Uptake And Usage Of Digital Self-Management Interventions: Triangulating Mixed Methods Studies Of A Weight Management Intervention
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Abstract
Background.
A key question for public health is how best to engage users cost-effectively with digital interventions. Two popular methods of encouraging greater engagement are to provide human support or to provide ‘just-in-time’ mobile intervention components.
Objective.
Our aim was to examine effects on uptake and usage of the web-based POWeR (Positive Online Weight Reduction) intervention a) when intermittent telephone support was provided and b) when mobile intervention components were provided.
Methods.
To test the effects of human support we trialed POWeR in a community public health setting, randomising users (n=786) to website only, website plus two telephone support sessions, or an 8 week waiting list. Telephone interviews were carried out with purposively sampled participants to elicit views and experiences of those who did and did not receive support. Quantitative follow-up finishes in March 2013 and automatic tracking of website usage ensures we will have complete data for our primary outcomes. Novel visualisation techniques are being used to identify patterns of usage and relate these to participant baseline characteristics. To test the effects of adding mobile intervention components we developed a Smartphone application that provides on-the-go access to key intervention components, and evaluated it in a series of intensive ‘n of 1’ studies, using an ABAB design to compare weeks when the app was or was not made available to supplement the web-based intervention. Experiences of the intervention were assessed by daily and weekly self-report questionnaire measures and weekly telephone interviews, and were analysed using novel modelling techniques for small samples.
Results.
The community rollout attracted a diverse sample of overweight/obese users. Qualitative interview data suggested that users who engaged with the coaching felt supported, accountable, and found it prompted a return to using POWeR after gaps in use. However, over half the participants in the coach arm refused or were unreachable for telephone contact. Qualitative findings from the ‘n of 1’ studies of supplementing the intervention with mobile phone usage indicated that many participants preferred using the app and found it a more convenient way to keep track of goals than the website, but no systematic effect of app availability on questionnaire outcome measures was observed. Time series data revealed large individual differences in patterns of app and website usage, related to lifestyle factors identified in the qualitative interviews.
Conclusions.
Although qualitative analyses of user views and experiences suggested many reasons why users might value and benefit from both telephone support and mobile intervention components, quantitative analyses suggested that these benefits may not reliably affect intervention usage and outcomes. Our understanding of user engagement with digital interventions can be enriched by triangulation of qualitative with quantitative methods, and intensive n-of-1 studies with large field trials.
A key question for public health is how best to engage users cost-effectively with digital interventions. Two popular methods of encouraging greater engagement are to provide human support or to provide ‘just-in-time’ mobile intervention components.
Objective.
Our aim was to examine effects on uptake and usage of the web-based POWeR (Positive Online Weight Reduction) intervention a) when intermittent telephone support was provided and b) when mobile intervention components were provided.
Methods.
To test the effects of human support we trialed POWeR in a community public health setting, randomising users (n=786) to website only, website plus two telephone support sessions, or an 8 week waiting list. Telephone interviews were carried out with purposively sampled participants to elicit views and experiences of those who did and did not receive support. Quantitative follow-up finishes in March 2013 and automatic tracking of website usage ensures we will have complete data for our primary outcomes. Novel visualisation techniques are being used to identify patterns of usage and relate these to participant baseline characteristics. To test the effects of adding mobile intervention components we developed a Smartphone application that provides on-the-go access to key intervention components, and evaluated it in a series of intensive ‘n of 1’ studies, using an ABAB design to compare weeks when the app was or was not made available to supplement the web-based intervention. Experiences of the intervention were assessed by daily and weekly self-report questionnaire measures and weekly telephone interviews, and were analysed using novel modelling techniques for small samples.
Results.
The community rollout attracted a diverse sample of overweight/obese users. Qualitative interview data suggested that users who engaged with the coaching felt supported, accountable, and found it prompted a return to using POWeR after gaps in use. However, over half the participants in the coach arm refused or were unreachable for telephone contact. Qualitative findings from the ‘n of 1’ studies of supplementing the intervention with mobile phone usage indicated that many participants preferred using the app and found it a more convenient way to keep track of goals than the website, but no systematic effect of app availability on questionnaire outcome measures was observed. Time series data revealed large individual differences in patterns of app and website usage, related to lifestyle factors identified in the qualitative interviews.
Conclusions.
Although qualitative analyses of user views and experiences suggested many reasons why users might value and benefit from both telephone support and mobile intervention components, quantitative analyses suggested that these benefits may not reliably affect intervention usage and outcomes. Our understanding of user engagement with digital interventions can be enriched by triangulation of qualitative with quantitative methods, and intensive n-of-1 studies with large field trials.
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