Social comparison opportunities in digital health interventions: Are we using theory and evidence effectively?

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By Dr. Dani Arigo, Rowan University and Rowan University School of Osteopathic Medicine (reposted from UCL’s Center for Behavior Change Digi-Hub blog, published May 24, 2018)

As a clinical psychologist who studies the role of social process and perceptions in health behavior change, I’ve been both delighted and overwhelmed by our increasing ability to use digital tools that connect users to each other. So much of our daily lives are spent engaged in social interaction (or pondering social experiences), and there is huge potential to use the social environment to promote health. But it seems that we still have a long way to go before we can capitalize on this potential.

For instance, literature on intervention components of digital health tools – particularly work that describes mobile apps for physical activity and weight loss – indicates that a significant proportion of these tools uses “social comparison” to promote behavior change. (See here for an example.) Yet “social comparison” can mean a lot of different approaches or techniques. When researchers say that social comparison is used in an intervention, what does this mean in practice? Moreover, is this work maximizing the vast body of knowledge on social comparison theory and applications to health contexts?

Social comparison refers to the process of self-evaluation relative to another person or group. The ability to size ourselves up next to potential allies or competitors is thought to be innate and protective; it often happens quickly and implicitly, whenever we’re exposed to relevant information about other people. As a result, any digital health intervention that offers the opportunity to learn about others’ health behaviors could facilitate social comparison. This means that features such as message boards, direct messages, profiles/feeds, or anything else that lets users share text or photos with each other could be categorized as social comparison.

But simply providing information about others may not actually induce social comparison, as people (and therefore, users of digital health tools) differ in their tendencies to make comparisons or value the evaluations they provide. Here, concluding that comparison is a primary mechanism of action could lead us astray; other mechanisms such as social support and social reinforcement may be more powerful in these situations, or may interact with social comparison to produce behavior change. Features such as challenges (competitions) and leaderboards, which directly compare a user’s progress to that of other users, are more likely to induce the types of comparisons that could lead to behavior change.

Unfortunately, many existing reviews of digital health interventions do not specify what they categorize as “social comparison,” making it difficult to determine which features of a tool are most beneficial. To make things even more confusing, these reviews rarely indicate how users’ information is communicated to each other – via raw numbers (pounds lost or steps taken), data visualization (graphs), photos, videos, or avatars? Or some combination? Which of these is most effective for promoting behavior change?

But perhaps the most significant limitation of existing work in this space is the assumption that all opportunities for social comparison are created equal – specifically, that they will always have the desired positive effect. Social psychology theory and empirical work show that this is not accurate. As noted, people differ in their affinity for social comparison, meaning that facilitating or inducing this process via digital health tool won’t be very effective for some people. Even more importantly, for some people, comparison has negative effects. Anxiety, despondence, and frustration all are fairly common responses to comparison, and only some people are able to channel this negative affect into motivation for behavior change; many of us simply give up. (This could explain some users’ disengagement from digital health tools.)

Finally, differences in affinity for comparison or positive/negative response to a comparison opportunity do not exist just between people. Each of us fluctuates in our interest and response over time, depending on factors such as mood, stress level, and progress toward our behavioral goals. We’re continually improving the capacity for digital health tools to assess users’ dynamic preferences and needs, and respond to these in real time (e.g., JITAI designs), but this capacity has not yet been applied to tools’ social comparison features. We now have enormous potential to tailor social comparison features, which may provide more engaging and effective digital health interventions.

Questions:

  • What is the best approach to assessing social comparison preferences and needs, in order to inform social comparison tailoring in a digital health tool?
  • What steps are necessary in order to tease apart which social comparison intervention features and formats (e.g., text vs. photos) are most beneficial, for whom, and when?
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UofSHealth Psych on the Road: Trainee Reflections on the Society of Behavioral Medicine Annual Meeting (New Orleans, April 2018)

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Post by Kristen Pasko, B.S. (research coordinator) and Sabrina DiBisceglie (senior undergraduate student). This was their first opportunity to attend a professional conference. 

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Kristen

The 2018 Society of Behavioral Medicine (SBM) conference was a learning opportunity distinct from any of my prior professional development experiences. Specifically, I was able to disseminate my original findings, discover cutting-edge research in health psychology, connect with pioneers in the field of similar interest, and experience growth as a budding clinical psychologist.

As someone who is about to enter graduate school, SBM provided me KP SBM 2018 2with an opportunity to grow as an independent researcher. This experience was a chance to build my network of potential collaborators, train my eye to qualities of impactful posters and presentations, and gain a deeper understanding of topics of particular interest. One observation was how specific the research projects were, which got me thinking about how generalizable these findings are, beyond the particular context of each study. From these lines of consideration, I was able to make connections across findings and develop new research questions.

I also realized that I am now a member of this professional organization, in the same learning environment among fellow beginners, intermediate and advanced individuals alike. The continued educational aspect of this field excited me. Likewise, experiencing many collaborative efforts in action was helpful, as members of SBM include healthcare professionals from a variety of disciplines besides psychology. These differences between fields provoked interactive conversation within almost every presentation to work across disciplines and perspectives for the common goal of creating research for the best healthcare outcomes.

Social Divides and Health Divides – Keynote: Sandro Galea
In a seamless narrative that led with data, this keynote addressed the connection between social and health disparities across the United States. The speaker demonstrated the extent to which life expectancy can range at the levels of country, state, and even county. For example, an individual could receive the same treatment in two different countries for a chronic illness and still have a large gap in life expectancy depending on where they reside. Furthermore, when we compare healthcare costs by country, the United States prioritizes treatment over prevention, as opposed to most other countries. Overall, the speaker acknowledged that health behaviors don’t exist in a vacuum and proposed getting social and economic forces into the healthcare conversation.

Acceptance-Based Approaches to Behavior Changes; Application to Weight Control and Physical Activity Interventions – Symposium: Jocelyn Remmert, Leah Schumacher, Courtney Stevens, Meghan Butryn
This symposium centered around the affective barriers before, during, and after engaging in physical activity. It was suggested that acceptance-based therapy (ACT) could mitigate barriers that stem from the associated uncomfortable feelings (fatigue, sweat) as many aspects of moderate-to-vigorous physical activity are not subject to change. Taken together, these findings are intuitive as ACT and psychological flexibility go hand-in-hand and are associated with the greatest long-term outcomes for physical activity. Individuals could benefit from being flexible with guidelines for physical activity for a more tailored approach to their ability and goals.     

Sabrina

SD SBM 2018SBM was a stimulating experience that bolstered my interest in pursuing a career in the behavioral medicine field. Sandro Galea’s opening keynote provided an eye opening presentation on social divides and health divides. His enthusiasm and fascinating findings set the tone for the following days of the conference. As this was my first professional conference, this was a great learning experiences as to how conferences work as well as an experience to be exposed to thought provoking research.

Not only did I gain knowledge on interesting topics and research, I also gained professional knowledge in terms of sharing and presenting research. Attending poster sessions as well as paper sessions allowed me to observe different ways people shared knowledge. It was exciting as a beginner to be introduced to new information alongside experts in this field. My favorite portion of the conference was the poster sessions. These sessions allowed close and personalized interaction with investigators. I was amazed by the breadth of topics that were covered throughout these sessions.

This experience has allowed me to not only gain knowledge on topics new to me, but it has also allowed me to reflect on my individual research and to reevaluate as well as add components to support and further my research. I look forward to continuing my membership with SBM and to continue to use this society to further my research interests.

 

Research Coordinator Position at Rowan University

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Fit5

Research Coordinator
Clinical Health And Social Experiences (CHASE) Lab
Rowan University

Application deadline: May 11, 2018

Start Date: September 1, 2018

Are you looking for an exciting opportunity to hone your skills in behavioral science research? Come work with the new Clinical Health And Social Experiences (CHASE) Lab at Rowan University! The CHASE Lab is hiring a full-time research coordinator. This position will provide opportunities to interact with research participants, collaborate with graduate and undergraduate students in clinical/health psychology, and receive mentoring to prepare for future graduate study in clinical/health psychology or a related field.

The research coordinator position will be under the direction of Danielle Arigo, Ph.D., who is joining Rowan from The University of Scranton in Pennsylvania (http://www.scranton.edu/faculty/arigod/index.shtml). Dr. Arigo’s research investigates social influences on health and health behavior, physical activity promotion, and weight control, particularly in the area of women’s health. This research emphasizes the development and optimization of digital health tools, including mobile health apps, wearable physical activity trackers, and social media platforms.

The coordinator’s primary responsibilities will be related to project management for an NIH-funded clinical trial (e.g., budget management; preparing and updating reports for NIH and IRB; managing participant recruitment, enrollment, and scheduling). Additional activities will include data management, training and supervision of research assistants, and contributing to the preparation of manuscripts and conference presentations. Previous experience with these tasks in the context of physical activity, weight control, women’s health, and/or digital health is desirable, and the coordinator will have the opportunity to improve skills in each of these areas.

Candidates should have a bachelor’s degree in psychology or a related area; coursework and/or work experience related to clinical research is preferred. Experience with using social media (particularly Twitter) in a professional or organizational capacity is desirable. Reliable transportation and some early morning/evening hours are required.

To apply, submit a CV and a one-page cover letter describing your preparation for this position to arigo@rowan.edu by May 11, 2018. Questions about the position can be directed to this email address.