BackgroundStudies of criteria-based assessment tools have demonstrated the feasibility of objectively evaluating eHealth interventions independent of empirical testing. However, current tools have not included some quality constructs associated with intervention outcome, such as persuasive design, behavior change, or therapeutic alliance. In addition, the generalizability of such tools has not been explicitly examined.ObjectiveThe aim is to introduce the development and further analysis of the Enlight suite of measures, developed to incorporate the aforementioned concepts and address generalizability aspects.MethodsAs a first step, a comprehensive systematic review was performed to identify relevant quality rating criteria in line with the PRISMA statement. These criteria were then categorized to create Enlight. The second step involved testing Enlight on 42 mobile apps and 42 Web-based programs (delivery mediums) targeting modifiable behaviors related to medical illness or mental health (clinical aims).ResultsA total of 476 criteria from 99 identified sources were used to build Enlight. The rating measures were divided into two sections: quality assessments and checklists. Quality assessments included usability, visual design, user engagement, content, therapeutic persuasiveness, therapeutic alliance, and general subjective evaluation. The checklists included credibility, privacy explanation, basic security, and evidence-based program ranking. The quality constructs exhibited excellent interrater reliability (intraclass correlations=.77-.98, median .91) and internal consistency (Cronbach alphas=.83-.90, median .88), with similar results when separated into delivery mediums or clinical aims. Conditional probability analysis revealed that 100% of the programs that received a score of fair or above (≥3.0) in therapeutic persuasiveness or therapeutic alliance received the same range of scores in user engagement and content—a pattern that did not appear in the opposite direction. Preliminary concurrent validity analysis pointed to positive correlations of combined quality scores with selected variables. The combined score that did not include therapeutic persuasiveness and therapeutic alliance descriptively underperformed the other combined scores.ConclusionsThis paper provides empirical evidence supporting the importance of persuasive design and therapeutic alliance within the context of a program’s evaluation. Reliability metrics and preliminary concurrent validity analysis indicate the potential of Enlight in examining eHealth programs regardless of delivery mediums and clinical aims.

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The objective of this study was to examine the acute effects of a portable respiratory sinus arrhythmia (RSA) biofeedback device as compared to passive biofeedback control on state anxiety, heart rate (HR), and Stroop task (Congedo, 2003) performance during repeated administration of the Stroop task cognitive stressor in a single brief session. Participants were individuals reporting stress levels at least 1 SD above the mean on the Perceived Stress Scale (Cohen, Kamarck, & Mermelstein, 1983). The RSA group had significantly reduced HR compared to the control group at postintervention and Stressor 2. Both groups significantly improved Stroop scores. Together, these preliminary results suggest that brief relaxation training can reduce state anxiety but that RSA biofeedback appears to have added benefits in reducing state anxiety and HR stress reactivity compared to passive relaxation techniques.

Previous investigations of electroencephalograms during relaxation have identified increases in slow wave band power, correlations between increased levels of alpha activity with lower levels of anxiety, and autonomic changes characterized by otherwise documented decreased sympathetic activity. This study was carried out to determine the overall changes in quantitative electroencephalographic activity and the current source as a result of an acute session of respiratory sinus arrhythmia (RSA) biofeedback in a population of subjects experiencing stress. This study's findings provide physiological evidence of RSA feedback effect and suggest that RSA training may decrease arousal by promoting an increase of alpha band frequencies and decrease in beta frequencies overall and in areas critical to the regulation of stress. It was of interest that novices could achieve these objective alterations in EEG activity after minimal training and intervention periods considering that the previous literature on EEG and meditative states involve experienced meditators or participants who had been given extensive training. Additionally, these effects were present immediately following the training suggesting that the intervention may have effects beyond the actual practice.