Information Paper

OCT 2010

Subject: T2MoodTracker Smart Phone Application

  1. Background and Rationale

a.T2 MoodTrackeris a comprehensive self-monitoring tool built on an Android Smart Phone platform that supports Ecological Momentary Assessment (EMA).

b.Self-monitoring of behavior and affective states has been demonstrated to impact behavior change both directly and as an adjunct to therapeutic interventions.[1],[2]

c.Historically there have been a number of barriers to effective and efficient self-monitoring. These barriers are generally associated with the high response cost associated with data collection. These include patients forgetting to record data or maintain recording materials, awkward recording strategies, and difficulty translating records into meaningful and useful data.

d.The development of smart phone technology has created an easily accessible platform for developing self-monitoring software using visual analogue scales (VAS)[3] for data collection, providing an opportunity to overcome traditional barriers to accurate and consistent self-monitoring.

e.Ecological Momentary Assessment is an experience sampling method used in clinical assessment. Ecological Momentary Assessment (EMA) is characterized by (a) collection of data in real-world environments; (b) assessments that focus on individuals’ current or very recent states or behaviors; (c) assessments that may be event-based, time-based, or randomly prompted (depending on the research question); and (d) completion of multiple assessments over time.[4] There are numerous advantages to using an EMA methodology which are multiplied when using a mobile platform.

  1. T2 MoodTracker
  1. Utilizing touch screen technology and visual analogue scales (VAS) for data input by users, T2 MoodTrackerallows users to self-monitor emotional experience on six pre-loaded scales associated with deployment-related behavioral health issues. Additional custom scales can be created to meet individual needs.
  1. Post-Traumatic Stress
  2. Brain Injury
  3. Stress
  4. Depression
  5. Anxiety
  6. General Well-Being
  1. T2 MoodTrackerautomatically generates graphical feedback of all ratings across time.
  2. Users can create notes documenting daily experience to allow for evaluation of the effects of events on mood.[5]
  1. Medication initiation or change
  2. Appointments for treatments or therapies
  3. Interpersonal events
  4. Stressors
  5. Injuries
  1. Users can use the application as a self-care tool by utlilizing the therapeutic effects of self-monitoring.
  2. Data collected in real time can be shared with healthcare providers if the user so desires.
  1. Research Possibilities
  1. The effects of self-monitoring on compliance with medication or other treatments.
  2. The effects of self-monitoring on behavior change.
  3. The relationship of self-monitored data to data from standardized assessments.
  4. The use of self-monitoring to collect multiple data points over time for single case design research.
  1. Plan
  1. Develop the T2 MoodTracker application across multiple smart phone platforms.
  2. Develop secure networks allowing data to be transmitted to health care providers.
  3. Using VAS data collecting methodology, develop self-monitoring applications for assessing actual behavioral functioning.
  4. Provide tailored cognitive or behavioral coping strategies based on user ratings.
  1. Appendix follows.

Prepared by: Charles P. Bosmajian, Jr., Ph.D., Telehealth and Technology, 253-968-3741

Approved by: Robert Ciulla, Ph.D., Teleheatlh and Technology, 253-968-2849

Appendix

  1. Self-Monitoring Strategy: Visual Analogue Scale (VAS).

a. A Visual Analogue Scale (VAS) is a self-report instrument that measures a characteristic or attitude that is believed to range across a continuum of values and cannot easily be directly measured.

b.Operationally, a VAS is usually a horizontal line anchored by word descriptors at each end.

c.Subjects select a point on the line that represents their perception of their current affective state by using a sliding pointer.

d.The VAS score is determined by measuring from the left hand end of the line to the point marked by the individual. Example:

HAPPY SAD

f.Applying smart phone technology to the VAS self-rating strategy allows users to provide a quick assessment of themselves on a number of affective domains, to be able to save their previous ratings over time for comparison purposes, and to communicate their ratings to anyone they wish, including health care professionals.

  1. User Testing Results

a.User testing was conducted October 5 -13, 2009to evaluate user reaction to a VAS as a tool for measuring feeling states. There were 58 active duty respondents who completed the user testing which was conducted on-line using Survey Gizmo.

b. The survey addressed a number of questions including:

  1. User reaction to VAS format: 79.3% preferred using the VAS format over the Likert scale format to rate themselves
  2. User interest in saving results of VAS for later comparison: 79.3% reported that it would be helpful to save their results to refer to later.

Information Paper T2 MoodTracker Smart Phone ApplicationOCT 2010

[1]Lightfoot, M, Rotheram-Borus, M. J., Comulada, S.,Gundersen, G., & Reddy, V . (2007). Self-monitoring of behavior as a risk reduction strategy for persons living with HIV.Aids Care, 19, 757-763

[2]Baker R and Kirschenbaum D. Self-monitoring may be necessary for successful weight control.Behavior Therapy, 1993, 24, 377 - 394.

[3]See appendix

[4]Trull, T.J. & Ulriach, W.E. (2009). Using experience sampling methods/ecological momentary assessment (ESM/EMA) in clinical assessment and clinical research: Introduction to the special section. Psychological Assessment, 21, 457-462.

[5]Harmon, T.M., Nelson, R.O., & Hayes, S.C. (1980). Self-monitoring of mood versus activity by depressed clients

Journal of Consulting and Clinical Psychology, 48, 30-38.