What are internet-delivered interventions, why use them? Lucy Yardley Centre for Applications of Health Psychology (CAHP) LifeGuide:

Q: What are behavioural interventions? A: Packages of advice and support for behaviour change eat a healthy diet cope with illness learn parenting skills use less energy at home work more efficiently

Traditional methods of delivering behavioural interventions a) face-to-face, e.g. teacher, therapist, manager expert, personalised effective but resource intensive b) print format, e.g. leaflet generic, no support cheap but low impact

Core components of effective behavioural interventions 1. Delivering advice, ‘tailored’; use ‘diagnostic’ questions to select relevant advice from extensive expert resources 2. Providing longitudinal support, e.g. plans, reminders progress monitoring progress-relevant feedback social support (therapist, peers)

7 What opportunities does the Internet offer for behaviour change interventions? For policy-makers – cost-effective delivery (for meta- analysis of effectiveness see Webb, Joseph, Yardley & Michie, Journal of Medical Internet Research, 2010, 12, 4) For lay people – convenient 24/7 access to personalised advice for all problems from worldwide resources For professionals – detailed longitudinal monitoring, automation of routine services For scientists – potential to collect detailed longitudinal data on large samples

What challenges are posed by delivering interventions via the Internet? The human challenge – creating Internet interventions that lay people and professionals find accessible, engaging, trustworthy, useful The technological challenge – generating flexible and accessible methods of creating web-based interventions 8

Introduction to LifeGuide: New software that allows YOU to create internet-delivered health-care interventions Sarah Williams

Introducing LifeGuide LifeGuide is the first open source tool permitting rapid, flexible creation and modification of interventions. Enables researchers with no programming skills to develop and modify online interventions Open source & Free to use – Improved cost-effectiveness of research –Opens up use by new researchers –Researchers can add own functionality –Embedded in our VRE (LifeGuide Community) – sharing with other researchers 10

What can you do in LifeGuide?  Deliver tailored advice based on diagnostic questions, charted progress  Create questionnaires, change look and feel, add images and videos  Send automated s and text messages (e.g. reminders)  Provide social support (e.g. discussion board, forums)  Automated randomisation, data collection 11

12 LifeGuide Software – The Authoring Tool Used to create intervention pages Add content to intervention pages: –text, interactive questions, buttons to navigate through the intervention, images and video. Flexible drag and drop interface for styling pages Templates

13 Logic Allows end-users to move from one page to another Directs users to pages that are tailored to their needs. Logic is also used to perform many of the functions of LifeGuide including –Feedback messages –Randomisation –Scoring questionnaire items –Automated s Show page1 Show page2 Show page3 if (page2.gender = “male”) Show page4 if (page2.gender=“female”) Show page5 Show page5.warning if (page2.smoking = “yes”) The LifeGuide Researcher Manual contains step-by-step tutorials to perform logic commands in LifeGuide

14 Intervention Manager Completed interventions can be uploaded to the intervention manager Records: –Participants’ responses to interactions –What pages they used Data can then be exported to Excel

Interventions in development (funded by MRC, NIHR, EC, DoH) smoking cessation weight reduction (diet and physical activity promotion) cognitive-behavioural therapy (8 sessions) for irritable bowel syndrome e-learning and assessment for NHS staff (smoking cessation trainers) intervention to reduce antibiotic prescribing in GPs across Europe many more in preparation... 15

16 The Internet Doctor

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Future of the LifeGuide added functionality as desired (open source) added connectivity (remote monitoring, NHS links) different modalities (mobile computing) 23

The LifeGuide Community Download software and help materials Support from other users - networks of researchers, forum, demos of how to use different logic functions Collaboration and supervision – share and discuss interventions with own research team, work together on interventions (e.g. translating into other languages) Dissemination – share and discuss interventions with wider e-health community (demo interventions) Testing with end-users

A beta version of the LifeGuide Community website site is now available at Statistics (Mid-June 2010) –Number of international users registered for the LifeGuide Community website: over 220 –Number of authoring tool downloads: 170 –Number of interventions using the VRE as part of their development: 6

Acknowledgements Health psychologists: Lucy Yardley Susan Michie Judith Joseph Sarah Williams Leanne Morrison Computer scientists: Dave de Roure Gary Wills Mark Weal Adrian Osmond David Fowler Pei Zhang 28 Funded by the ESRC as a node of the national programme for Digital Social Research

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