Technology and public health interventions

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  • First, technology-based interventions are scalable and cost effective. There are fewer personnel and infrastructure costs 27. Second, technology-based interventions lack many of the access issues of traditional interventions including competition for time among other activities. People who live in areas without nearby smoking cessation programs are able to easily access programs on the Internet or via cell phone. Third, computer technology allows the tailoring of the program to the individual’s motivations for behavior change (e.g., health), demographic characteristics (e.g., sex), and stage of behavior change (e.g., planning, relapse) 28-30.
  • Smoking: ONLINE:Strecher et al. 54 recruited participants through advertisements inserted in nicotine patch products. Researchers report a 53% retention rate at 6-weeks and 43% retention rate at 3-months. Stoddard et al. 51 report a 43% retention rate at 1 month using an Internet-based recruitment strategy. Using a combination recruitment strategy, Feil et al. 52 report a 56% retention rate at 3-months. TEXT MESSAGINGRodgers et al. 11 report a 74% retention rate at 6-monthsWe had an 80.5% response rate at 3-monthsHIVONLINEBull: 15% response rate at Ybarra: 93% at 6 months (in Uganda)
  • Smoking: ONLINE:Strecher et al. 54 recruited participants through advertisements inserted in nicotine patch products. Researchers report a 53% retention rate at 6-weeks and 43% retention rate at 3-months. Stoddard et al. 51 report a 43% retention rate at 1 month using an Internet-based recruitment strategy. Using a combination recruitment strategy, Feil et al. 52 report a 56% retention rate at 3-months. TEXT MESSAGINGRodgers et al. 11 report a 74% retention rate at 6-monthsWe had an 80.5% response rate at 3-monthsHIVONLINEBull: 15% response rate at Ybarra: 93% at 6 months (in Uganda)
  • 95% of participants completed 3-month follow-up and 93% 6-month follow-up assessments. At 6-months post-intervention, among youth sexually active at baseline, those in the intervention + booster showed trends of reduced likelihood of recent sexual activity in the past 3 months (20%) versus those in the no booster intervention (43%) or control groups (45%; χ2(2)= 3.9, p=0.15). Among abstinent youth at baseline who reported recent sexual intercourse at 6-months follow-up, those in the intervention+ booster arm averaged fewer unprotected sex acts (16% of sex acts) compared to the no booster intervention (20% of sex acts) and control groups (28% of sex acts; F(2) = 0.23, p=.79).
  • 80% response rate at 3 months 40% of intervention smokers were quit at 12-weeks versus 30% or control participants(aRR = 1.5, 95% CI: 0.72, 3.0)
  • Program launched in 2006Compared to two control cities, African American and Black youth in the two intervention cities had: improved normative condom-use negotiation expectancies and increased sex refusal self-efficacy. Older adolescents (aged 16–17 years) had a less risky age trajectory of unprotected sex(see http://www.annenbergpublicpolicycenter.org/ShowPage.aspx?myID62 for copies of the advertisements).
  • Technology and public health interventions

    1. 1. APPC Conference 2012: Media and the Well-Being of Children and Adolescents The Annenberg Public Policy Center, University of Pennsylvania Enhancing Opportunities for Positive Youth Development April 13, 2012, 10:30 – 12:15 Technology and public health interventions Michele Ybarra MPH PhD Center for Innovative Public Health Research * Thank you for your interest in this presentation. Please note that analyses included herein are preliminary. More recent, finalized analyses may be available by contacting CiPHR for further information.
    2. 2. Advantages of using technology  Allows us to go where youth ‘are’ instead of expecting them to come to us  Can tailor the intervention to the individual without loosing program fidelity  Overcomes barriers to uptake with which traditional interventions struggle (e.g., transportation; scheduling and time constraints)  Exposes person to important health information anonymously  Programs are scalable and cost effective (once developed)
    3. 3. Disadvantages of using technology  It’s tempting to try to use technology for *everyone* in *every* case  Requires self-motivation to first look for the information, and to subsequently come back to complete the intervention: ◦ Follow-up rates (for online programs especially) are lower than those for inperson interventions ◦ Need to think about *why* the young person would be self-interested in the health behavior change
    4. 4. Disadvantages of using technology  Ethical issues (e.g., identifying and referring youth in crisis; unintentional disclosure of tracking / usage data)  High development costs make it difficult to get pilot data for larger trials  It’s challenging to determine what is a fad and what is transcendent (i.e., testing last year’s Big Thing vs. anticipating trends and developing the program ahead of the curve so its ready and waiting)
    5. 5. Technology in public health: CyberSenga
    6. 6. Technology in public health: CyberSenga
    7. 7. Technology in public health: SMS USA
    8. 8. Technology in public health: Additional examples      Acosta: Mobile web-based psychosocial intervention for people in methadone maintenance treatment (R01DA029630) Belzer : cell phones reminders for adherence to HIV drugs among adolescents (5U01HD040463) Bull: text messaging-based HIV prevention program for Black and African American 1620 year olds (5R21MH083318) Cornelius: using text messaging to deliver ‘boosters’ for an adolescent HIV prevention program (5R21NR011021) Olsen: text messaging to promote physical activity in adolescents (1R21HS018214)
    9. 9. Technology in public health: Don’t forget traditional media
    10. 10. Conclusion  Technology-based interventions combine the wide reach of mass media campaigns with the individual, tailored approach of clinical interventions.  At the same time, technology is not a panacea and should not be seen as the go-to answer for all prevention and intervention efforts.  Understanding when, why, and how to use technology is integral for today’s public health professionals.
    11. 11. Michele Ybarra MPH PhD Michele Ybarra MPH PhD http://www.InnovativePublicHealth.org http://www.InnovativePublicHealth.org Michele@InnovativePublicHealth.org Michele@InnovativePublicHealth.org
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