement with planning interventions and self-monitoring prompts was low and 30% of participants stopped using the app over the course of the study. Conclusions Daily cash incentives increased physical activity in the short term. Planning interventions and self-monitoring prompts require revision before they can be included in future versions of the app. Selection effects and engagement can be important challenges for physical-activity apps. Clinical Trial Information This study was registered on ClinicalTrials.gov, NCT03384550.

As globalization has opened up channels of communication between different countries and increased interest in cross-national analysis, public opinion survey research has expanded its reach in the world. This article examines both the breadth and the depth of the globalization of public opinion research. First, we discuss the growth of cross-national surveys such as the World Values Survey, the International Social Survey Program, the European Social Survey, and the various Global Barometers. We then turn to the issues of data quality and comparability. Has the globalization of survey research meant the spread of a standard "product" of known and equivalent quality to diverse countries? Can survey research in diverse countries and contexts deliver meaningful comparisons of public opinion? Has globalization led to the dominance of an intellectual framework and set of assumptions that may not be quite appropriate outside their original homes? Finally, the article suggests a new standard for "grading" cross-national programs of survey research, inspired by debates in evidence-based medicine.

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