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Pilot and Feasibility Test
of a Mobile Health-
Supported Behavioral
Counseling Intervention
for Weight Management
Among Br...
Pilot and Feasibility Test of a Mobile Health-
Supported Behavioral Counseling Intervention for
Weight Management Among Br...
Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Bre...
Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Bre...
Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Bre...
Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Bre...
Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Bre...
Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Bre...
Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Bre...
Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Bre...
Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Bre...
Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Bre...
Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Bre...
Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Bre...
Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Bre...
Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Bre...
Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Bre...
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Pilot and Feasibility Test of a Mobile Health Counseling Intervention for Weight Management Among Breast Cancer Survivors

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2016년 6월 2일자 발제 내용

유방암 환자들을 대상으로 체중 관리 프로그램을 진행, 여러 유형의 개입을 제공했을 때 나타나는 결과를 살펴보았습니다.

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Pilot and Feasibility Test of a Mobile Health Counseling Intervention for Weight Management Among Breast Cancer Survivors

  1. 1. Pilot and Feasibility Test of a Mobile Health- Supported Behavioral Counseling Intervention for Weight Management Among Breast Cancer Survivors + JMIR, 2016 - Quintiliani, L. et al. / 송지은 x 2016 Spring
  2. 2. Pilot and Feasibility Test of a Mobile Health- Supported Behavioral Counseling Intervention for Weight Management Among Breast Cancer Survivors Lisa M Quintiliani, PhD., Boston University, Department of Medicine, Section of General Internal Medicine, Devin M Mann, MD, MS, Boston University, Department of Medicine, Section of Preventive Medicine and Epidemiology Marissa Puputti, B.S., Boston University, Department of Medicine, Section of General Internal Medicine, Emily Quinn, M.A., Boston University, School of Public Health, Data Coordinating Center Deborah J Bowen, PhD, University of Washington, School of Medicine, Department of Bioethics & Humanities JMIR CANCER 2016 Spring 2016 | SNU UXLAB Ji Eun Song
  3. 3. Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Breast Cancer Survivors SNU UXLAB | Ji Eun Song 3 WHY THIS PAPER 3. JMIR 에서는 accept 하고 있다! 1. 2016년인데... 2. 사람이 인터페이스가 되는 ‘체중 개입 프로그램’이... ==> 그렇다면 PHR sugarcoating 으로서의 체중 데이터도?...!! 0. PHR 암재활에서도 체중을 쟀었는데....
  4. 4. Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Breast Cancer Survivors SNU UXLAB | Ji Eun Song 4 ABSTRACT Before After engagement (use and acceptability) behavioral (diet and physical activity) physiological (weight) secondary outcomes daily text4 interview sessions w/ nonprofessionally trained counselor 10 women avg. age 59 50% racial/ethnic minority 50% some college or less 40% health insurance wristband pedometer 64days weight scale 45days responding to text msg 60days 4 calls completed very likely to participate again (90%) weight decreased fruit/vegetable daily serving increased self-reported moderate physical activity increased10 weeks (70 days)
  5. 5. Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Breast Cancer Survivors SNU UXLAB | Ji Eun Song 5 INTRODUCTION 건강한 몸무 게를 유지하고 주중 150분 정 도의 유산소 와 근력운동 을 하고 채소, 과일, 곡 류 등의 식단 을 짤 것! 미국 암 학회에서 제안하는 암 생존자들을 위한 가이드라인에 따르면.... 이를 유지할 만한 보편적이고, 비용이 많이 들지 않으며, 유지가능한 프로그램이 존재하지 않는다는 것이 현실 그러나
  6. 6. Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Breast Cancer Survivors SNU UXLAB | Ji Eun Song 6 INTRODUCTION mHealth의 배경 스마트폰 사용의 보편화 스마트폰과 무선 센서의 발전 더 다양한 e헬스 기술과 활용에 대한 수요 mHealth의 현시점 다양한 유형의 인터벤션을 기획하고 있으 나, 실제로 기술을 활용한 사례는 찾기 어 려움 기술, 매체를 활용한 인터벤션 사례 조사: 27건 중 3건은 웹 문자활용은 0건 전화도 0건.... 웹, 문자, 전화를 넘어 더 새로운 기술을 활용해야 한다는 의견들이 나오고 있음
  7. 7. Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Breast Cancer Survivors SNU UXLAB | Ji Eun Song 7 INTRODUCTION 본 연구의 접근방법 : (결국) 사람이 전달하는 방식의 행동 개입이 체중 관련 행동으로 이어질 수 있도록 여러 m헬스 전략 을 활용 본 연구의 목적 : 인게이지먼트 (활용/수용성); 생리적(체중); 행동적(다이어트와 신체 활동); 심리적 (자기 효능감, 인식된 스트레스, 사회적 서포트, 수면, 피로, 식이제어) 결과가 나올 수 있는 m헬스 개입의 체중 관리를 평가함
  8. 8. Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Breast Cancer Survivors SNU UXLAB | Ji Eun Song 8 METHODS 스터디 설계 구성 피드백 (사전예비조사) : 여러 m헬스 전략을 이용하여 인간이 카운셀링하는 형태의 행동 개입의 사전적 효능성/ 실행 가능성을 살펴보 기 위해 단일 그룹의 파일럿 스터디 + pre/post 평가로 실시 : 파일럿 실험을 진행하기 전 4명의 여성에게 사전 인터뷰 조사를 토대로 m헬스 개입 디자인 피처 도출 인터뷰 참여자의 경우 평균 62.3세 / BMI 33.5kg/m2 / 히스패닉 2명; 흑인 1명; 백인 1명 사전 조사 결과, - 교육/문화 정보를 비롯해 커뮤니티 등의 소셜 서포트 관련 정보를 제공하고, 더 많은 정보를 얻기 위해 인터넷에서 검색하거나 앱 활용을 유도하는 형태의 m헬스 개입이 마련되어야 한다는 결론 - 식이 섭취에 대한 참여자들의 기억은 정확하지 않으며, - 카운셀러와 참여자간의 적절한 인터랙션 횟수를 설정하는 것이 중요
  9. 9. Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Breast Cancer Survivors SNU UXLAB | Ji Eun Song 9 METHODS 리크루팅/참여자 개입 - 리크루팅 방식: 1) 대학가 웹사이트, 2) 이메일, 3) 사전조사 참여자, 4) 유방암 환자 커뮤니티, 5) 전단지, 6) 크레이 그리스트 - 리크루팅 조건: 18세 이상, 영어 구사, 여성, 암진단 받은지 2년 이상, 암 치료가 끝난지 6개월 이상, BMI는 25kg/m2 이상 집에 무선 인터넷이 잡히며, 스마트폰을 활용 - 리크루팅 과정: 병원 스태프가 키와 체중을 재며, 핏빗 계정 정보 제공 동의를 얻은 뒤 스마트폰 친숙도를 확인 - 10주간 4번 설문을 실시했으며, 설문을 완료할 때마다 20$ 제공, 실험이 끝난 뒤 기기(핏빗, 체중계) 제공 자가-모니터링할 수 있는 장치들 : 1)체중계, 2)팔에다 감는 측정기, 3) 카운셀러으로부터 받을 수 있는 폰 카운셀링
  10. 10. Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Breast Cancer Survivors SNU UXLAB | Ji Eun Song 10 METHODSIntervention component 1. Self-monitoring Daily text messages sent to ascertain participants’ dietary intake immediately after enrollment and for the next 10 weeks. Each message was the same and contained 5 questions that prompted a yes or no response or a numerical value. Responses from the messages were recorded and conveyed to the health counselor to assist in the counseling sessions. Messages corresponded to content in the telephone counseling sessions. Questions: • Did you eat more than one high-calorie snack? • Did you eat food from a restaurant or fast-food place? • Did you drink more than one sugary drink? • Did you eat until you were uncomfortably full? • How many servings of fruits & vegetables did you eat? 2. Automatic weight and behavioral monitoring Weight scale: Participants were asked to record their body weight daily using Fitbit Aria [18,19]. Wristband pedometer: Participants were asked to wear the wristband daily to track their steps and hours of sleep by wearing the Fitbit Flex wristband. Weight, steps, and sleep recordings were synchronized through WiFi (weight) or via cellular Bluetooth (steps & sleep) connections to the participants' Fitbit app installed on their mobile phone. 3. Technology-assisted counseling Counselor training: A behavioral health counselor conducted telephone sessions with participants. The counselor underwent training in study-specific protocols (eg, recording phone calls) and motivational interviewing techniques, such as viewing and discussing a series of 4 training videos, practicing and receiving feedback on counseling with a structured call guide. Before interacting with participants, the study director rated a recorded telephone session between the counselor and a volunteer for attaining a sufficient level of motivational interviewing spirit and empathy (eg, asking permission, supporting the participant and not confronting or giving advice). The coach had a bachelor’s degree in nutrition. Counseling session topics and ordering: Participants engaged in 4 phone calls with the study counselor, one every other week. The first and second calls focused on physical activity, sleep, and fatigue. The third and fourth calls focused on 2 out of 4 possible nutrition topics chosen by the participant. The 4 nutrition topics were sugary beverages, fruits and vegetables, snacking, and cooking/preparing meals/eating out. This approach was intended to bring about small decreases in daily energy intake by making small daily behavioral changes, such as substituting no-calorie beverages for sugary beverages. This “small changes” approach has demonstrated efficacy in multiple populations, including overweight or obese adults [20] and multicultural socioeconomically disadvantaged adults [21,22]. Counseling session content: The counselor used a structured, yet flexible, guide to conduct the sessions that followed principles of motivational interviewing [23], the Social Contextual Model [24], and was adapted from a guide used in a previous study [25]. The guide was built in Excel and used embedded logic to flow from section to section. The calls included 6 sections: introduction (introduce the topic of the call, review privacy information); provide feedback on current behavior compared with recommendations, obtain information on participant’s behavior (eg, what type of physical activity she enjoys); assess importance & confidence in changing the behavior; assess influences on their behavior (eg, finances, stress, family/friends/neighborhood); assess motivation to change behavior; if motivated, conduct collaborative goal setting, and if not, prompt discussion of what it would be like to change). In each subsequent call, the counselor checked in about what was discussed in the previous call. Participants’ data collected during self-monitoring were used to guide the counseling sessions. All calls were recorded. Resources: The counselor had a list of weblinks for resources around each topic area (such as sleep, fatigue, fruits and vegetables, and so on) The resources were compiled from sources that were both reputable and user-friendly. Examples included choosemyplate.gov, mayoclinic.org, and cdc.gov. Resources were sent to the participants if the participant requested them. Asynchronous messages: During interim weeks between calls, the counselor maintained contact with the participants through 3 asynchronous text messages per week to monitor their progress in the study. The messages served several purposes: • The counselor would monitor whether participants were tracking behaviors (self-monitoring and automatic weight and behavioral monitoring). If participants were not tracking all behaviors at least 5 days per week, the counselor would try to resolve any issues with tracking (eg, device difficulties, confusion on how or what to track). If they were meeting the 5- day-per-week target, the counselor encouraged them to keep up the good work. The counselor would check in on any goals the participant had set during the counseling calls (eg, “Hi, it looks like you have not yet reached your goal of walking 10,000 steps 7 days per week. Do you have any questions about this goal? Have you been experiencing any difficulties?” or “Just checking in on the goal you set to plan out your meals every Sunday evening. How has that been going? Have you experienced any successes? Any difficulties?”). • The counselor would send a message to the participant 2 days before each counseling call as a reminder of the upcoming call. • The participants and counselor also used asynchronous messages as needed to ask/answer questions, comments, or requests for information.
  11. 11. Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Breast Cancer Survivors SNU UXLAB | Ji Eun Song 11 METHODS - 인게이지먼트/ 수용성 - 평가 결과 몸무게 다이어트: primescreen 설탕음료: bevq-15 패스트푸드 신체활동: ipaq 자가효능감 스트레스 사회적 서포트 수면 식이제어 인식도 피로 측정 생리학적: 행동적: 심리적/ 기타 부수 가 치 : 수집된 데이터로는 1) 받은 전화 통화 수 2) 통화 길이 3) 문자 메시지 회신 수 4) 팔 측정기 찬 날짜 수 5) 체중 데 터
  12. 12. Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Breast Cancer Survivors SNU UXLAB | Ji Eun Song 12 RESULTS 실험 참여에 신청한 27명 중 14명은 조건에 맞지 않음 wifi/스마트폰이 없거나 (n=9), 비만이 아님 (n=3) 3명은 세팅 과정에서 기기 복잡도 이슈로 참여 거부 병원 리크루팅 (n=4) / 사전 조사 (n=2) / 병원 이메일 (n=2) / 신문광고 (n=1) 참여 플로우 인구학적 특성: 50% 소수 인종 / 40%가 Medicaid 보험 혜택 휴대폰 활용: 휴대폰으로 인터넷에 접속이 가능했지만, 대부분의 사용자가 건강을 목적으로 활용하지 않음 암 병기: 초기 0 -1기 (n=6), 2기 + (n=4) 참여자 특성 평가 결과 지난 4주간 아침에 일었났을 때 상쾌함이 5에서 7로 올라감 패스트푸드 소비는 6명이 유지, 2명이 주1회 이하에서 주1회, 1명이 주1회에서 주1회 이하, 1명은 무응답
  13. 13. Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Breast Cancer Survivors SNU UXLAB | Ji Eun Song 13 RESULTS 인게이지먼트: 실험 진행하는 70일동안 문자 메시지 회신은 평균 60일 (SD 13, median =13, range 24-68) 유산소 운동은 64일 (SD 7, range 3-67) 체중 측정은 45일 (SD 24, median 52-70) 수면 측정은 43일 (SD 19, median 47, range 9-63) 10명 모두 4번 카운셀링 통화를 받았으며, 평균통화량은 각각 29분, 22분, 28분, 24분 이었음 식이 관련 통화에서 통화 8건은 과일/채소, 6건은 요리, 5건은 주전부리, 1건은 설탕음료에 관해 문의 수용성: 9명은 지난 3개월 간 설정한 건강 목표 중 어느 정도(n=8) 또는 다(n=2) 수행했다고 응답 모두 개인 목표 설정과 전화 통화는 “적절했다”고 응답 문자 메시지/메일의 경우 2명이 “너무 많다”, 8명이 “적절했다”고 9명이 다시 참여하거나 다른 사람들에게도 추천하겠다고 응답 7명은 프로그램이 유료로 진행할 경우 참여하지 않겠다고 응답 기기를 활용하는 것이 어렵다고 응답 전화와 팔에 차는 측정기 그리고 체중계 모두 목표 달성에 도움되었다고 응답 인게이지먼트/수용성
  14. 14. Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Breast Cancer Survivors SNU UXLAB | Ji Eun Song 14 RESULTS
  15. 15. Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Breast Cancer Survivors SNU UXLAB | Ji Eun Song 15 DISCUSSION 1. 개입: 문자 메시지 회신률은 86% 측정기 착용룔의 경우 94% 유산소 운동 실행률 91% 2. 생리적/행동적/ 기타 부수 효과: 몸무게가 3.38 파운드 떨어짐 임상적 효과는 전체 몸무게의 5%로 상정하고 있으나, 전체 실험이 10주임을 감안했을 때 3.38 파운든 유의미한 수치임 피로와 수면에도 영향을 미침 3. 인간 카운셀링/코칭은 불가피: 사람을 대체할 수 있을 정도의 자동화된 e헬스/m헬스 개입이 존재하지 않음 : 본 실험을 통해 체중 관리는 적용 가능한 것으로 나타났으며, 참여자들 사이에서도 개입에 대한 수용이 높은 것으 로 나타남
  16. 16. Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Breast Cancer Survivors SNU UXLAB | Ji Eun Song 16 DISCUSSION 1. 대조군의 부재/ 작은 샘플 규모: 다음 실험에는 보다 더 다양한 대조군을 설계하고, 더 많은 사람들을 모집할 예정 2. 기기 제한에 따른 높은 참여 조건: 스마트폰과 무선 인터넷을 갖추지 못한 사람들이 예상 밖으로 많았으며, 특히 무선 인터넷 미설치 가구의 경우 체중계 설치가 어려웠음 다음 실험에서는 무선 인터넷에 의존하지 않는 체중계를 활용할 예정 3. 일부 부정확한 데이터 측정: 신체 활동의 부정확성 (Fitbit Flex 는 원래 활동량보다 적게 활동을 감지함) : 한계
  17. 17. Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Breast Cancer Survivors SNU UXLAB | Ji Eun Song 17 END OF DOCUMENT

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