Developing and Evaluating Digital Interventions to Promote Behavior Change in Health and Health Care: Recommendations Resulting From an International Workshop.
Developing and Evaluating Digital Interventions to Promote Behavior Change in Health and Health Care: Recommendations Resulting From an International Workshop.
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DOI：
10.2196/jmir.7126
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发表时间：
2017-06-29
影响因子：
7.4
通讯作者：
Greaves F
中科院分区：
文献类型：
--
作者：
Michie S;Yardley L;West R;Patrick K;Greaves F
利用数字技术促进或支持行为改变（数字干预）的设备和程序越来越普遍，被用于患者诊断和治疗，慢性病的自我管理和初级预防。它们被认为是潜在的革命性方式，个人可以通过改善结果，降低成本和改善患者体验来监测和改善他们的健康行为和医疗保健。然而，我们仍然主要处于承诺而不是交付的时代。开发和评估这些数字干预措施提出了新的挑战和旧挑战的新版本，需要使用改进的甚至是全新的研究和评估方法。本文讨论了这些挑战，并提出了旨在加快数字行为干预研究和实践进展速度的建议。涉及的领域包括在快速变化的技术环境中的干预发展，促进用户参与，推进基础科学和理论，评估有效性和成本效益，以及解决监管，道德和信息治理问题。这篇文章是为期两天的国际研讨会的结果，该研讨会讨论如何创建，评估和实施与健康行为有关的有效数字干预措施。它于2015年9月在伦敦举行，得到了英国医学研究理事会（MRC），国家卫生研究所（NIHR），方法研究计划（PI Susan米吉）和美国罗伯特伍德约翰逊基金会（PI凯文帕特里克）的支持。管理快速变化的重要建议包括考虑使用数据科学，机器学习和贝叶斯方法的新兴技术，以及从计算机科学和工程等其他学科学习。关于评估和促进参与，一个关键结论是，并不总是需要持续参与，对于每一项干预措施，确定什么是“有效参与”，即实现预期成果的充分参与，是有益的。通过生成生态有效的实时客观数据，数字干预在测试和推进行为改变理论方面的潜力得到了认可。评估应包括开发周期的所有阶段，并考虑新的实验设计，以充分利用丰富的数据流。未来的卫生经济学分析需要认识到数字干预的复杂性和潜在的深远成本和效益，并对其进行建模。在治理方面，数字行为干预的开发人员应该遵守现有的监管框架，但要考虑围绕信息治理、道德和互操作性的新兴标准。
Devices and programs using digital technology to foster or support behavior change (digital interventions) are increasingly ubiquitous, being adopted for use in patient diagnosis and treatment, self-management of chronic diseases, and in primary prevention. They have been heralded as potentially revolutionizing the ways in which individuals can monitor and improve their health behaviors and health care by improving outcomes, reducing costs, and improving the patient experience. However, we are still mainly in the age of promise rather than delivery. Developing and evaluating these digital interventions presents new challenges and new versions of old challenges that require use of improved and perhaps entirely new methods for research and evaluation. This article discusses these challenges and provides recommendations aimed at accelerating the rate of progress in digital behavior intervention research and practice. Areas addressed include intervention development in a rapidly changing technological landscape, promoting user engagement, advancing the underpinning science and theory, evaluating effectiveness and cost-effectiveness, and addressing issues of regulatory, ethical, and information governance. This article is the result of a two-day international workshop on how to create, evaluate, and implement effective digital interventions in relation to health behaviors. It was held in London in September 2015 and was supported by the United Kingdom’s Medical Research Council (MRC), the National Institute for Health Research (NIHR), the Methodology Research Programme (PI Susan Michie), and the Robert Wood Johnson Foundation of the United States (PI Kevin Patrick). Important recommendations to manage the rapid pace of change include considering using emerging techniques from data science, machine learning, and Bayesian approaches and learning from other disciplines including computer science and engineering. With regard to assessing and promoting engagement, a key conclusion was that sustained engagement is not always required and that for each intervention it is useful to establish what constitutes “effective engagement,” that is, sufficient engagement to achieve the intended outcomes. The potential of digital interventions for testing and advancing theories of behavior change by generating ecologically valid, real-time objective data was recognized. Evaluations should include all phases of the development cycle, designed for generalizability, and consider new experimental designs to make the best use of rich data streams. Future health economics analyses need to recognize and model the complex and potentially far-reaching costs and benefits of digital interventions. In terms of governance, developers of digital behavior interventions should comply with existing regulatory frameworks, but with consideration for emerging standards around information governance, ethics, and interoperability.
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