Marily A. Oppezzo

A Behavior Change Perspective on Self-Regulated Learning with Teachable Agents

Producing lasting changes to metacognition, or the more encompassing construct of self-regulated learning (SRL), has strong parallels to producing behavior change. In the former case, the goal is to develop new “habits of mind,” and in the latter, the goal is to develop new “habits of behavior.” The techniques and theories of behavior change can inform the design of instruction intended to support the development and transfer of SRL. For example, we describe a set of studies in which teaching adolescents behavior change techniques improves their motivational control for both diet and homework goals. Behavior change theories often emphasize the stages of behavior change. We abstract from the various theories to present a four-stage model of behavior change. We then use the model to critique our own work on Teachable Agents. Teachable Agents are a software program where students learn by teaching a computerized pupil. We discuss the successes of the Teachable Agents in achieving SRL goals and improving learning for each stage of the model, but we also describe how Teachable Agents has missed possible opportunities to improve SRL outcomes based on the behavior change literature.

Effects of a methodological infographic on research participants’ knowledge, transparency, and trust.

Objective: Given participants’ research literacy is essential for clinical trial participation, evidence-based strategies are needed that improve literacy and easily accessed online. We tested whether an infographic letter–that illustrated how dropouts can distort study conclusions–improved participant knowledge about the impact of dropouts relative to a control letter. Method: In three distinct online samples purposely recruited to assess reproducibility, young ethnically diverse adults were randomized to read an infographic letter or control letter in a hypothetical scenario. Secondary outcomes included participants’ perceived transparency of the research organization, perceived value of retention, and perceived trust of the organization. We purposely included two discriminant items, perceived value for the trial outcome and keeping commitments in general, both hypothesized not to change. Results: Across samples, ∼20% more infographic participants correctly answered how dropouts affected study conclusions than control participants. For example (Experiment 3), nearly 90% of infographic participants correctly answered versus only two thirds of controls (88.7% vs. 66.7%, absolute percentage difference 22.0%, p < .0001). Infographic participants had substantially higher transparency, perceived value for retention, and trust (Cohen’s ds = 0.4–1.0, ps < .0001), yet importantly did not value the study outcome or report keeping commitments more than control participants (Cohen’s ds = 0.0–0.1, ps > .10). Conclusions: Promisingly, this transparent, visually powerful methodological infographic improved knowledge and trust. Future trials could embed and experimentally test whether such low-cost online infographics improve not only research literacy, but also trial retention, especially among populations with less initial trust about research.

The Healing and Empowering Alaskan Lives Toward Healthy-Hearts (HEALTHH) Project: Study protocol for a randomized controlled trial of an intervention for tobacco use and other cardiovascular risk behaviors for Alaska Native People

BACKGROUND Tobacco use and tobacco-related diseases disproportionately affect Alaska Native (AN) people. Using telemedicine, this study aims to identify culturally-tailored, theoretically-driven, efficacious interventions for tobacco use and other cardiovascular disease (CVD) risk behaviors among AN people in remote areas. DESIGN Randomized clinical trial with two intervention arms: 1) tobacco and physical activity; 2) medication adherence and a heart-healthy AN diet. PARTICIPANTS Participants are N = 300 AN men and women current smokers with high blood pressure or high cholesterol. INTERVENTIONS All participants receive motivational, stage-tailored, telemedicine-delivered counseling sessions at baseline and 3, 6, and 12 months follow-up; an individualized behavior change plan that is updated at each contact; and a behavior change manual. In Group 1, the focus is on tobacco and physical activity; a pedometer is provided and nicotine replacement therapy is offered. In Group 2, the focus is on medication adherence for treating hypertension and/or hypercholesterolemia; a medication bag and traditional food guide are provided. MEASUREMENTS With assessments at baseline, 3, 6, 12, and 18 months, the primary outcome is smoking status, assessed as 7-day point prevalence abstinence, biochemically verified with urine anabasine. Secondary outcomes include physical activity, blood pressure and cholesterol, medication compliance, diet, multiple risk behavior change indices, and cost-effectiveness. COMMENTS The current study has the potential to identify novel, feasible, acceptable, and efficacious interventions for treating the co-occurrence of CVD risk factors in AN people. Findings may inform personalized treatment and the development of effective and cost-effective intervention strategies for use in remote indigenous communities more broadly. Clinical Trial Registration # NCT02137902.

“You have the right to protect your health”: Perceptions of Secondhand Smoke and Exposure Mitigation Strategies in Low-Income Patients With Heart Disease, San Francisco, 2011–2012

We examined the understanding of the harms of secondhand smoke (SHS) exposure among low-income, hospitalized adults with cardiovascular disease. Participants were 15 nonsmokers reporting daily SHS exposure and 15 light or nondaily cigarette smokers. We coded responses from audiotaped semistructured interviews for themes. No participant spontaneously identified heart risks related to SHS exposure. Strategies to avoid SHS included verbal requests to not smoke and physically avoiding smoke; both smokers and nonsmokers prioritized politeness over urgency. Most participants thought a blood test quantifying SHS exposure would be clinically useful. Health education, assertiveness communication training, and protective policies (eg, smoke-free multiunit housing) also were supported.