Development and Evaluation of Novel Mobile Phone and Location-based Systems to Promote Resilience and Healthy Lifestyles among College Students

Funding Source: Dartmouth College Office of the Provost Seed Funding

Project Period: June 2015 – June 2016

Principal Investigator: Sarah Lord, PhD

Other Project Staff: Elizabeth Carpenter-Song, PhD (Co-PI); Andrew Campbell, PhD (Co-PI); Lorie Loeb (Co-PI); Sunny Kim, PhD (Research Associate/Project Coordinator)

Partners: Dartmouth College Health Services: Ann Bracken, MD; Virginia Brack, MD; The Wellness Center (Student Health Promotion and Wellness): Caitlin Barthelmes, MPH

Project Summary:
College students rank stress and sleep as the top two factors that negatively impact academic performance. High stress and poor sleep are also associated with impaired decision making and exacerbation of illnesses. In this project, we will develop, implement and evaluate an innovative interactive digital health communication initiative on the Dartmouth College campus that integrates behavioral science, mobile technology, engaging digital content, and state-of-the-art location-based technologies to: 1) build awareness about the causes and consequences of stress and poor sleep, 2) foster stress management skills and healthy lifestyle choices among students, and 3) promote knowledge about, and use of, campus support resources.  Our goal is to bring effective information about stress and healthy lifestyles to students in ways that are engaging and fun, useful, and accessible where and when students need it.

HealthMatters brings together faculty and students from CTBH, the Department of Computer Science and the Digital Arts, Leadership and Innovation Lab, Anthropology, Dartmouth College Health Services, Student Health Promotion, and the broader Dartmouth student community. A Student Advisory Board and participatory approach will ensure that students are involved in all aspects of the design, development, implementation and evaluation of the digital health communication system. Early formative research with students (and conducted by students) will determine the content, approach, and optimal technologies for the initiative. Students will test the system throughout the development process.  HealthMatters will be evaluated in a limited campus deployment with 40 students using qualitative and qualitative methods to assess technical feasibility and acceptance by students.

Public Health Relevance:
This cross-disciplinary project aligns with Moving Dartmouth Forward by promoting attitudes and skills for healthy lifestyle choices by students. If successful, this project will be a valuable resource to students, offer a campus-based technology infrastructure and collaborative framework for other health initiatives, and serve as a foundation for future funding initiatives to evaluate the digital health communication system more broadly for impact on student outcomes (i.e., academic performance, well-being, campus resource utilization.)

Cutting Edge Literature: Stay Up to Date with Evidence for Technology-Based Approaches

The Eye on Innovation section of the CTBH website contains a compilation of references and synopses of current empirical literature related to technology-based behavioral health care approaches.

The compendium is updated biweekly by our research staff and contains up-to-date literature related to emerging technologies and state-of-the-science care approaches to mental health and substance use issues.  Synopses are tagged for easy filtering by particular topics or technologies.  You can access the Cutting Edge Literature collection here.

CTBH Research Spotlight: Increasing HIV Testing in Urban Emergency Departments using Mobile Technology

CTBH affiliate Ian David Aronson, PhD has received a grant from the National Institute on Drug Abuse to develop a mobile video-based intervention to increase HIV testing among patients in a high volume urban emergency department (ED) who initially decline HIV tests offered by hospital staff. The three-year study will randomize patients into four groups, which will each see a different onscreen presentation about the importance of HIV testing. Pre-post intervention data collection instruments will measure the effectiveness of each presentation in terms of HIV test rates, change in self-efficacy to test for HIV and deal with the results, and changes in HIV-related knowledge.

Because people with undiagnosed HIV will not receive treatment and may unknowingly infect others, the CDC recommends routine HIV testing in healthcare settings, including EDs. Unfortunately, those most at risk frequently decline HIV tests offered by triage staff, and in the New York ED where data will be collected for the current study, far more patients decline tests compared to those who accept.

This new study builds upon findings from a 2012 NIDA-funded trial, in which approximately one third of ED patients who initially declined HIV testing agreed to an HIV test after completing a similar computer-based intervention. The current study also builds upon findings from Dr. Aronson’s CTBH-funded pilot to integrate a qualitative protocol into the 2012 trial to understand why patients did or did not test after watching a video, how the intervention could be improved, and why they initially declined a test upon arrival in the ED. Based on the combined findings of both studies, the current project will develop a new set of videos, a new set of measures, and a new technology-based intervention. Resulting data may provide valuable new information about optimal strategies to leverage mobile technology to promote HIV testing behavior.

CTBH Research Spotlight: Web-based Prescription Opioid Abuse Prevention for Adolescents

Under the leadership of CTBH Director Dr. Marsch, CTBH is partnering on a new NIDA-funded project to develop and evaluate a mobile-friendly, web-based program designed to prevent abuse of prescription opioids among adolescents.

Recreational use of prescription opioids among adolescents is a significant and growing public health concern and has been referred to as an emerging epidemic in the U.S. Although a number of science-based, interactive, drug-abuse prevention programs focus on preventing use of non-prescription drugs among youth, to our knowledge, no science-based, interactive program focused on the prevention of prescription opioid abuse among youth exists. Given that adolescents' views about the recreational use of prescription opioids differ in systematic ways from use of illegal, non-prescription drugs, developing an effective prevention program for youth targeted specifically at prescription opioid abuse is critical.

In this project, we are developing an interactive, web-based program for youth ages 11-14 focused on the prevention of prescription opioid abuse. This program will be grounded in a scientific understanding of risk factors for prescription opioid abuse among youth, employ informational technologies which are effective in promoting relevant knowledge and skills, and present program content using strategies which have been shown to be highly appealing to adolescents. Once development is completed, we will conduct a randomized, controlled trial with youth (ages 11-14 years) to evaluate the effectiveness of the web-based prevention intervention in increasing knowledge about key issues relevant to prescription opioid abuse among youth, skills acquisition relevant to preventing their misuse, negative attitudes about prescription opioid misuse, and perceived risk associated with their misuse. We will also assess the program’s effectiveness in reducing intentions to misuse prescription opioids as well as actual rates of such use. If effective, this scalable prevention program could enable widespread reach to youth in tackling the urgent public health issues of opioid misuse among adolescents.

CTBH Research Spotlight: Integrating Evidence-Based Behavioral Health Technologies into Primary Care

Funded by the Community Engagement Core of Dartmouth’s SYNERGY Program (Dartmouth’s NIH-funded Clinical Translational Science Award), Lisa Marsch, PhD, Sarah Lord, PhD, and Robert Drake, MD, PhD lead a CTBH team on this innovative project engaging community and academic partners in understanding needs and priorities among rural community health care systems around shifting health care systems – with a particular focus on integrating behavioral health and medical care in rural settings.

Behavioral health problems (addictions and mental health disorders, such as depression) are highly prevalent, especially in poor and disenfranchised populations. The great majority of these people (over 90%) receive no treatment. Behavioral health problems also complicate diagnosis, treatment, and outcomes for many chronic conditions, such as diabetes, obesity, heart failure, and cancer.  A sufficient workforce to address these problems does not exist - especially in rural communities.

Incorporating new health technologies could be a cost-effective solution. New technology tools could be used in primary care to improve access, self-care, and outcomes, and to reduce costs and health disparities. Yet, successful implementation and sustainability of any new intervention process, including a technology-based care approach, is strengthened by attention to pre-implementation readiness of the primary care community agencies and constituent stakeholders to adopt a technology treatment innovation in their system of care. 

This two-year, 2-phased project includes mixed-methods formative research in year 1 to assess community priorities and readiness for technology-based behavioral health tools in primary care settings, followed by a demonstration implementation project of a technology-based behavioral health intervention within rural primary care settings in year 2. This work will inform strategies for optimizing implementation outcomes when embedding technology-based behavioral health tools in rural primary care settings, supported by appropriate training/technical assistance.