PDF(Pubmed)
Abstract：
BACKGROUND: Mobile health (mHealth) apps offer unique opportunities to support self-care and behavior change, but poor user engagement limits their effectiveness. This is particularly true for fully automated mHealth apps without any human support. Human support in mHealth apps is associated with better engagement but at the cost of reduced scalability.
OBJECTIVE: This work aimed to (1) describe the theory-informed development of a fully automated relaxation and mindfulness app to reduce distress in people with cancer (CanRelax app 2.0), (2) describe engagement with the app on multiple levels within a fully automated randomized controlled trial over 10 weeks, and (3) examine whether engagement was related to user characteristics.
METHODS: The CanRelax app 2.0 was developed in iterative processes involving input from people with cancer and relevant experts. The app includes evidence-based relaxation exercises, personalized weekly coaching sessions with a rule-based conversational agent, 39 self-enactable behavior change techniques, a self-monitoring dashboard with gamification elements, highly tailored reminder notifications, an educational video clip, and personalized in-app letters. For the larger study, German-speaking adults diagnosed with cancer within the last 5 years were recruited via the web in Switzerland, Austria, and Germany. Engagement was analyzed in a sample of 100 study participants with multiple measures on a micro level (completed coaching sessions, relaxation exercises practiced with the app, and feedback on the app) and a macro level (relaxation exercises practiced without the app and self-efficacy toward self-set weekly relaxation goals).
RESULTS: In week 10, a total of 62% (62/100) of the participants were actively using the CanRelax app 2.0. No associations were identified between engagement and level of distress at baseline, sex assigned at birth, educational attainment, or age. At the micro level, 71.88% (3520/4897) of all relaxation exercises and 714 coaching sessions were completed in the app, and all participants who provided feedback (52/100, 52%) expressed positive app experiences. At the macro level, 28.12% (1377/4897) of relaxation exercises were completed without the app, and participants\' self-efficacy remained stable at a high level. At the same time, participants raised their weekly relaxation goals, which indicates a potential relative increase in self-efficacy.
CONCLUSIONS: The CanRelax app 2.0 achieved promising engagement even though it provided no human support. Fully automated social components might have compensated for the lack of human involvement and should be investigated further. More than one-quarter (1377/4897, 28.12%) of all relaxation exercises were practiced without the app, highlighting the importance of assessing engagement on multiple levels.
OBJECTIVE: This work aimed to (1) describe the theory-informed development of a fully automated relaxation and mindfulness app to reduce distress in people with cancer (CanRelax app 2.0), (2) describe engagement with the app on multiple levels within a fully automated randomized controlled trial over 10 weeks, and (3) examine whether engagement was related to user characteristics.
METHODS: The CanRelax app 2.0 was developed in iterative processes involving input from people with cancer and relevant experts. The app includes evidence-based relaxation exercises, personalized weekly coaching sessions with a rule-based conversational agent, 39 self-enactable behavior change techniques, a self-monitoring dashboard with gamification elements, highly tailored reminder notifications, an educational video clip, and personalized in-app letters. For the larger study, German-speaking adults diagnosed with cancer within the last 5 years were recruited via the web in Switzerland, Austria, and Germany. Engagement was analyzed in a sample of 100 study participants with multiple measures on a micro level (completed coaching sessions, relaxation exercises practiced with the app, and feedback on the app) and a macro level (relaxation exercises practiced without the app and self-efficacy toward self-set weekly relaxation goals).
RESULTS: In week 10, a total of 62% (62/100) of the participants were actively using the CanRelax app 2.0. No associations were identified between engagement and level of distress at baseline, sex assigned at birth, educational attainment, or age. At the micro level, 71.88% (3520/4897) of all relaxation exercises and 714 coaching sessions were completed in the app, and all participants who provided feedback (52/100, 52%) expressed positive app experiences. At the macro level, 28.12% (1377/4897) of relaxation exercises were completed without the app, and participants\' self-efficacy remained stable at a high level. At the same time, participants raised their weekly relaxation goals, which indicates a potential relative increase in self-efficacy.
CONCLUSIONS: The CanRelax app 2.0 achieved promising engagement even though it provided no human support. Fully automated social components might have compensated for the lack of human involvement and should be investigated further. More than one-quarter (1377/4897, 28.12%) of all relaxation exercises were practiced without the app, highlighting the importance of assessing engagement on multiple levels.
摘要：
背景：移动健康（mHealth）应用程序提供了独特的机会来支持自我护理和行为改变，但是糟糕的用户参与度限制了他们的有效性。对于没有任何人支持的全自动mHealth应用程序尤其如此。mHealth应用程序中的人工支持与更好的参与度相关，但以降低可扩展性为代价。
目的：这项工作旨在（1）描述一种全自动放松和正念应用程序的理论基础开发，以减少癌症患者的痛苦（CanRelax应用程序2.0），（2）描述在10周内的全自动随机对照试验中，在多个层面上参与应用程序，(3)检查参与度是否与用户特征相关。
方法：CanRelax应用程序2.0是在迭代过程中开发的，涉及癌症患者和相关专家的输入。该应用程序包括基于证据的放松练习，使用基于规则的会话代理进行个性化的每周辅导会议，39种可自我执行的行为改变技术，带有游戏化元素的自我监控仪表板，高度定制的提醒通知，一个教育视频剪辑，和个性化的应用内信件。对于更大的研究，在过去5年内被诊断出患有癌症的讲德语的成年人通过网络在瑞士招募。奥地利,和德国。在100名研究参与者的样本中分析了参与度，在微观层面上进行了多项测量(完成的辅导课程，使用应用程序练习放松练习，和对应用程序的反馈）和宏观水平（在没有应用程序和自我效能感的情况下练习放松练习，以实现自我设定的每周放松目标）。
结果：在第10周，共有62％（62/100）的参与者积极使用CanRelax应用程序2.0。在基线时，没有发现参与度和痛苦程度之间的关联，出生时分配的性别，教育程度,或年龄。在微观层面，71.88%（3520/4897）的所有放松练习和714个教练课程在应用程序中完成，所有提供反馈的参与者（52/100，52%）都表达了积极的应用体验。在宏观层面，28.12%（1377/4897）的放松练习是在没有应用程序的情况下完成的，参与者的自我效能感稳定在较高水平。同时,参与者提高了他们每周的放松目标，这表明自我效能感的潜在相对增加。
结论：CanRelax应用程序2.0取得了有希望的参与，尽管它没有提供人类支持。完全自动化的社会组件可能已经弥补了人类参与的不足，应该进一步调查。超过四分之一（1377/4897，28.12％）的所有放松练习是在没有应用程序的情况下进行的，强调评估多层次参与的重要性。
目的：这项工作旨在（1）描述一种全自动放松和正念应用程序的理论基础开发，以减少癌症患者的痛苦（CanRelax应用程序2.0），（2）描述在10周内的全自动随机对照试验中，在多个层面上参与应用程序，(3)检查参与度是否与用户特征相关。
方法：CanRelax应用程序2.0是在迭代过程中开发的，涉及癌症患者和相关专家的输入。该应用程序包括基于证据的放松练习，使用基于规则的会话代理进行个性化的每周辅导会议，39种可自我执行的行为改变技术，带有游戏化元素的自我监控仪表板，高度定制的提醒通知，一个教育视频剪辑，和个性化的应用内信件。对于更大的研究，在过去5年内被诊断出患有癌症的讲德语的成年人通过网络在瑞士招募。奥地利,和德国。在100名研究参与者的样本中分析了参与度，在微观层面上进行了多项测量(完成的辅导课程，使用应用程序练习放松练习，和对应用程序的反馈）和宏观水平（在没有应用程序和自我效能感的情况下练习放松练习，以实现自我设定的每周放松目标）。
结果：在第10周，共有62％（62/100）的参与者积极使用CanRelax应用程序2.0。在基线时，没有发现参与度和痛苦程度之间的关联，出生时分配的性别，教育程度,或年龄。在微观层面，71.88%（3520/4897）的所有放松练习和714个教练课程在应用程序中完成，所有提供反馈的参与者（52/100，52%）都表达了积极的应用体验。在宏观层面，28.12%（1377/4897）的放松练习是在没有应用程序的情况下完成的，参与者的自我效能感稳定在较高水平。同时,参与者提高了他们每周的放松目标，这表明自我效能感的潜在相对增加。
结论：CanRelax应用程序2.0取得了有希望的参与，尽管它没有提供人类支持。完全自动化的社会组件可能已经弥补了人类参与的不足，应该进一步调查。超过四分之一（1377/4897，28.12％）的所有放松练习是在没有应用程序的情况下进行的，强调评估多层次参与的重要性。
