Calissa J. Leslie-Miller

Objectives: Human resources (HR) initiatives can reduce healthcare costs and improve productivity, yet participation remains low. This study evaluated usability and predictors of engagement for Aspire2B, a personalized wellness application leveraging behavior change principles, alongside a 6-week HR-led movement challenge. Methods: Participants were US-based, salaried PepsiCo employees, aged 21-68. Aspire2B integrated step data and provided heart rate, stress index, and biological age via transdermal optical imaging. No monetary incentives were provided. Results: Of 512 registrants, 84% completed onboarding, 14% interacted with the app in week 2, 12% in week 3, and 6% in week 6, trending higher than commercial apps, though populations may not be directly comparable. Older age and higher heart and respiratory rates were associated with more steps and app usage. Conclusions: Aspire2B demonstrated preliminary feasibility for increasing engagement in HR wellness initiatives.

Background: Adolescent asthma is a significant contributor to youth morbidity and is known to be best managed through consistent medication use and symptom management. However, adolescents often struggle to perceive their symptoms accurately and consistently use their medication at the recommended rate, risking worsened symptoms and impaired quality of life. The Responsive Asthma Care for Teens (ReACT) system is a project aimed at identifying and and providing supporting for several barriers adolescents may face in asthma management. By integrating both software and hardware to monitor medication adherence, ReACT provides a personalized support plan to improve asthma management and, subsequently, quality of life. Objective: The objective of this study is to conduct a proof-of-concept assessment of the ReACT system following an initial pilot study and adjusting for the feedback received. In addition to assessing the acceptability and usability of the current version, this study aims to assess whether the proposed ReACT system leads to indications of improvement in medication adherence because of the personalized support plans. Methods: Participants in the study were 5 adolescents aged 15 to 17 years recruited using a combination of consent-to-contact forms delivered via an in-person asthma clinic and Qualtrics panels. As a part of this study, participants met with the study team 3 times over 1 month. After completing initial surveys on stress, problem-solving, and asthma-related quality of life, we oriented the participants to the ReACT platform and asked them to interact with it as normal. After the month, the participants were interviewed, and they discussed the system and completed surveys assessing their opinions on acceptability and usability. Results: On a 4-point scale, participants reported high acceptability of ReACT (mean score 3, SD 0.32), willingness to use it again (mean score 4, SD 0.89), and willingness to recommend it to a friend (mean score 3.75, SD 0.55), and they considered it to be helpful (mean score 3.2, SD 0.84). Conclusions: Our findings suggest that ReACT is an acceptable and usable mobile health intervention to improve asthma self-management among adolescents, and it had promising results for improving self-regulation, problem-solving, and asthma control. The system continues improving based on feedback from a larger sample size of participants, and we hope that ReACT will aid adolescent development while delivering highly personalized support for each user.

Background: An adaptive text messaging intervention to promote adolescent physical activity has demonstrated feasibility, acceptability, and preliminary efficacy in a recent proof-of-concept study. To inform future intervention development, a secondary analysis of the data examined how physical activity is influenced by mood, environment, and physical feelings of energy and fatigue. Objective: This study aims to understand how both macro- and microtemporal variables (eg, psychological and environmental variables at both levels) influence the efficacy of a brief mobile health intervention (ie, NUDGE) for physical activity. Methods: Using a matched control design, we evaluated the effect of daily positive and negative affect, perceptions of the weather, energy, and fatigue as moderators of the effect of the intervention on 21 intervention participants and 21 matched controls. Results: Consistent with study hypotheses, macrotemporal (levels of the variable on a 3-week timescale) moderators of intervention effectiveness were observed for positive affect ( P <.001), negative affect ( P =.03), energy ( P <.001), fatigue ( P <.001), and perceived weather barriers ( P <.001) for moderate-to-vigorous physical activity. These effects were observed more consistently for moderate-to-vigorous physical activity than for sedentary behavior, which was only significant for energy ( P <.001). No effects for microtemporal variables (at the day level) were observed. Conclusions: There appears to be an optimization opportunity for mobile health physical activity interventions that can be achieved by personalizing intervention features and content based on approximately monthly assessments of affect, physical feeling states, and perceived weather barriers.

Background: There is significant global interest in promoting wellness, with digital solutions like mobile health apps being broadly downloaded; yet, there is a challenge in maintaining engagement for long-term behavior change. Developing a widely accepted mobile wellness app is imperative for advancing personalized wellness interventions. Objective: The primary objective of this study was to evaluate the Aspire2B wellness app (powered by Salus Optima), designed to exceed industry standards for participant engagement by incorporating evidence-based behavior change strategies and to assess its acceptability (eg, liking the face scan) and utility (eg, willing to use the face scan technology for other health insights) as a digital health solution. Methods: Participants aged 18-65 years, who were smartphone and fitness tracker users, were recruited in the United States during March-May 2022. Participants received US $5 compensation for downloading the app, with no further incentive for usage. Following completion of onboarding (ie, survey questions about lifestyle behaviors), participants were placed in either a nutrition, sleep, or fitness 4-week challenge. During the challenge, participants used various app features at their own will, such as a facial scan for wellness insights (eg, heart rate and biological age), recipes, and workout videos. These interactions with the app were cumulatively evaluated as engagement metrics. Participants were also asked to answer offboarding questions to evaluate any changes to lifestyle behaviors and experience using the app features (eg, acceptability of face scan experience). Results: Out of the 398 people who created an account, 85.9% (342/398) completed onboarding and a face scan. Following this, 74.9% (298/398) of users completed additional survey questions about current wellness behaviors. Notably, interaction with the app was relatively stable from week 2 to 4 (173/398, 43.5%), outperforming industry standards by roughly 3×. In addition, on average, participants completed 2.1‐2.7 face scans per week, with approximately 7% (24/342) of participants maintaining regular use of face scan technology for 4 weeks. In users who completed offboarding questions, 88.8% (111/125) found Aspire2B credible, 64.8% (81/125) liked the face scan experience, 7.2% (9/125) disliked the face scan experience, and 83.2% (104/125) said they would use face scan technology for other insights into their health. Conclusions: These findings highlight strong initial engagement with Aspire2B, followed by significant sustained user engagement over a 4-week period. Furthermore, users indicated high levels of credibility and willingness to use face scan technology for wellness insights. These findings collectively demonstrate the capability of a personalized wellness app using AI-enabled digital biomarkers and evidence-supported behavior change techniques to yield positive user perception and provide long-term engagement.

Introduction: The early part of the coronavirus pandemic (COVID-19) was a chronic stressor that led to decreased life satisfaction, increased psychopathology, and decreased social interaction, making it important to study coping strategies that stimulate increases in emotional well-being. Previous research has demonstrated that disengagement coping may be beneficial in scenarios where engagement coping is too difficult or not possible. We hypothesized that disengagement coping would be related to good emotional well-being (high positive emotions and/or perceived control, lower negative emotions and/or stress), with distraction (taking a break from a stressor) related to better emotional well-being than is avoidance (avoiding thoughts and feelings associated with a stressor).Methods: Using a daily reconstruction method that represents a “day in the life” of people in the United States during the early stages of the COVID-19 pandemic, we assessed people’s (N = 329) activities, their intention to distract from or avoid the stressor during these activities, emotions, and thoughts about and motivation to deal with COVID.Results: Between-subjects’ analyses revealed that habitual distraction did not predict any outcomes, while habitual avoidance related to poorer emotional well-being. Within-subject analyses, however, demonstrated that engaging in distraction (and to a smaller extent, avoidance) was associated with better concurrent emotional well-being and less thinking about COVID. Furthermore, the intent to distract/avoid was more reliable in predicting emotional outcomes than was the activity type.Conclusion: These findings suggest that disengagement from stress can be an adaptive coping behavior during global pandemics and possibly other chronic stressors with similar attributes.

The COVID-19 pandemic was a novel chronic stressor that necessitated figuring out how to cope with it. We hypothesized that disengagement coping – coping with a stressor by disengaging from it – would be effective because the pandemic featured heightened uncertainty and enduring intensity. We assessed the disengagement strategies of distraction – taking a break from a stressor – and avoidance – avoiding thoughts and feelings associated with a stressor – and emotional well-being outcomes (positive/negative emotions, stress) in three waves one week apart (305 participants completed all three waves). Distraction was one of the most frequently endorsed coping strategies. The results of multi-level models and cross-lagged panel models showed that participants who used distraction habitually experienced better emotional well-being overall and that using distraction led to better emotional well-being that week, but did not predict increases in well-being from one week to the next. Those who used avoidance also experienced better emotional well-being that week, but habitual use of avoidance was associated with worse emotional well-being overall. These findings suggest that in the midst of chronic stressors like this pandemic, the disengagement coping strategy of distraction is popular and effective for temporarily improving people’s well-being.