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Eric Hekler, PhD
School of Nutrition and Health Promotion
        Arizona State University
Collaborators
      Abby King
     Frank Chen
   Shauna Shapiro
   Matthew Buman
    Lauren Grieco
     Sandi Winter
   Jesse Cirimele
    Tom Robinson
   Banny Banerjee
Outline
   The Problem

   Testing commercial apps

   Commercial products as “Hacks”

   Agile Science
Outline
   The Problem

   Testing commercial apps

   Commercial products as “Hacks”

   Agile Science
We want interventions that are:
    Evidence-based

    Cost-effective
    Tailored

    Easy to disseminate

    Promote maintenance
500,000th App
                                                                 Accepted on
                                                                 App Store




 2005        2006        2007      2008   2009       2010     2011     2012



Conceive        Submit
                                          Conduct the study
of a study      Grant


    Gather               Receive                              Submit publications
   Pilot Data            Funding                                 for review
In less time than it takes to complete a
standard R01, the app store has gone from
nonexistent to over 500,000 apps.
Who’s doing which piece?
   Evidence-based           Cost-effective

   Promote maintenance      Easy to disseminate

   Tailored                 Tailored?




Academia                  Industry
What to do?
   New methods for fast efficacy testing?

   Partner w/ business and use their data?

   Create new methods for development?

   Other strategies?
What to do?
   New methods for fast efficacy testing?

   Partner w/ business and use their data?

   Create new methods for development?

   Other strategies?
Outline
   The Problem

   Testing commercial apps

   Commercial products as “Hacks”

   Agile Science
Testing Commercial Apps
(Examples)
    Calorific     Mindfulness Bell
Calorific Test
                See full details at tonight’s
                 poster session (C-89).

                Compared this app to
                 custom apps we developed
                 focused on PA (see other
                 poster tonight; C-156).

                8-week study with 36
                 participants (older adults,
                 naïve to using smartphones)
Calorific Results
                           12


                           10


                            8
∆Consumption servings/wk




                            6


                            4


                            2

                                                                                                       Control
                            0

                                                                                                       Intervention
                           -2
                                Vegetables   Fruits   Processed   Sweets   Fatty Meats   Fatty Dairy
                                                        Foods
                           -4


                           -6
Mindfulness Bell Test
               RCT comparing
                 Mindfulness training (conducted
                  by Shauna Shapiro) and
                  Mindfulness Bell App
                 Assessment-only control


               Population: College students

               8-week study with
                approximately 20 per arm
Mindfulness Bell Preliminary
Results
                No differences with any
                 variable measured including:
                  Mindfulness practices
                  Stress
                  Subjective Happiness
                  Self-compassion
                  Physical Activity
                  Healthful Eating
Key findings from both
   Apps we tested did not indicate much utility
    (though, definitely could be due to sample size)

   Both apps changed repeatedly during the
    intervention trials
     4 updates for Calorific
     2 for Mindfulness Bell, one including name change; it
      used to be called Zen Reminder

   For both, we received very positive feedback that
    they “worked” (i.e., the feedback often reported in
    the app store ratings)
Implications
   Apps are often changing so quickly that
    they may easily change during your trial

   Good reviews do not necessarily translate
    to behavior change

   Regardless of outcomes, apps offer a very
    quick “hack” for testing behavioral ideas
Outline
   The Problem

   Testing commercial apps

   Commercial products as “Hacks”

   Agile Science
“Hacking” behavioral
science
   Quick tests of commercial apps
     Already discussed


   Designing Health Behavior Change
    Interventions Class

   Data visualization “hack”
Designing Health Behavior
Change Interventions
   Grad level class  evidence-informed interventions
     theory, qualitative research methods; survey selection and
        development; experimental design, and prototyping (see McClain
        poster tonight on prototyping)
 Key focus is on identifying assumption/hypotheses and then
  devising the most rapid way of testing that assumption via a
  prototype
 Key preexisting technologies that foster “hacking”
       Gmail (Free SMS from a computer)
       Apps (e.g., Handcent SMS for automating text sends)
       Twitter/Facebook (easy for quick polls on ideas)
       Google Docs
       Bit.ly
   See “hacks” at http://www.slideshare.net/DesigningHealth/
The Stanford Healthy
                 Neighborhood Discovery Tool
      Harness technology to improve
       neighborhood designs for
       physical activity and healthful
       nutrition
      Engage seniors as auditors and
       advocates
      Crowd-sourcing




Buman, Winter, Sheats, Hekler, Otten, Grieco, & King, April 2012, Society of Behavioral Medicine
Data visualizations for
         policymakers




How far out did they
venture?

1.0 ± 0.6 km (.62 miles)
Data visualizations for
policymakers
Outline
   The Problem

   Testing commercial apps

   Commercial products as “Hacks”

   Agile Science
The Agile Manifesto (highlights)
 Our highest priority is to satisfy the
  customer through early and continuous
  delivery of valuable software.
 Welcome changing requirements, even
  late in development. Agile processes
  harness change for the customer's
  competitive advantage.




          http://agilemanifesto.org/principles.html
The Agile Manifesto (highlights)
 Deliver working software
  frequently, from a couple of weeks to a
  couple of months, with a preference to
  the shorter timescale.
 Business people and developers must
  work together daily throughout the
  project.




          http://agilemanifesto.org/principles.html
We want interventions that are:
    Evidence-based

    Cost-effective
    Tailored

    Easy to disseminate

    Promote maintenance
Agile Science – beta
   Beyond efficacy and cost-effectiveness, time-effectiveness
    also needs to play a central role methods decisions.
   Key Principles
     Utilize the fastest methods for getting funding, particularly when
      piloting.
      ○ Crowd-funding?
     Utilize the most time-effective formative research methods
      ○ User Experience Design? (McClain, Hekler, et al poster, C-087)
     Create, test, and iterate w/ Minimal Viable Products
      ○ “Hacks” (See Lean Startup book by Eric Reis)
     Use a variety of dissemination channels
      ○ CHI 2012 Conference; Blogs? Wikis?
     Use business to disseminate evidence-based work
We need to stop sacrificing good enough at
the altar of perfection.
Reactions? Let’s figure this out!


                Eric Hekler
        Designing Health Lab @ASU
             Twitter: @ehekler
             ehekler@asu.edu

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Hekler sbm 2012_friday_symposium_final

  • 1. Eric Hekler, PhD School of Nutrition and Health Promotion Arizona State University
  • 2. Collaborators Abby King Frank Chen Shauna Shapiro Matthew Buman Lauren Grieco Sandi Winter Jesse Cirimele Tom Robinson Banny Banerjee
  • 3. Outline  The Problem  Testing commercial apps  Commercial products as “Hacks”  Agile Science
  • 4. Outline  The Problem  Testing commercial apps  Commercial products as “Hacks”  Agile Science
  • 5. We want interventions that are:  Evidence-based  Cost-effective  Tailored  Easy to disseminate  Promote maintenance
  • 6. 500,000th App Accepted on App Store 2005 2006 2007 2008 2009 2010 2011 2012 Conceive Submit Conduct the study of a study Grant Gather Receive Submit publications Pilot Data Funding for review
  • 7. In less time than it takes to complete a standard R01, the app store has gone from nonexistent to over 500,000 apps.
  • 8. Who’s doing which piece?  Evidence-based  Cost-effective  Promote maintenance  Easy to disseminate  Tailored  Tailored? Academia Industry
  • 9. What to do?  New methods for fast efficacy testing?  Partner w/ business and use their data?  Create new methods for development?  Other strategies?
  • 10. What to do?  New methods for fast efficacy testing?  Partner w/ business and use their data?  Create new methods for development?  Other strategies?
  • 11. Outline  The Problem  Testing commercial apps  Commercial products as “Hacks”  Agile Science
  • 12. Testing Commercial Apps (Examples) Calorific Mindfulness Bell
  • 13. Calorific Test  See full details at tonight’s poster session (C-89).  Compared this app to custom apps we developed focused on PA (see other poster tonight; C-156).  8-week study with 36 participants (older adults, naïve to using smartphones)
  • 14. Calorific Results 12 10 8 ∆Consumption servings/wk 6 4 2 Control 0 Intervention -2 Vegetables Fruits Processed Sweets Fatty Meats Fatty Dairy Foods -4 -6
  • 15. Mindfulness Bell Test  RCT comparing  Mindfulness training (conducted by Shauna Shapiro) and Mindfulness Bell App  Assessment-only control  Population: College students  8-week study with approximately 20 per arm
  • 16. Mindfulness Bell Preliminary Results  No differences with any variable measured including:  Mindfulness practices  Stress  Subjective Happiness  Self-compassion  Physical Activity  Healthful Eating
  • 17. Key findings from both  Apps we tested did not indicate much utility (though, definitely could be due to sample size)  Both apps changed repeatedly during the intervention trials  4 updates for Calorific  2 for Mindfulness Bell, one including name change; it used to be called Zen Reminder  For both, we received very positive feedback that they “worked” (i.e., the feedback often reported in the app store ratings)
  • 18. Implications  Apps are often changing so quickly that they may easily change during your trial  Good reviews do not necessarily translate to behavior change  Regardless of outcomes, apps offer a very quick “hack” for testing behavioral ideas
  • 19. Outline  The Problem  Testing commercial apps  Commercial products as “Hacks”  Agile Science
  • 20. “Hacking” behavioral science  Quick tests of commercial apps  Already discussed  Designing Health Behavior Change Interventions Class  Data visualization “hack”
  • 21. Designing Health Behavior Change Interventions  Grad level class  evidence-informed interventions  theory, qualitative research methods; survey selection and development; experimental design, and prototyping (see McClain poster tonight on prototyping)  Key focus is on identifying assumption/hypotheses and then devising the most rapid way of testing that assumption via a prototype  Key preexisting technologies that foster “hacking”  Gmail (Free SMS from a computer)  Apps (e.g., Handcent SMS for automating text sends)  Twitter/Facebook (easy for quick polls on ideas)  Google Docs  Bit.ly  See “hacks” at http://www.slideshare.net/DesigningHealth/
  • 22. The Stanford Healthy Neighborhood Discovery Tool  Harness technology to improve neighborhood designs for physical activity and healthful nutrition  Engage seniors as auditors and advocates  Crowd-sourcing Buman, Winter, Sheats, Hekler, Otten, Grieco, & King, April 2012, Society of Behavioral Medicine
  • 23. Data visualizations for policymakers How far out did they venture? 1.0 ± 0.6 km (.62 miles)
  • 25. Outline  The Problem  Testing commercial apps  Commercial products as “Hacks”  Agile Science
  • 26. The Agile Manifesto (highlights)  Our highest priority is to satisfy the customer through early and continuous delivery of valuable software.  Welcome changing requirements, even late in development. Agile processes harness change for the customer's competitive advantage. http://agilemanifesto.org/principles.html
  • 27. The Agile Manifesto (highlights)  Deliver working software frequently, from a couple of weeks to a couple of months, with a preference to the shorter timescale.  Business people and developers must work together daily throughout the project. http://agilemanifesto.org/principles.html
  • 28. We want interventions that are:  Evidence-based  Cost-effective  Tailored  Easy to disseminate  Promote maintenance
  • 29. Agile Science – beta  Beyond efficacy and cost-effectiveness, time-effectiveness also needs to play a central role methods decisions.  Key Principles  Utilize the fastest methods for getting funding, particularly when piloting. ○ Crowd-funding?  Utilize the most time-effective formative research methods ○ User Experience Design? (McClain, Hekler, et al poster, C-087)  Create, test, and iterate w/ Minimal Viable Products ○ “Hacks” (See Lean Startup book by Eric Reis)  Use a variety of dissemination channels ○ CHI 2012 Conference; Blogs? Wikis?  Use business to disseminate evidence-based work
  • 30. We need to stop sacrificing good enough at the altar of perfection.
  • 31. Reactions? Let’s figure this out! Eric Hekler Designing Health Lab @ASU Twitter: @ehekler ehekler@asu.edu

Editor's Notes

  • #6: To quickly summarize a very large field of work and focus the discussion for today…although there have been some fantastic interventions developed for promoting health behaviors in the field, including several successful interventions developed here; we still need to identify health promotion interventions that are evidence-based, cost-effective, tailored, easy to disseminate, and promote maintenance. As a clinical health psychologist, I believe that a key way to do this is to gain a better understanding of the theories that drive behavior change interventions.
  • #9: To quickly summarize a very large field of work and focus the discussion for today…although there have been some fantastic interventions developed for promoting health behaviors in the field, including several successful interventions developed here; we still need to identify health promotion interventions that are evidence-based, cost-effective, tailored, easy to disseminate, and promote maintenance. As a clinical health psychologist, I believe that a key way to do this is to gain a better understanding of the theories that drive behavior change interventions.
  • #29: To quickly summarize a very large field of work and focus the discussion for today…although there have been some fantastic interventions developed for promoting health behaviors in the field, including several successful interventions developed here; we still need to identify health promotion interventions that are evidence-based, cost-effective, tailored, easy to disseminate, and promote maintenance. As a clinical health psychologist, I believe that a key way to do this is to gain a better understanding of the theories that drive behavior change interventions.