Authors
Plaitano EG, McNeish D, Bartels SM, et al.
Purpose
This study examined the impact of the transdisciplinary digital self-regulation intervention, Laddr, on health behaviors and outcomes in individuals who were either (1) overweight/obese and met criteria for binge eating disorder (BED) or (2) smoked tobacco. Assessments across the two target populations aimed to demonstrate similar mechanisms underlying positive behavior change. The investigators hypothesized that (1) momentary self-regulation (e.g., higher perseverance/goal setting, emotion regulation, mindfulness, and lower sensation seeking) would predict next-day use of Laddr (treatment adherence), (2) treatment adherence would predict behavior change, (3) the combination of treatment adherence and behavior change would predict next day self-regulation.
Methods
Adult participants were recruited online through social media platforms for the BED group (N=50) or the smoking group (N=50). During the 28-day study period, participants were asked to complete four daily Ecological Momentary Assessments (EMA) evaluating four factors of momentary self-regulation plus contextual information. Participants were also asked to use Laddr daily (minimum of 5 minutes, ideally focused on binge eating or smoking therapy guides) and input their daily health outcome measures of Fitbit activity (BED group), or CO readings (smoking group) to track progress. Objective health outcome measurements were recorded and analyzed from additional mobile applications (Fitabase or Smokerlyzer®). Mediation effects between momentary self-regulation measures, treatment adherence, and behavioral outcomes were assessed using novel Bayesian dynamic mediation models.
Findings
- Overall EMA response rates for participants completing at least 10% of EMAs were 72% for the BED group and 63% for the Smoking group.
- Higher reported perseverance and emotion regulation were associated with increased next day Laddr adherence in the BED group. Higher reported perseverance was associated with increased next day Laddr adherence in the smoking group.
- Higher Laddr adherence was associated with increased levels of physical activity (approximately 335 more Fitbit steps) in the BED group. These results were not seen for CO measures in the smoking group.
- In the BED group Laddr adherence and Fitbit steps taken day were associated with increases in perseverance the following day. Laddr adherence, but not steps taken, were associated with increases in emotion regulation the following day.
- A positive feedback loop was found in the smoking group: Laddr adherence and CO values were both associated with increases in perseverance the following day.
Relevance
- Digital therapeutics targeting common mechanisms can facilitate behavior change for different health outcomes.
- Self-regulation was associated with increased intervention adherence, which in turn was associated with improved behavioral outcomes.
- Adherence and behavioral outcomes were associated with increased self-regulation the following day in both BED and smoking samples.
- Future work might include a focus on incorporating passive sensing components to better examine external contexts and adherence.