Microrandomized trials: An experimental design for developing just-in-time adaptive interventions.

Klasnja, Predrag; Hekler, Eric B.; Shiffman, Saul; Boruvka, Audrey; Almirall, Daniel; Tewari, Ambuj; Murphy, Susan A.

doi:10.1037/hea0000305

Cited by 528 publications

(435 citation statements)

References 24 publications

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“…One particularly promising methodology to understand the benefit for each individual is the use of microrandomized trials (MRTs). An MRT is a sequential factorial design that randomly assigns an intervention component to each individual at relevant time points (Klasnja et al, 2015). Thus, within an MRT, each individual is randomized multiple times in order to better understand the time-varying and dynamic nature of interventions and how their effectiveness corresponds to various contextual factors.…”

Section: Evaluation Of Emismentioning

confidence: 99%

Ecological momentary interventions for depression and anxiety

2017

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Ecological momentary interventions (EMIs) are becoming more popular and more powerful resources for the treatment and prevention of depression and anxiety due to advances in technological capacity and analytic sophistication. Previous work has demonstrated that EMIs can be effective at reducing symptoms of depression and anxiety as well as related outcomes of stress and at increasing positive psychological functioning. In this review, we highlight the differences between EMIs and other forms of treatment due to the nature of EMIs to be deeply integrated into the fabric of people's day-to-day lives. EMIs require unique considerations in their design, deployment, and evaluation. Furthermore, given that EMIs have been advanced by changes in technologies and that the use of behavioral intervention technologies for mental health has been increasing, we discuss how technologies and analytics might usher in a new era of EMIs. Future EMIs might reduce user burden and increase intervention personalization and sophistication by leveraging digital sensors and advances in natural language processing and machine learning. Thus, although current EMIs are effective, the EMIs of the future might be more engaging, responsive, and adaptable to different people and different contexts.

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Section: Evaluation Of Emismentioning

confidence: 99%

Ecological momentary interventions for depression and anxiety

2017

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“…They also reported whether they would recommend the app to others with chronic back pain. Preliminary efficacy is measured with several proximal measures that can lead to reduction of pain in the long-term [47].…”

Section: Methodsmentioning

confidence: 99%

Feasibility and Acceptability of Mobile Phone–Based Auto-Personalized Physical Activity Recommendations for Chronic Pain Self-Management: Pilot Study on Adults (Preprint)

Rabbi¹,

Aung²,

Gay³

et al. 2018

Preprint

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Chronic Pain (CP) is defined as pain that persists despite the resolution of injury or pathology [1] and is attributed to changes in the central and peripheral nervous system resulting in amplified or uninhibited pain signals [2,3]. The persistency of pain signals over long periods of time can severely affect people both physically and psychologically.CP is closely linked with distress, can affect behavior, lead to a loss of productivity and daily functioning. Among people with CP, 86% report an inability to sleep well [4], 70% report trouble concentrating [4], 44-51% report anxiety [5], 88% express anger due to not seeing improvement [5]; CP related productivity related losses are 4.6 hour per week (5.5 hours/ week for chronic back pain) [6]. These adverse effects of CP can further result in depression and mood disorders; 40-50% CP population suffer from depressive disorders, while 77% report feeling depressed [5,7,8,9]. In terms of prevalence, the World Health Organization recognizes CP as a public health problem worldwide [10] (32% in low income countries and 30% in high income countries) [11,12]. In the US alone, 120 million adults are reported to be suffering from CP [13].Related costs have exceeded diabetes, cancer and heart disease in US [14] and CP is also related to substance abuse; 12 million (12 year or older) reported non-medical use of pain medication and overdose related deaths are rising every year [15].A particularly common form of CP is musculoskeletal chronic pain, which affects one in ten adults globally; 28.1% of the CP population has a musculoskeletal form.Musculoskeletal CP is a leading cause of disability, with 28% of people with chronic back pain reporting limited movement due to the condition [16]. Having said this, it is well understood that successful management in musculoskeletal CP is achievable with regular and sustained physical activity [10]. This is due to regular activity having the effect of protecting against muscle weakening and also inhibiting the neurophysiological mechanisms underlying the spread of pain [4]. Physical activity also has fewer side effects than drugs [17]. The National Institute of Health Care in the UK (NICE) recommends reducing the dependence on drugs and suggests exercise to be a core treatment for CP [10]. Despite these benefits, adherence to regular and sustained physical activity is very low [12] and the need to improve adherence to prescribed physiotherapies among individuals with musculoskeletal CP has been a longstanding problem [18]. This is especially challenging in self-managed settings where there is no care provider present to offer encouragement and respond to the individual's specific needs in real time [12]. This low adherence is principally due to the perceived onset of pain exacerbation due to physical activity which over time results in psychological barriers. Some barriers manifest at an affective level [5], typically fear and anxiety [19,20] which are also closely linked to more cognitive barriers such as negative beliefs [5] and catast...

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“…A proximal measure for the 4PM inspirational message is whether or not the participant self-reports later on the same day. For more details on MRTs, we refer the readers to Klasnja et al [78,79,80]. In the following, we describe the MRT protocol for SARA.…”

Section: Objective Of the Studymentioning

confidence: 99%

“…Recently, micro-randomized trials (MRT) have been proposed as a way to develop just-in-time adaptive interventions for mobile health [78,79]. In SARA, the intervention is composed of the engagement strategies, such as giving a meme or issuing an inspirational message.…”

Section: Objective Of the Studymentioning

confidence: 99%

Toward Increasing Engagement in Substance Use Data Collection: Development of the Substance Abuse Research Assistant App and Protocol for a Microrandomized Trial Using Adolescents and Emerging Adults (Preprint)

Rabbi¹,

Philyaw-Kotov²,

Cunningham³

et al. 2018

Preprint

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BACKGROUND Substance use is an alarming public health issue associated with significant morbidity and mortality. Adolescents and emerging adults are at particularly high risk because substance use typically initiates and peaks during this developmental period. Mobile health apps are a promising data collection and intervention delivery tool for substance-using youth as most teens and young adults own a mobile phone. However, engagement with data collection for most mobile health applications is low, and often, large fractions of users stop providing data after a week of use. OBJECTIVE Substance Abuse Research Assistant (SARA) is a mobile application to increase or sustain engagement of substance data collection overtime. SARA provides a variety of engagement strategies to incentivize data collection: a virtual aquarium in the app grows with fish and aquatic resources; occasionally, funny or inspirational contents (eg, memes or text messages) are provided to generate positive emotions. We plan to assess the efficacy of SARA’s engagement strategies over time by conducting a micro-randomized trial, where the engagement strategies will be sequentially manipulated. METHODS We aim to recruit participants (aged 14-24 years), who report any binge drinking or marijuana use in the past month. Participants are instructed to use SARA for 1 month. During this period, participants are asked to complete one survey and two active tasks every day between 6 pm and midnight. Through the survey, we assess participants’ daily mood, stress levels, loneliness, and hopefulness, while through the active tasks, we measure reaction time and spatial memory. To incentivize and support the data collection, a variety of engagement strategies are used. First, predata collection strategies include the following: (1) at 4 pm, a push notification may be issued with an inspirational message from a contemporary celebrity; or (2) at 6 pm, a push notification may be issued reminding about data collection and incentives. Second, postdata collection strategies include various rewards such as points which can be used to grow a virtual aquarium with fishes and other treasures and modest monetary rewards (up to US $12; US $1 for each 3-day streak); also, participants may receive funny or inspirational content as memes or gifs or visualizations of prior data. During the study, the participants will be randomized every day to receive different engagement strategies. In the primary analysis, we will assess whether issuing 4 pm push-notifications or memes or gifs, respectively, increases self-reporting on the current or the following day. RESULTS The microrandomized trial started on August 21, 2017 and the trial ended on February 28, 2018. Seventy-three participants were recruited. Data analysis is currently underway. CONCLUSIONS To the best of our knowledge, SARA is the first mobile phone app that systematically manipulates engagement strategies in order to identify the best sequence of strategies that keep participants engaged in data collection. Once the optimal strategies to collect data are identified, future versions of SARA will use this data to provide just-in-time adaptive interventions to reduce substance use among youth. CLINICALTRIAL ClinicalTrials.gov NCT03255317; https://clinicaltrials.gov/show/NCT03255317 (Archived by WebCite at http://www.webcitation.org/70raGWV0e) REGISTERED REPORT IDENTIFIER RR1-10.2196/9850

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Microrandomized trials: An experimental design for developing just-in-time adaptive interventions.

Cited by 528 publications

References 24 publications

Ecological momentary interventions for depression and anxiety

Ecological momentary interventions for depression and anxiety

Feasibility and Acceptability of Mobile Phone–Based Auto-Personalized Physical Activity Recommendations for Chronic Pain Self-Management: Pilot Study on Adults (Preprint)

Toward Increasing Engagement in Substance Use Data Collection: Development of the Substance Abuse Research Assistant App and Protocol for a Microrandomized Trial Using Adolescents and Emerging Adults (Preprint)

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