Eduardo L. Bunge

Massive Open Online Interventions A Novel Model for Delivering Behavioral-Health Services Worldwide

Massive open online interventions (MOOIs) have the potential to increase the reach, scalability, and affordability of psychological interventions. This article reports on an extension of a proof-of-concept participant-preference smoking-cessation trial conducted in the form of a MOOI. This resource was available in Spanish and English for 30 months, and a total of 292,978 individuals from 168 countries visited the site. This report presents data on the last 18 months of recruitment during which 27,163 participants were screened for eligibility, 8,881 signed consent, and 7,407 completed the baseline survey. Observed quit rates were 39.2%, 43.5%, 45.7%, and 50.3%, respectively, at 1, 3, 6, and 12 months; at the same time intervals, the missing=smoking quit rates were 7.6%, 5.7%, 4.8%, and 5.5%. Results suggest that MOOIs have the potential to provide people worldwide with evidence-based behavioral interventions. The authors conclude that MOOIs should become an integral part of global health efforts.

Microinterventions produce immediate but not lasting benefits in mood and distress

Untreated depression remains one of the largest public health concerns. However, barriers such as unavailability of mental health providers and high cost of services limit the number of people able to benefit from traditional treatments. Though unsupported Internet interventions have proven effective at bypassing many of these barriers given their reach and scalability, attrition from interventions has been an ongoing concern. Microinterventions, or ultra-brief online tools meant to produce a rapid improvement in mood, may offer a way to provide the benefits of unsupported Internet interventions quickly, before attrition might occur. This study examined the immediate and lasting effects of three microinterventions (breathing exercises, thought records, and a pleasant activities selector) on mood and distress. Participants (N = 122) were randomized into three groups, each group completing two of the three microinterventions. Participants were asked to rate their mood and level of distress before and after completing the microintervention. Depression and perceived stress were assessed at baseline and at four weekly follow-ups. Although lasting effects were not found, a significant within-group reduction in distress and improvement in mood were observed immediately following the completion of the microintervention. This study demonstrates the potential benefits of microinterventions to individuals for their immediate needs vis-à-vis mood and distress.

The impact of phone calls on follow-up rates in an online depression prevention study

Background Automated Internet intervention studies have generally had large dropout rates for follow-up assessments. Live phone follow-ups have been often used to increase follow-up completion rates. Objective To compare, via a randomized study, whether receiving phone calls improves follow-up rates beyond email reminders and financial incentives in a depression prevention study. Method A sample of 95 participants (63 English-speakers and 32 Spanish-speakers) was recruited online to participate in a “Healthy Mood” study. Consented participants were randomized to either a Call or a No Call condition. All participants were sent up to three email reminders in one week at 1, 3, and 6 months after consent, and all participants received monetary incentives to complete the surveys. Those in the Call condition received up to ten follow-up phone calls if they did not complete the surveys in response to email reminders. Results The follow-up rates for Call vs. No Call conditions at 1, 3, and 6 months, respectively, were as follows: English speakers, 58.6% vs. 52.9%, 62.1% vs. 52.9%, and 68.9% vs. 47.1%; Spanish speakers, 50.0% vs. 35.7%, 33.3% vs. 21.4%, and 33.3% vs. 7.1%. The number of participants who completed follow-up assessments only after being called at 1-, 3- and 6 months was 2 (14.3%), 0 (0%), and 3 (25.0%) for English speakers, and 2 (18.9%), 0 (0%), and 1 (7.7%) for Spanish speakers. The number of phone calls made to achieve one completed follow-up was 58.8 in the English sample and 57.7 and Spanish-speaking sample. Conclusions Adding phone call contacts to email reminders and monetary incentives did increase follow-up rates. However, the rate of response to follow-up was low and the number of phone calls required to achieve one completed follow-up raises concerns about the utility of adding phone calls. We also discuss difficulties with using financial incentives and their implications.

Information Systems and Technology

Immigrant youths often struggle with a variety of mental and physical challenges associated with moving to a new country. These challenges can be adaptively confronted through digital communication and information technology (CIT) particularly for those who are digitally native and capable of navigating electronic systems. This chapter first defines the ways in which CIT can increase the reach and capability of psychotherapy when working with immigrant youth and, finally, an exploration of the potential risks and ethical issues, which may develop when these interventions are provided.

Using Behavioral Intervention Technologies to Help Low-Income and Latino Smokers Quit: Protocol of a Randomized Controlled Trial

Background The Institute for International Internet Interventions for Health at Palo Alto University proposes to develop digital tools specifically to help low-income English- and Spanish-speaking smokers to quit. Individuals from lower-income countries and those with lower social status quit at lower rates than those from high-income countries and those with higher social status. Objective We plan to launch a project designed to test whether a mobile-based digital intervention designed with systematic input from low-income English- and Spanish-speaking smokers from a public-sector health care system can significantly improve its acceptability, utilization, and effectiveness. Methods Using human-centered development methods, we will involve low-income patients in the design of a Web app/text messaging tool. We will also use their input to improve our recruitment and dissemination strategies. We will iteratively develop versions of the digital interventions informed by our human-centered approach. The project involves three specific aims: (1) human-centered development of an English/Spanish smoking cessation web app, (2) improvement of dissemination strategies, and (3) evaluation of resulting smoking cessation web app. We will develop iterative versions of a digital smoking cessation tool that is highly responsive to the needs and preferences of the users. Input from participants will identify effective ways of reaching and encouraging low-income English- and Spanish-speaking smokers to use the digital smoking cessation interventions to be developed. This information will support ongoing dissemination and implementation efforts beyond the grant period. We will evaluate the effectiveness of the successive versions of the resulting stop smoking Web app by an online randomized controlled trial. Increased effectiveness will be defined as increased utilization of the Web app and higher abstinence rates than those obtained by a baseline usual care Web app. Results Recruitment will begin January 2016, the study is intended to be completed by summer 2018, and the results should be available by fall 2019. Conclusions This study will provide useful knowledge in developing, testing, and disseminating mobile-based interventions for low-income smokers. ClinicalTrial ClinicalTrials.gov NCT02666482; https://clinicaltrials.gov/ct2/show/NCT02666482 (Archived by WebCite at http://www.webcitation.org/6gtcwaT28)