Leveraging Self-Affirmation to Improve Behavior Change: A Mobile Health App Experiment (Preprint)

Abstract

Background:Mobile health (mHealth) interventions can improve the lives of participants by enhancing both physical and mental wellbeing. Unfortunately, mHealth interventions often suffer from low adherence. One possible way to increase adherence is the usage of self-affirmations. Self-affirmations are writing exercises that have been effective in increasing behavior change in many realms. However, current self-affirmations involve a level of writing not amenable to deployment on mobile platforms. Objective:The aim of this experiment was to adapt a self-affirmation exercise to a form better suited for delivery through a mobile application and test effectiveness of differing self-affirmation doses on adherence to behavior change goals over time. Methods:We examine how the self-affirmation doses affect behavior change using a 2x2 factorial design with 127 participants using an mHealth application. Participants were asked to adhere to a daily goal of eating 5 servings of fruits and vegetables. Participants were divided into the 4 total conditions based on 2 independent variables. The first independent variable was whether the participant received an initial self-affirmation exercise as part of their onboarding. The second independent variable was whether the participant received ongoing booster self-affirmations throughout the 28 day study. Results:Analysis of 3556 observations from 127 participants indicates that higher doses of self-affirmation result in improved adherence to mHealth intervention goals, (coefficient = 1.42, SE = 0.71, p = .044). Under our conservative definition of attrition, this increase in adherence does not seem to translate to a decrease in participant attrition (.61 < p's < .96). Finally we examine the mechanisms by which self-affirmation may affect intentions of behavior change; we build a strong model of intention (R 2 =.39, p < .001) but self-affirmation does not directly affect final intentions (.09 < p's < .93). Conclusions:Self-affirmations can successfully increase adherence to recommended diet and health goals using an mHealth application. These self-affirmations are easy to implement and low cost for both users and developers. We recommend that other mHealth applications integrate self-affirmations to examine their effects on adherence and behavior change in the context of other mHealth applications.

Memory, Interrupted: A Retrieval Model of Intrusive Memories, Recovery Trajectories, and Neurobiological Effects in Post-Traumatic Stress Disorder

“…However, the degree of detail and realism achieved by these simulations, in both their timescale and the detail of behavioral and neural predictions, make it possible to consider using this model in realistic mental health applications. For example, this model could be calibrated on individual data and provide mobile health recommendation, data collection, and monitoring (Pirolli et al, 2017;Springer et al, 2018), which could be key in the case of disorders, like PTSD, where identifying in the immediate aftermath of a potentially traumatic event those who are most likely to have chronic psychopathology and should receive triaged intervention has been elusive and barriers to receiving early intervention high, even despite having impairing symptoms (Shalev et al, 2011).…”