SOLVE-IT: Socially Optimized Learning in Virtual Environments: A Web-Delivered HIV Prevention 3D Game Intervention for Young At-Risk MSM

LynnCarol Miller,¹Paul Robert Appleby,¹AlexandraN Anderson,² StephenJ Read,¹John L Christensen,³StacyMarsella^1
1University of Southern California, ²Stanford University, ³University of Connecticut

Journal MTM 1:4S:10, 2012
DOI:10.7309/jmtm.34

Abstract

Young men (18-24) who have sex with men (YMSM), especially men of color, are at high risk for contracting HIV. Most existing HIV prevention interventions focus on changing intervening cognitive and deliberative processes or outcomes (e.g., beliefs, norms, self-efficacy, intentions) to change behavior. Many MSM, however, guided by contextual cues in emotionally arousing scenarios, make more automatic risky decisions they later regret. One emotion in a sexual narrative that might precipitate more automatic risky choices for young MSM may be shame (e.g., in one’s sexual desires). But, HIV prevention interventions are not designed to reduce MSM’s shame. SOLVE (Socially Optimized Learning in Virtual Environments), as demonstrated by an NIAID RCT grant, used a sex-positive game to reduce MSM’s shame, increase traditional immediate cognitive outcomes, and reduce unprotected anal intercourse for young Black, Latino, and White MSM (18-24) over 3 months. Could interactive interventions be delivered more broadly over the web? In prior CHRP funded work, a SOLVE interactive video (IAV) intervention was streamed over the web throughout California. However, an IAV approach limits the amount of user interaction, risk challenges users receive, and intervention tailoring to MSM’s decisions. This is addressed using a nationally deliverable 3D animated intelligent agents/interactive digital storytelling game in UNITY. MSM design their own characters, make choices for them on dates and sexual interactions, and are scaffolded by the user character’s virtual future self (participant’s older chosen self-character) to enhance self-regulation when risky. The NIMH-funded SOLVE-IT game development process for young MSM is discussed. Results (N=876) from an ongoing 6-month randomized controlled trial (RCT) — conducted nationally, over the web, are promising. They reveal greater initial shame reduction and cognitive variable increase (e.g., intention, self-efficacy, consideration of future consequences p’s <.01) for at-risk YMSM immediately following the SOLVE-IT game compared to the wait-list control group.

Wrist-based accelerometers successfully differentiate walking from other activities

AmyPapadopoulos,¹Nicolas Vivaldi,²ChristineSilvers,^1
1AFrame Digital, Inc,²George Washington University

Journal MTM 1:4S:9, 2012
DOI:10.7309/jmtm.33

Abstract

There is a significant body of literature that demonstrates that accelerometers placed at various locations on the body can provide the data necessary to recognize walking. Most of this literature, though, either does not consider accelerometers placed at the wrist, or suggests that the wrist is not the ideal location. The wrist, however, is probably the most socially-acceptable location for a monitoring device. This study evaluates the possibility of using wrist accelerometers to recognize walking during everyday life in order to not only evaluate the amount of time spent walking, but also potentially recognize changes in stability that might lead to falls. Thirty elderly individuals aged 65 years and older were asked to wear a wrist accelerometer for four hours each while simultaneously being videorecorded. Study participants were instructed to go about their normal daily activities during those four hours. Activities captured in the videorecordings ranged from doing laundry and cooking lunch to watching television. Accelerometer data were then analyzed by looking for the well-recognized walking frequencies between 0.7 and 3.0 Hz, as well as by calculating a number of other features from the time-series data. Particular attention was given to features that are capable of being calculated on the wrist device so that future work will not require streaming large amounts of data from the device to a central server. Using the presence or absence of the walking frequencies to characterize the test set yielded results of 93% area under the receiver operating characteristic curve (AUC). Using an algorithm limited to features calculable on the wrist device, moreover, achieved an AUC of 90%. A wrist-based accelerometer, therefore, can successfully be used to differentiate walking from other activities, and, moreover, can do so on a small, socially-acceptable wrist-based device.

The project described was supported by Grant Number R43AG039176 from the National Institute On Aging. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute On Aging or the National Institutes of Health.

A Tablet Game for Risk Reduction and HIV Prevention in Adolescents

Kimberly Hieftje,¹Lindsay Duncan,¹Benjamin Sawyer,²Sabrina Haskell,²Lynn Fiellin,^1
1Yale University,²Digitalmill, ³Schell Games

Journal MTM 1:4S:8, 2012
DOI:10.7309/jmtm.32

Abstract

Background: Thirty-nine percent of new HIV infections in 2009 occurred among individuals aged 13-29 years. Videogames are ubiquitous, can improve health behavior, but have not been evaluated as a tool for HIV/AIDS prevention in adolescents.

Purpose:  To develop and evaluate a videogame designed to help teens acquire and practice skills to avoid or reduce overall and HIV risk behaviors.

Methods: Yale’s Play2PreventTM, Digitalmill, and Schell Games are developing PlayForward: Elm City Stories, a videogame that incorporates evidence-based tools for behavior change. We will evaluate the efficacy of thegame by conducting a randomized trial in 330 youths assigned to play PlayForward or a commercial videogame. Subjects will play two sessions/week of their assigned game for six weeks. Assessments will evaluate the game’s efficacy for reducing risk and promoting good decision making.

Results: The videogame will be ready for testing as a final playable iPad product in late Fall 2012. The player uses a personalized avatar to “travel” through life, making decisions and facing challenges in a repetitive and meaningful way, equipping them with skills that potentially translate to real life. During this talk we will describe how an originally planned desktop application was quickly retooled for touch interface tablets. While many traditional desktop and Web-based applications will easily move to tablet and mobile phone frameworks, understanding some of the nuances involved will provide new insights. We will outline specific approaches to game development for behavior change and discuss the potential global implications of our work.

Conclusions:  This videogame represents a paradigm shift, hopefully providing evidence for the role of games as risk reduction and HIV/AIDS prevention in youth. Videogame technology has the potential to expand the available vehicles for HIV/AIDS prevention to the increasing number of electronic gaming platforms including mobile technologies, creating a new venue for public health interventions.

Feasibility of a Virtual Exercise Coach to Promote Walking in Community-Dwelling Persons with Parkinson’s Disease

Nancy K Latham,¹TerryEllis,²Tamara De Angelis,² Katy Hendron,²CathiA Thomas,³ MarieSaint-Hilaire,³ Timothy Bickmore^4
1Boston University School of Public Health,²Boston University, ³Boston University Medical Campus,⁴College of Computer and Information Science, Northeastern University

Journal MTM 1:4S:7, 2012
DOI:10.7309/jmtm.31

Abstract

Objective: Exercise improves function and quality of life in persons with Parkinson’s Disease (PD), but few people adhere long-term to home-based programs. A Virtual Exercise Coach (VEC) is an animated character viewed on a notebook computer in the subject’s home that emulates face to face interactions. The effectiveness of VECs to improve exercise adherence in people with PD or any other neurodegenerative disease has never been explored. The aim of this study is to explore the feasibility, acceptability and preliminary evidence of efficacy of a VEC to promote daily walking in community dwelling persons with PD over a one month period.

Methods: 20 sedentary subjects with a diagnosis of PD participated in this Phase I clinical trial. Subjects were instructed to interact with the VEC for 5 minutes, wear a pedometer and walk daily for one month. Mobility (six-minute walk and gait speed) and exercise self-efficacy were assessed at baseline and one-month. Retention rate, satisfaction and interaction history were assessed at 1-month.

Results: Participants were 55% female, mean age 65.6. At study completion, there was a 100% retention rate and subjects had an average satisfaction score of 5.6/7 (with seven maximal satisfaction) with the VEC. Mean adherence to daily walking was 85% of prescribed sessions. Both gait speed and the 6-minute walk test significantly improved (P<0.05) from baseline to one month. No adverse events were reported.

Conclusions: Sedentary persons with PD successfully used a computer and interacted with a VEC. Retention, satisfaction and adherence to daily walking were high over one-month and significant improvements were seen in mobility assessments. Longer, controlled trials are needed to assess the effectiveness of the VEC in promoting adherence to long-term exercise in persons with PD.

IN Touch: impact of and lessons learned from an mHealth intervention for overweight and obese youth

KatherineKim,¹ ChristinaSabee,¹ HollyLogan¹

¹San Francisco State University

Journal MTM 1:4S:6, 2012
DOI:10.7309/jmtm.30

Abstract

Minority and low-income communities are disproportionately affected by obesity, a risk factor for diabetes, heart disease, and cancer. The iN Touch pilot study was conducted to determine whether use of a mobile Observations of Daily Living (ODL) tracking application with health coaching impacted a variety of health outcomes.

The study was a mixed methods pilot using a pre-post-comparison of a single group. Minority youths age 13-24 who were overweight or obese (BMI > 85th percentile for age and gender in adolescents and BMI > 25.0 in adults) from three clinics in San Francisco were enrolled. Twenty-four of 34 participants completed the study (70.59%).

Participants were provided an iPod Touch with a customized ODL application from TheCarrot.com that included exercise, food, mood and socializing. Weekly summaries were available to providers. Participants met in person with a lay health coach. Measures included BMI, waist and hip measurements, depression (PHQ-2) and modified patient activation measure (PAM) which assesses the patient’s knowledge, skills and confidence to manage health and healthcare. Barriers and facilitators to use of technology were evaluated using semi-structured interviews.

Paired t-tests revealed a significant improvement in PAM scores (M = 3.21, SD = 7.472); t(23) = 2.10, p = 0.047 and waist circumference (M = -1.21 inches, SD = 2.52); t(22) = -2.21, p = 0.038. There were no other significant changes. Participants’ use of the technology varied significantly, ranging from almost none to multiple times per day. Interviews suggested the technology was easy to use, data entry burden was minimal, and ability to record ODLs was beneficial.

We demonstrated significant preliminary success with iN Touch suggesting it is a promising tool for self-management for overweight/obese youths when used in a health coaching program. This application may also provide valuable patient-centered data that is not currently in electronic health records.