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  • Tim Bickmore
  • COMPASS participant interacting with Carmen
  • Mean increase from first two weeks of program to last two weeks= 2029.9 + 2303.8 steps/day) (represents about a 50% increase in steps)
  • 5 of 7 processes changed significantly. 2 for which no posttest between-group difference existed were understanding the benefits of a physically active lifestyle and enlisting social support in one’s environment for physical activity.

 Mobile health2011 slide skingfinal Mobile health2011 slide skingfinal Presentation Transcript

  • Employing ‘Virtual Advisors’ to Promote Physical Activity in Underserved Communities: Results from the COMPASS Study Abby King, Tim Bickmore, Ines Campero, Leslie Pruitt, Langxuan Yin Stanford University School of Medicine Northeastern University NIH R21CA127511 © Stanford University
    • BACKGROUND
    • While electronically delivered ‘e-Health’ interventions have proliferated . . . • Few have targeted specific needs/preferences of older adults as well socioeconomically disadvantaged & ethnic minority populations © Stanford University
  • COMPASS Study - OBJECTIVES
    • Evaluate 4-month impacts on Walking of a ‘Virtual Advisor’, tailored in visual and auditory dimensions to inactive, low income Latino older adults
    • Experiment preceded by a year of formative research to culturally adapt intervention, study procedures
    • All study components occurred at a neighborhood senior center
  • Stanford Health Aging Studies Technology Team Tim Bickmore, Northeastern University
    • COMPASS
    • PARTICIPANTS
    • Low-income, ethnic minority older adults living in San Jose, CA (n = 40) (93% Latino; 72% women; ~50% with < high school education) • Ages 55 yrs & older (mean = 68 + 8 yrs) • Inactive (< 60 mins MVPA/wk), able to walk unaided (mean BMI = 30)
    • COMPASS
    • PHYSICAL ACTIVITY PROGRAM
    • Based on successful 2-mo ECA PA program aimed at older African Americans in Boston (Bickmore et al., 2005) • ECA (Embodied Conversational Agent): - Animated computer character simulating face-to-face counseling using speech, facial cues & other nonverbal behaviors - Interact with ECA through touching one of several conversation-based responses shown on computer screen (encouraged weekly interaction or whenever at Center)
  • (Culturally adapted, bi-lingual) © Stanford University Carmen
  •  
    • COMPASS
    • PHYSICAL ACTIVITY PROGRAM - continued
    • ‘ Carmen’ incorporated evidence-based cognitive & behavioral strategies • Some Personal information also programmed for each individual (e.g., favorite hobbies, family member names) • Program accessed using a PIN; housed on dedicated computer located at Senior Center
    • COMPASS
    • PHYSICAL ACTIVITY PROGRAM - continued
    • Downloadable Omron pedometer used to capture daily/weekly steps • ‘ Carmen’ used pedometer info to provide tailored feedback, advice
    • COMPASS
    • CONTROL PROGRAM
    • Adapted version of general health education workshops used in previous PA research • Monthly Age-relevant topics (no PA)
    • COMPASS
    • RESULTS
    Intervention participants: • Logged into program mean of 1.6 sessions/week (range = .35 – 2.3) • Mean of 27 total sessions across 4 months (range = 6 – 40) • Mean length of Virtual Advisor sessions = 7 minutes • 55 % interacted with Virtual Advisor in Spanish
  • COMPASS - RESULTS 4-mos Change in Minutes of Walking/Wk [CHAMPS] (N = 39) * * p < .0008 Reported Change in Mins/Wk 0 50 100 150 200 250 300 © Stanford University
  • 4-month Change in Daily Steps (Omron Pedometer) Intervention Participants (n = 20) * Slope analysis: p = .002; Spearman rho with CHAMPS walking items = .47 ( p =.04) Week 1 Week 16 Mean Daily Steps 0 3000 4000 5000 6000 7000 8000 COMPASS Study *
  • Baseline-adjusted mean * p < .03 vs. Control 0 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 Substituting Alternatives Rewarding Oneself Committing Oneself * * * * Control Reminding Oneself COMPASS 4-month Motivational Processes of Change * Understanding Risks
  • AFTER the 4-month Study Period . . . • ‘ Carmen’ remained in Senior Center for additional 20 weeks (in response to participant requests) • All but 1 intervention participant accessed ‘Carmen’ during this post-study period • Participants accessed ‘Carmen’ mean of 14 additional times (range of <1 to 4.5 times/week)
  • At 4-month Post-test, Intervention participants indicated that . . . • ‘ Carmen’ cared about them (average rating = 6.2 out of 7) • Felt close to ‘Carmen’ (average = 6 out of 7) • Trusted ‘Carmen’ (average = 6 out of 7) • Felt that length of talks with ‘Carmen’ was “just about right” • Were interested in continuing to work with ‘Carmen’
  • Conclusions • Intervention participants reported ~30 minute/day increase in usual walking activity relative to modest changes in controls by 4 months • Daily pedometer steps in last intervention month (~6800) generally commensurate with National Recs. in this age group
  • Conclusions - continued • Program was safe (no significant PA injuries) • Program found to be easy to use/engaging for this less educated, low computer-literate sample • 95% of intervention participants accessed the Virtual Advisor after the study ended
  • Next Steps • Expand community venues & populations in which to test ‘Carmen’, as well as lengthen time period e.g., clinics, pharmacies, libraries, recreation centers • Explore which subgroups may do better with Carmen vs. other intervention sources & delivery channels • Explore this technology further for other health behaviors
  • THANK YOU!