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Technology and public health interventions
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. 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. 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. 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)
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)
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.
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).