ABSTRACT
This study evaluated the effectiveness of different recruitment messages for encouraging enrollment in a digital mental health intervention (DMHI) for anxiety among 1,600 anxious patients in a large healthcare system. Patients were randomly assigned to receive a standard message, or one of five messages designed to encourage enrollment: Three messages offered varying financial incentives, one message offered coaching, and one message provided consumer testimonials. Patients could then click a link in the message to visit the DMHI website, enroll, and start the first session. We examined the effects of message features and message length (short vs. long) on rates of site clicks, enrollment, and starting the first session. We also tested whether demographic and clinical factors derived from patients' electronic health records were associated with rates of enrollment and starting the first session to understand the characteristics of patients most likely to use DMHIs in this setting. Across messages, 19.4% of patients clicked a link to visit the DMHI website, but none of the messages were significantly associated with rates of site clicks, enrollment, or starting the first session. Females (vs. males) had a greater probability of enrollment. No other demographic or clinical variables were significantly associated with enrollment or starting the first session. Findings provide guidance for resource allocation decisions in larger scale DMHI implementations in healthcare settings.
ABSTRACT
The benefits of walking in older age include improved cognitive health (e.g., mental alertness, improved memory functioning) and a reduced risk of stress, depression and dementia. However, research capturing the benefits of walking among older people in real-time as they navigate their world is currently very limited. This study explores cognitive health and well-being outcomes in older people as they walk in their local neighborhood environment. Residents from an independent living facility for older people (mean age 65, n = 11) walked from their home in two dichotomous settings, selected on the basis of significantly different infrastructure, varying levels of noise, traffic and percentage of green space. Employing a repeated-measures, cross over design, participants were randomly allocated to one of two groups, and walked on different days in an urban busy "gray" district (a busy, built up commercial street) vs. an urban quiet "green" district (a quiet residential area with front gardens and street trees). Our study captured real-time air quality and noise data using hand-held Airbeam sensors and physiologic health data using a smart watch to capture heart rate variability (a biomarker of stress). Cognitive health outcome measures were a pre- and post-walk short cognitive reaction time (SRT) test and memory recall of the route walked (captured via a drawn mental map). Emotional well-being outcomes were a pre- and post-walk mood scale capturing perceived stress, happiness and arousal levels. Findings showed significant positive health benefits from walking in the urban green district on emotional well-being (happiness levels) and stress physiology (p < 0.05), accompanied by faster cognitive reaction times post-walk, albeit not statistically significant in this small sample. Cognitive recall of the route varied between urban gray and urban green conditions, as participants were more likely to rely on natural features to define their routes when present. The environmental and physiologic data sets were converged to show a significant effect of ambient noise and urban conditions on stress activation as measured by heart rate variability. Findings are discussed in relation to the complexity of combining real-time environmental and physiologic data and the implications for follow-on studies. Overall, our study demonstrates the viability of using older people as citizen scientists in the capture of environmental and physiologic stress data and establishes a new protocol for exploring relationships between the built environment and cognitive health in older people.