The behavioral intervention technology model: an integrated conceptual and technological framework for eHealth and mHealth interventions

David C Mohr, Stephen M Schueller, Enid Montague, Michelle Nicole Burns, Parisa Rashidi, David C Mohr, Stephen M Schueller, Enid Montague, Michelle Nicole Burns, Parisa Rashidi

Abstract

A growing number of investigators have commented on the lack of models to inform the design of behavioral intervention technologies (BITs). BITs, which include a subset of mHealth and eHealth interventions, employ a broad range of technologies, such as mobile phones, the Web, and sensors, to support users in changing behaviors and cognitions related to health, mental health, and wellness. We propose a model that conceptually defines BITs, from the clinical aim to the technological delivery framework. The BIT model defines both the conceptual and technological architecture of a BIT. Conceptually, a BIT model should answer the questions why, what, how (conceptual and technical), and when. While BITs generally have a larger treatment goal, such goals generally consist of smaller intervention aims (the "why") such as promotion or reduction of specific behaviors, and behavior change strategies (the conceptual "how"), such as education, goal setting, and monitoring. Behavior change strategies are instantiated with specific intervention components or "elements" (the "what"). The characteristics of intervention elements may be further defined or modified (the technical "how") to meet the needs, capabilities, and preferences of a user. Finally, many BITs require specification of a workflow that defines when an intervention component will be delivered. The BIT model includes a technological framework (BIT-Tech) that can integrate and implement the intervention elements, characteristics, and workflow to deliver the entire BIT to users over time. This implementation may be either predefined or include adaptive systems that can tailor the intervention based on data from the user and the user's environment. The BIT model provides a step towards formalizing the translation of developer aims into intervention components, larger treatments, and methods of delivery in a manner that supports research and communication between investigators on how to design, develop, and deploy BITs.

Keywords: behavioral intervention technology; ehealth; mhealth.

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
BITs facilitate reaching future changes (ie, intervention aims) through possible interventions.
Figure 2
Figure 2
BIT model example using MyFitnessPal calorie intake monitoring features.
Figure 3
Figure 3
Three paradigms: Reactive, Deliberative, and Hybrid.
Figure 4
Figure 4
BIT-Tech framework: required environment and user data is collected by the Profiler component; collected data is passed to the Intervention Planner, which is responsible for planning intervention at time t; the Intervention Repository component stores all the interventions and passes specific details of the selected intervention to the User interface component, which then delivers the intervention.
Figure 5
Figure 5
Example workflow generated by the workflow-planner specifying the elements (rectangular nodes), element’s characteristics (elliptical nodes), as well as order of transitions among elements.
Figure 6
Figure 6
Workflow for MyFitnessPal specifying the elements (rectangular nodes), element’s characteristics (elliptical nodes), as well as order of transitions among elements.

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