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Transcript of Mobile health2011 slide skingfinal
Employing ‘Virtual Advisors’ to Promote Physical
Activity in Underserved Communities: Results from
the COMPASS Study
Abby King, Tim Bickmore, Ines Campero, Leslie Pruitt,
Langxuan Yin
Stanford University School of MedicineNortheastern University
NIH R21CA127511
© Stanford University
BACKGROUND
• While electronically delivered ‘e-Health’
interventions have proliferated . . .
• Few have targeted specific needs/preferences of
older adults as well socioeconomically
disadvantaged & ethnic minority populations
© Stanford University
COMPASS Study -
OBJECTIVES
• Evaluate 4-month impacts on Walking of a ‘Virtual Advisor’, tailored in visual and auditory dimensions to inactive, low income Latino older adults
• Experiment preceded by a year of formative research to culturally adapt intervention, study procedures
• All study components occurred at a neighborhood senior center
Stanford Health Aging Studies Technology Team
Tim Bickmore, Northeastern University
COMPASS
PARTICIPANTS
• Low-income, ethnic minority older adults living in San Jose, CA (n = 40)
(93% Latino; 72% women; ~50% with < high school education)
• Ages 55 yrs & older (mean = 68 + 8 yrs)
• Inactive (< 60 mins MVPA/wk), able to walk unaided
(mean BMI = 30)
COMPASS
PHYSICAL ACTIVITY PROGRAM
• Based on successful 2-mo ECA PA program aimed at older African Americans in Boston (Bickmore et al., 2005)
• ECA (Embodied Conversational Agent):
- Animated computer character simulating face-to-face counseling using speech, facial cues & other nonverbal behaviors
- Interact with ECA through touching one of several conversation-based responses shown on computer screen (encouraged weekly interaction or whenever at Center)
(Culturally adapted, bi-lingual)© Stanford University
Carmen
COMPASS
PHYSICAL ACTIVITY PROGRAM - continued
• ‘Carmen’ incorporated evidence-based cognitive & behavioral strategies
• Some Personal information also programmed for each individual (e.g., favorite hobbies, family member names)
• Program accessed using a PIN; housed on dedicated computer located at Senior Center
COMPASS
PHYSICAL ACTIVITY PROGRAM - continued
• Downloadable Omron pedometer used to capture daily/weekly steps
• ‘Carmen’ used pedometer info to provide tailored feedback, advice
COMPASS
CONTROL PROGRAM
• Adapted version of general health education workshops used in previous PA research
• Monthly Age-relevant topics (no PA)
COMPASS
RESULTS
Intervention participants:
• Logged into program mean of 1.6 sessions/week
(range = .35 – 2.3)
• Mean of 27 total sessions across 4 months (range = 6 – 40)
• Mean length of Virtual Advisor sessions = 7 minutes
• 55% interacted with Virtual Advisor in Spanish
COMPASS - RESULTS 4-mos Change in Minutes of Walking/Wk [CHAMPS]
(N = 39)
** p < .0008
Rep
orte
d C
hang
e in
Min
s/W
k
0
50
100
150
200
250
300
© Stanford University
4-month Change in Daily Steps (Omron Pedometer)
Intervention Participants (n = 20)
* Slope analysis: p = .002; Spearman rho with CHAMPS walking items = .47 (p=.04)
Week 1 Week 16
Mea
n D
aily
Ste
ps
0
3000
4000
5000
6000
7000
8000
COMPASS Study
*
Bas
elin
e-ad
just
ed m
ean
* p < .03 vs. Control
0
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
SubstitutingAlternatives
RewardingOneself
CommittingOneself
* **
*
Control
RemindingOneself
COMPASS
4-month Motivational Processes of Change
*
UnderstandingRisks
AFTER the 4-month Study Period . . .
• ‘Carmen’ remained in Senior Center for additional 20 weeks (in response to participant requests)
• All but 1 intervention participant accessed ‘Carmen’
during this post-study period
• Participants accessed ‘Carmen’ mean of 14 additional times (range of <1 to 4.5 times/week)
At 4-month Post-test, Intervention participants indicated that . . .
• ‘Carmen’ cared about them (average rating = 6.2 out of 7)
• Felt close to ‘Carmen’ (average = 6 out of 7)
• Trusted ‘Carmen’ (average = 6 out of 7)
• Felt that length of talks with ‘Carmen’ was “just about
right”
• Were interested in continuing to work with ‘Carmen’
Conclusions
• Intervention participants reported ~30 minute/day increase in usual walking activity relative to modest changes in controls by 4 months
• Daily pedometer steps in last intervention month (~6800) generally commensurate with National Recs. in this age group
Conclusions - continued
• Program was safe (no significant PA injuries)
• Program found to be easy to use/engaging for
this less educated, low computer-literate sample
• 95% of intervention participants accessed the Virtual
Advisor after the study ended
Next Steps
• Expand community venues & populations in which
to test ‘Carmen’, as well as lengthen time period
e.g., clinics, pharmacies, libraries, recreation centers
• Explore which subgroups may do better with Carmen
vs. other intervention sources & delivery channels
• Explore this technology further for other health
behaviors
THANK YOU!THANK YOU!