Amaël Arguel

The influence of social networking sites on health behavior change: a systematic review and meta-analysis

OBJECTIVEnOur aim was to evaluate the use and effectiveness of interventions using social networking sites (SNSs) to change health behaviors.nnnMATERIALS AND METHODSnFive databases were scanned using a predefined search strategy. Studies were included if they focused on patients/consumers, involved an SNS intervention, had an outcome related to health behavior change, and were prospective. Studies were screened by independent investigators, and assessed using Cochranes risk of bias tool. Randomized controlled trials were pooled in a meta-analysis.nnnRESULTSnThe database search retrieved 4656 citations; 12 studies (7411 participants) met the inclusion criteria. Facebook was the most utilized SNS, followed by health-specific SNSs, and Twitter. Eight randomized controlled trials were combined in a meta-analysis. A positive effect of SNS interventions on health behavior outcomes was found (Hedges g 0.24; 95% CI 0.04 to 0.43). There was considerable heterogeneity (I(2) = 84.0%; T(2) = 0.058) and no evidence of publication bias.nnnDISCUSSIONnTo the best of our knowledge, this is the first meta-analysis evaluating the effectiveness of SNS interventions in changing health-related behaviors. Most studies evaluated multi-component interventions, posing problems in isolating the specific effect of the SNS. Health behavior change theories were seldom mentioned in the included articles, but two particularly innovative studies used network alteration, showing a positive effect. Overall, SNS interventions appeared to be effective in promoting changes in health-related behaviors, and further research regarding the application of these promising tools is warranted.nnnCONCLUSIONSnOur study showed a positive effect of SNS interventions on health behavior-related outcomes, but there was considerable heterogeneity. Protocol registration The protocol for this systematic review is registered at http://www.crd.york.ac.uk/PROSPERO with the number CRD42013004140.

Using video and static pictures to improve learning of procedural contents

Animations and videos are often designed to present information that involves change over time, in such a way as to aid understanding and facilitate learning. However, in many studies, static displays have been found to be just as beneficial and sometimes better. In this study, we investigated the impact of presenting together both a video recording and a series of static pictures. In experiment 1, we compared 3 conditions (1) video shown alone, (2) static pictures displayed alone, and (3) video plus static pictures. On average the best learning scores were found for the 3rd condition. In experiment 2 we investigated how best to present the static pictures, by examining the number of pictures required (low vs. high frequency) and their appearance type (static vs. dynamic). We found that the dynamic presentation of pictures was superior to the static pictures mode; and showing fewer pictures (low frequency) was more beneficial. Overall the findings support the effectiveness of a combination of instructional animation with static pictures. However, the number of static pictures, which are used, is an important moderating factor.

Which Bundles of Features in a Web-Based Personally Controlled Health Management System Are Associated With Consumer Help-Seeking Behaviors for Physical and Emotional Well-Being?

Background Personally controlled health management systems (PCHMS), which include a personal health record (PHR), health management tools, and consumer resources, represent the next stage in consumer eHealth systems. It is still unclear, however, what features contribute to an engaging and efficacious PCHMS. Objective To identify features in a Web-based PCHMS that are associated with consumer utilization of primary care and counselling services, and help-seeking rates for physical and emotional well-being concerns. Methods A one-group pre/posttest online prospective study was conducted on a university campus to measure use of a PCHMS for physical and emotional well-being needs during a university academic semester (July to November 2011). The PCHMS integrated an untethered personal health record (PHR) with well-being journeys, social forums, polls, diaries, and online messaging links with a health service provider, where journeys provide information for consumer participants to engage with clinicians and health services in an actionable way. 1985 students and staff aged 18 and above with access to the Internet were recruited online. Logistic regression, the Pearson product-moment correlation coefficient, and chi-square analyses were used to associate participants’ help-seeking behaviors and health service utilization with PCHMS usage among the 709 participants eligible for analysis. Results A dose-response association was detected between the number of times a user logged into the PCHMS and the number of visits to a health care professional (P=.01), to the university counselling service (P=.03), and help-seeking rates (formal or informal) for emotional well-being matters (P=.03). No significant association was detected between participant pre-study characteristics or well-being ratings at different PCHMS login frequencies. Health service utilization was strongly correlated with use of a bundle of features including: online appointment booking (primary care: OR 1.74, 95% CI 1.01-3.00; counselling: OR 6.04, 95% CI 2.30-15.85), personal health record (health care professional: OR 2.82, 95% CI 1.63-4.89), the poll (health care professional: OR 1.47, 95% CI 1.02-2.12), and diary (counselling: OR 4.92, 95% CI 1.40-17.35). Help-seeking for physical well-being matters was only correlated with use of the personal health record (OR 1.73, 95% CI 1.18-2.53). Help-seeking for emotional well-being concerns (including visits to the university counselling service) was correlated with a bundle comprising the poll (formal or informal help-seeking: OR 1.03, 95% CI 1.00-1.05), diary (counselling: OR 4.92, 95% CI 1.40-17.35), and online appointment booking (counselling: OR 6.04, 95% CI 2.30-15.85). Conclusions Frequent usage of a PCHMS was significantly associated with increased consumer health service utilization and help-seeking rates for emotional health matters in a university sample. Different bundles of PCHMS features were associated with physical and emotional well-being matters. PCHMS appears to be a promising mechanism to engage consumers in help-seeking or health service utilization for physical and emotional well-being matters.

Social and self-reflective use of a Web-based personally controlled health management system.

Background Personally controlled health management systems (PCHMSs) contain a bundle of features to help patients and consumers manage their health. However, it is unclear how consumers actually use a PCHMS in their everyday settings. Objective To conduct an empirical analysis of how consumers used the social (forum and poll) and self-reflective (diary and personal health record [PHR]) features of a Web-based PCHMS designed to support their physical and emotional well-being. Methods A single-group pre/post-test online prospective study was conducted to measure use of a Web-based PCHMS for physical and emotional well-being needs during a university academic semester. The PCHMS integrated an untethered PHR with social forums, polls, a diary, and online messaging links with a health service provider. Well-being journeys additionally provided information to encourage engagement with clinicians and health services. A total of 1985 students and staff aged 18 and above with access to the Internet were recruited online, of which 709 were eligible for analysis. Participants’ self-reported well-being, health status, health service utilization, and help-seeking behaviors were compared using chi-square, McNemar’s test, and Student’s t test. Social networks were constructed to examine the online forum communication patterns among consumers and clinicians. Results The two PCHMS features that were used most frequently and considered most useful and engaging were the social features (ie, the poll and forum). More than 30% (213/709) of participants who sought well-being assistance during the study indicated that other people had influenced their decision to seek help (54.4%, 386/709 sought assistance for physical well-being; 31.7%, 225/709 for emotional well-being). Although the prevalence of using a self-reflective feature (diary or PHR) was not as high (diary: 8.6%, 61/709; PHR: 15.0%, 106/709), the proportion of participants who visited a health care professional during the study was more than 20% greater in the group that did use a self-reflective feature (diary: P=.03; PHR: P<.001). Conclusions There was variation in the degree to which consumers used social and self-reflective PCHMS features but both were significantly associated with increased help-seeking behaviors and health service utilization. A PCHMS should combine both self-reflective as well as socially driven components to most effectively influence consumers’ help-seeking behaviors.

“Why Didn’t it Work?” Lessons From a Randomized Controlled Trial of a Web-based Personally Controlled Health Management System for Adults with Asthma

Background Personally controlled health management systems (PCHMS), which may include a personal health record (PHR), health management tools, and information resources, have been advocated as a next-generation technology to improve health behaviors and outcomes. There have been successful trials of PCHMS in various health settings. However, there is mixed evidence for whether consumers will use these systems over the long term and whether they ultimately lead to improved health outcomes and behaviors. Objective The aim was to test whether use of a PCHMS by consumers can increase the uptake or updating of a written asthma action plan (AAP) among adults with asthma. Methods A 12-month parallel 2-group randomized controlled trial was conducted. Participants living with asthma were recruited nationally in Australia between April and August 2013, and randomized 1:1 to either the PCHMS group or control group (online static educational content). The primary outcome measure was possession of an up-to-date written AAP poststudy. Secondary measures included (1) utilizing the AAP; (2) planned or unplanned visits to a health care professional for asthma-related concerns; (3) severe asthma exacerbation, inadequately controlled asthma, or worsening of asthma that required a change in treatment; and (4) number of days lost from work or study due to asthma. Ancillary analyses examined reasons for adoption or nonadoption of the intervention. Outcome measures were collected by online questionnaire prestudy, monthly, and poststudy. Results A total of 330 eligible participants were randomized into 1 of 2 arms (intervention: n=154; control: n=176). Access to the PCHMS was not associated with a significant difference in any of the primary or secondary outcomes. Most participants (80.5%, 124/154) did not access the intervention or accessed it only once. Conclusions Despite the intervention being effective in other preventive care settings, system use was negligible and outcome changes were not seen as a result. Consumers must perceive the need for assistance with a task and assign priority to the task supported by the eHealth intervention. Additionally, the cost of adopting the intervention (eg, additional effort, time spent learning the new system) must be lower than the benefit. Otherwise, there is high risk consumers will not adopt the eHealth intervention. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12612000716864; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=362714 (Archived by WebCite® at http://www.webcitation.org/6dMV6hg4A)

An Internet Intervention to Improve Asthma Management: Rationale and Protocol of a Randomized Controlled Trial

Background Many studies have shown the effectiveness of self-management for patients with asthma. In particular, possession and use of a written asthma action plan provided by a doctor has shown to significantly improve patients’ asthma control. Yet, uptake of a written asthma action plan and preventative asthma management is low in the community, especially amongst adults. Objective A Web-based personally controlled health management system (PCHMS) called Healthy.me will be evaluated in a 2010 CONSORT-compliant 2-group (static websites verse PCHMS) parallel randomized controlled trial (RCT) (allocation ratio 1:1). Methods The PCHMS integrates an untethered personal health record with consumer care pathways and social forums. After eligibility assessment, a sample of 300 adult patients with moderate persistent asthma will be randomly assigned to one of these arms. After 12 months of using either Healthy.me or information websites (usual care arm), a post-study assessment will be conducted. Results The primary outcome measure is possession of or revision of an asthma action plan during the study. Secondary outcome measures include: (1) adherence to the asthma action plan, (2) rate of planned and unplanned visits to healthcare providers for asthma issues, (3) usage patterns of Healthy.me and attrition rates, (4) asthma control and asthma exacerbation scores, and (5) impact of asthma on life and competing demands, and days lost from work. Conclusions This RCT will provide insights into whether access to an online PCHMS will improve uptake of a written asthma action plan and preventative asthma actions. Trial Registration Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12612000716864; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=362714 (Archived by WebCite at http://www.webcitation.org/6IYBJGRnW).

Inside Out Detecting Learners’ Confusion to Improve Interactive Digital Learning Environments

Confusion is an emotion that is likely to occur while learning complex information. This emotion can be beneficial to learners in that it can foster engagement, leading to deeper understanding. However, if learners fail to resolve confusion, its effect can be detrimental to learning. Such detrimental learning experiences are particularly concerning within digital learning environments (DLEs), where a teacher is not physically present to monitor learner engagement and adapt the learning experience accordingly. However, with better information about a learner’s emotion and behavior, it is possible to improve the design of interactive DLEs (IDLEs) not only in promoting productive confusion but also in preventing overwhelming confusion. This article reviews different methodological approaches for detecting confusion, such as self-report and behavioral and physiological measures, and discusses their implications within the theoretical framework of a zone of optimal confusion. The specificities of several methodologies and their potential application in IDLEs are discussed.

Consumers' Online Social Network Topologies and Health Behaviours

Personally controlled health management systems (PCHMS) often consist of multiple design features. Yet, they currently lack empirical evidence on how consumers use and engage with a PCHMS. An online prospective study was designed to investigate how 709 consumers used a web-based PCHMS to manage their physical and emotional wellbeing over five months. The web-based PCHMS, Healthy.me, was developed at UNSW and incorporates an untethered personal health record, consumer care pathways, forums, polls, diaries, and messaging links with healthcare professionals. The two PCHMS features that consumers used most frequently, found most useful, and engaging were the social features, i.e. forum and poll. Compared to participants who did not use any PCHMS social feature, those who used either the poll or the forum were 12.3% more likely to visit a healthcare professional (P=0.001) during the study. Social network analysis of forums revealed a spectrum of social interaction patterns - from question-and-answer structures to community discussions. This study provides a basis for understanding how a PCHMS can be used as a socially-driven intervention to influence consumers health behaviours.

Following in our footsteps: how adult demonstrations of literacy and numeracy can influence children’s spontaneous play and improve learning outcomes

ABSTRACT Play is traditionally considered the foundation of learning in the early years. Because play is characterized by free choice, it can be difficult for adults to ensure all learning is useful for children. The intervention described here took a novel approach to this problematic. It exposed 17 four-year-olds to different adult demonstrations to see if they influenced what children were interested to play with. It was theorized that by demonstrating certain problem-solving activities to children over four weeks, value would be ascribed to these literacy or numeracy activities and children would play with them. In doing so, they would learn literacy and numeracy skills. Results indicate that children exposed to numeracy demonstrations played significantly more with numeracy concepts, and those exposed to literacy demonstrations improved on reading measures. What children are exposed to may influence their interests and learning. Implications for early childhood education and parenting are discussed. GRAPHICAL ABSTRACT

Relationship between computational thinking and a measure of intelligence as a general problem-solving ability

Computational thinking – the ability to solve problems using concepts from computer science – has been widely discussed in the computer science education field. However, the relationship of computational thinking to intelligence – seen as the general ability to understand and solve complex problems – is contestable and has not been extensively explored. The present study addressed the question of how computational thinking is related to intelligence. To find an answer to this question, 71 pre-service teacher students completed a survey with 20 Bebras tasks as a measure of computational thinking and a non-verbal intelligence test (TONI-3) to assess their general problem-solving ability. The large and significant correlation of r(70) = .53, p < .001, indicates that both concepts are highly related. Implications of the findings are discussed, including the meaning of the relationship between computational thinking and intelligence during teaching and assessment, and the possibility of more holistic measures of computational thinking that incorporate procedural aspects.