Mobile & Social Technologies, Applications in Health Behavior Change. Describe studies using a social / mobile approach to weight loss mDIET SMART Facebook Connect Describe areas of focus to refine and further health behavior change

1. Consumer-Centric Health
Models for Change ‘11

2. Mobile & Social Technologies
Applications in Health Behavior Change
Karen J. Calfas, Ph.D.
Assistant Vice Chancellor, Health, Recreation & Well-being
University of CA, San Diego
Faculty Joint Doctoral Program in Clinical Psychology (SDSU/UCSD)
Faculty Graduate School of Public Health, SDSU
Co-Founder, Santech, Inc.
Seattle, Washington
October 13, 2011

3. | Slide 3
Overview
Describe our approach
Describe studies using a social / mobile approach to
weight loss
• mDIET
• SMART
• Facebook Connect
Describe areas of focus to refine and further health
behavior change

4. Research Background
• Primary research partners
– Kevin Patrick, MD, MS
– James Sallis, PhD
• Program of research (beginning 1990)
– Print-based interventions in clinical settings
– Web interventions (clinical and community)
– Texting interventions (community)
– Social / mobile interventions
4

5. | Slide 5
Conflicts of Interest
Co-Founder of Santech, Inc.
San Diego, California
Santechhealth.com
Other Co-Founders:
James Sallis, PhD & Kevin Patrick, MD, MS
Santech markets mobile and web products that promote improved
health behaviors and health outcomes with a focus on
lifestyle behaviors and obesity.
Santech licenses technologies from
San Diego State University and the University of California, San Diego
developed by the founders and conducts its own Research & Development.

6. California Institute for
Telecommunications
and Information
Technology
6

7. | Slide 7
Collaborating Investigators & Partners
UCSD School of Medicine
Kevin Patrick, MD, MS, Greg Norman, PhD, Fred Raab,
Jacqueline Kerr, PhD, Jeannie Huang, MD, MPH, Cheryl Rock, PhD
UCSD Jacobs School of Engineering
Bill Griswold, PhD, Ingolf Krueger, PhD, Tajana Simunic Rosing, PhD
San Diego Supercomputer Center
Chaitan Baru, PhD
UCSD School of Medicine, Division of Genetics & Department of Political Science
James Fowler, PhD
SDSU Departments of Psychology, Exercise/Nutrition Science
& School of Public Health
James Sallis, PhD, Simon Marshall, PhD, Elva Arredondo, PhD
PhD students and Post-doctoral Fellows (current)
Jordan Carlson, Barry Demchak, Laura Pina, Ernesto Ramirez, Celal Zifti
Santech, Inc.
Jennifer Shapiro, PhD, Ram Seshan, MS, MBA

8. Our point of view is an ecological one: Many factors
continuously interact with one another to create health outcomes
Environmental/Ecological factors
Environments for food
and physical activity,
trauma, noise,
Behavioral & Social factors Occupational factors,
environmental toxins
Physical activity,
diet, smoking,
alcohol & other drugs,
Genetic & stress, economic status,
Biological family & social networks
factors
Biological & Medical Behavioral Environment, Population
Sciences & Social Sciences & Policy Sciences
Systems Sciences 8

9. Rapidly growing base of mobile
information devices…
5+ Billion Mobile Phone users
- UN International Telecomm Union (2011)
14.2 Million iPads sold, 2010; 75% of market
- Wikipedia (2011)
9

10. | Slide 10
mDIET
Mobile Diet Intervention through Electronic Technology
PURPOSE
Randomized Clinical Trial to evaluate the use of Text Messages (SMS) to improve
dietary behaviors and weight outcomes in obese men and women.

11. MMS used for Images and Graphs
(>3000 messages and 1500 intervention rules)
Add a variety of A one-cup serving Nice progress. You're
colorful vegetable size is about the size on your way to
to your shopping of a tennis or reaching your goal. It
list this week. baseball. will take time, but you
Choose have the motivation to
green, red, orang succeed.
e and yellow
veggies. 11

12. | Slide 12
mobile
mDIET
Mobile Diet Intervention through Electronic Technology
Patrick et al. (J Med Internet
Res 2009;11(1):e1)

13. | Slide 13
SMART Social Mobile Approach to Reduce WeighT
PURPOSE
To leverage social networks, social media, mobile phones, and the
web for weight loss among 18-35 year old young adults.
Funded with a 5-year grant from NHLBI/NIH

14. | Slide 14
A “User-centered” Intervention
That requires at least 10 minutes of daily interaction with the ThreeTwoMe platform.
Web Smart- Facebook
phone
Apps
Mobile Txt Msgs
Email Other Tools
Be sure to check
your email for this
this week’s topic
from ThreeTwoMe
Bathroom Scale
Pedometer

15. Take What We Know
About Social Networks & Health
And Turn It Into
Interventions To
Improve Health…
Largest Connected Subcomponent of the
Social Network in the Framingham Heart Study in the Year 2000.
Each circle (node) represents one person in the data set.
The size of each circle is proportional to the person's body-mass index.
Christakis & Fowler, The spread of obesity in a large social network over 32 years.
New England Journal of Medicine, 2007 15

16. | Slide 16
SMART
Social Mobile Approaches to Reduce Weight
INTERVENTION
Facebook an intact social network
+
Mobile Phone txt messaging
+
Smartphone mobile apps
+
Website
SMART Study
1 - Participant
2 - Friend of Participant
3 - Friend of Friend

17. | Slide 17
ThreeTwoMe = A Suite of Apps
Mobile + Facebook Apps
APP TARGET BEHAVIORS & STRATEGIES
Self- Intention Goal- Goal
Feedback Knowledge
Monitoring Formation Setting Review
Be Healthy X X X
TrendSetter X X X X
Goal Getter X X X
Facts & Quizzes X X
All apps accessible via
 Mobile
 Web
 Facebook

18. | Slide 18
Facebook Connect
Unfunded Study at Univ. of CA, San Diego
Investigators: Karen Calfas, James Fowler,
Lucila Ohno-Machado, Myong Lah
Purpose:
• Identify how student networks form and evolve on facebook
• Gather and analyze data from posts and activity
• Analyze content of language

19. | Slide 19
Facebook Connect
How can we better understand student needs via their
social networks?
How can we affect important outcomes using social
network intervention?
• Depression and suicidality
• Academic success
• Racial tension
• Meaningful friendships and sense of belonging

20. | Slide 20
Focus Areas in Health Behavior Change

21. Maintenance of Behavior Change
• Ubiquitous technology
• Must be relevant to the patient and/or the
theoretical approach
• High degree of tailoring
• Continuous intervention
• Connect to personal values
• Focus on personal flourishing (+ psych)
• Environmental influences
| Slide 21

22. Special Considerations
• The annoyance factor
• Consider negative effects of intervention
– Assess and test for them
• Not a substitute for human interaction
22

23. Rapid proliferation of wearable bio-behavioral
sensors with mobile & network connectivity
Fitbit
Bioharness
BodyMedia
Useful for
• Monitoring
• Summarizing
• Sharing Zeo Sleep Monitor
23

24. The New Age of Dietary Assessment
Advances in Potential Advantages
Technology
• Computers • Improved compliance
• PDA • Increased accuracy
• Mobile telephones • Saves time
• Digital imaging • Reduces cost
• Global Positioning
System(GPS)

25. Automatic Volume Estimation
cc or ml
Woo, 2009
Uses a
fiducial
marker
Weiss, 2010

26. Social Component
• Long term evidence of importance of social
support
• Emerging evidence about social networks
• Existing social network vs. created network
– Where are their eyeballs?
• Promise of “positive contagion” effect
26

27. Thank You!
kcalfas@ucsd.edu
Santechhealth.com
27