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mobile technology as a channel for health interventions Case Study: SMS triggering of deep breathing stress reduction habit in Stanford undergraduates. By Shuqiao Song habits.stanford.edu
About Me Human Biology | Designing for Behavior Change Communication | Communication Technologies Health + Technology + Design
Why think about stress reduction?
Because of this…
Mental Health: Managing Stress… What to do?
Smallest Behavior That Matters Deep Breathing
How to persuade students to develop habit of deep breathing?
A Model for Behavior Change Motivation + Ability + TRIGGERS = Behavior Change www.behaviormodel.org
…use SMS for triggering?!
Current Research Still relatively new… But, evidence shows that SMS interventions can work well.  (Cole-Lewis & Kershaw)  Mostly for disease management. Need more research and innovation using SMS fordisease prevention behaviors!
Let’s try this out!
Ideal User Experience
Shotgun User Testing 10 busy students.  7 days.  SMS.   And, deep breaths.
So, what happened? 10 created accounts. 7 responded to post-survey. 5 were able to post-intervention stress assessment.
Uh Oh… Some users having difficulty using the program early on. …iterate, use Google Voice to text message personal reminders to them
Did it work? In doing the behavior: 3 users took a deep breath each time they received the reminder! Overall, 67% rate of success in triggering behavior. In reducing stress: Pre and Post stress assessment survey (scale 1-48) On average, participants decreased stress level by 2 points…during FINALS week!
Some important findings though…
Mismatch in Expectation of Effort Most thought this would be simple For some it was extremely difficult and their participation became a source of anxiety! “It was stressful to sign up for the experiment” Why?
Interface Confusion Perception of Difficulty was very varible 4 users thought scheduling SMS was extremely difficult or did not schedule; 3 thought it was easy
But the idea has potential! “I had received the messages during finals week and it was sort of a uplifting moment for some reason. I'm not sure why. It's just not many people tell you personally ( in person or through YOUR cellphone not just a generalized email) to relax.” “[Felt] cared for.” “The reminders were cheerful. […] I liked them more because they came from someone I knew, a friend.”
So focus on Reducing Effort on their Part Personal Touch—from a friend as a light hearted and caring reminder, not a stress inducing reminder
Use mobile tech as a rapid prototyping tool! Best part of intervention was the rapid iteration of the project idea to use Google Voice text message! Other features to explore: MMS, voice calling, Internet connectivity
The potential of mHealth Personal, portable, connected, intelligent (Adler) Widely available, inexpensive, and instant  (Cole-Lewis & Kershaw) Use those features for… Trigger Social Support Reinforcement/Feedback
Tech Tools with Potential JITSR ViveCoach Frontline SMS Google Voice
Take Home Points Keep it simple!  Make the trigger source personal!
Thank you!

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Mobile Health Talk

  • 1. mobile technology as a channel for health interventions Case Study: SMS triggering of deep breathing stress reduction habit in Stanford undergraduates. By Shuqiao Song habits.stanford.edu
  • 2. About Me Human Biology | Designing for Behavior Change Communication | Communication Technologies Health + Technology + Design
  • 3. Why think about stress reduction?
  • 5. Mental Health: Managing Stress… What to do?
  • 6. Smallest Behavior That Matters Deep Breathing
  • 7. How to persuade students to develop habit of deep breathing?
  • 8. A Model for Behavior Change Motivation + Ability + TRIGGERS = Behavior Change www.behaviormodel.org
  • 9. …use SMS for triggering?!
  • 10. Current Research Still relatively new… But, evidence shows that SMS interventions can work well. (Cole-Lewis & Kershaw) Mostly for disease management. Need more research and innovation using SMS fordisease prevention behaviors!
  • 13. Shotgun User Testing 10 busy students. 7 days. SMS. And, deep breaths.
  • 14. So, what happened? 10 created accounts. 7 responded to post-survey. 5 were able to post-intervention stress assessment.
  • 15. Uh Oh… Some users having difficulty using the program early on. …iterate, use Google Voice to text message personal reminders to them
  • 16. Did it work? In doing the behavior: 3 users took a deep breath each time they received the reminder! Overall, 67% rate of success in triggering behavior. In reducing stress: Pre and Post stress assessment survey (scale 1-48) On average, participants decreased stress level by 2 points…during FINALS week!
  • 18. Mismatch in Expectation of Effort Most thought this would be simple For some it was extremely difficult and their participation became a source of anxiety! “It was stressful to sign up for the experiment” Why?
  • 19. Interface Confusion Perception of Difficulty was very varible 4 users thought scheduling SMS was extremely difficult or did not schedule; 3 thought it was easy
  • 20. But the idea has potential! “I had received the messages during finals week and it was sort of a uplifting moment for some reason. I'm not sure why. It's just not many people tell you personally ( in person or through YOUR cellphone not just a generalized email) to relax.” “[Felt] cared for.” “The reminders were cheerful. […] I liked them more because they came from someone I knew, a friend.”
  • 21. So focus on Reducing Effort on their Part Personal Touch—from a friend as a light hearted and caring reminder, not a stress inducing reminder
  • 22. Use mobile tech as a rapid prototyping tool! Best part of intervention was the rapid iteration of the project idea to use Google Voice text message! Other features to explore: MMS, voice calling, Internet connectivity
  • 23. The potential of mHealth Personal, portable, connected, intelligent (Adler) Widely available, inexpensive, and instant (Cole-Lewis & Kershaw) Use those features for… Trigger Social Support Reinforcement/Feedback
  • 24. Tech Tools with Potential JITSR ViveCoach Frontline SMS Google Voice
  • 25. Take Home Points Keep it simple! Make the trigger source personal!

Editor's Notes

  1. Classic Finals Week Stanford Student. Dedicated, but desperate. And while it’s funny to poke fun This problem scales up in a really dangerous way. This stress is really detrimental to student’s lives.“Stanford has offered me an unparalleled education for which I am most grateful; however, I feel that much of it has been at the expense of my emotional and physical health.”In 2006, American College Health Association survey of college students44% felt so depressed it was difficult to function15% reported receiving a diagnosis of depression in their lifetime12% have an anxiety disorder32% say that stress has negatively impacted their academic performanceBut what’s worse is there is a mentality that it’s weak to seek help, until it’s absolutely too late
  2. Mental Health and Managing Stress is a huge issue. What can we do?Let’s start with the most basic stress management skill
  3. Smallest Behavior that matters on the road to major behavior change
  4. Focus on innovating triggering methodologies
  5. Perfect for the audience since college students never leave without their phones
  6. In a recently published review of literature on SMS interventions, Based on primary outcomes of frequency of health behavior and clinical outcomesSeveral interventions provided sufficient evident to support effectiveness of text messaging as a tool for behavior change.Some of the behaviors:Weightloss, smoking cessation, and diabetes management.Effects appeared to exist among adolexcents and adults, among minority and nonminority populations, and acrsoss nationalities.
  7. John is a typicalStanford college student. Since it’s almost finals week, he’s been spending the majority of his days and nights in the library. Lately he’s been feeling extra on edge, even his friends noticed. Jenny decides to tell John about this cool program she just signed up for called “Just in Time Stress Relief”. It’s a great website with easy to do modules to help people gain basic stress management skills. Jenny tellls him the website also lets you schedule text reminders do simple stress busting exercises like “breathing from your belly”. John decides to check it out. He signs up for an account and schedules one reminder a night. He takes the initial stress test, it says he’s stressed. Obviously. He goes back to studying and forgets about it. Promptly at 9PM that night, he gets a text! Inhale Exhale. Wow that was pretty relaxing. Over the course of the next week, John practices deep breathing each time he receives a reminder. He feels much more relaxed during his study sessions now! Nex
  8. FROM USERS WHO RECEIVED GOOGLE VOICE TEXT MESSAGES FROM ME!
  9. Making these ideas USEFUL TO YOU!