A Mixed-Methods Analysis of Mobile ACT Responses From Two Cohorts

Abstract

BackgroundMobile transdiagnostic therapies offer a solution to the challenges of limited access to psychological care. However, it is unclear if individuals can actively synthesize and adopt concepts and skills via an app without clinician support.AimsThe present study measured comprehension of and engagement with a mobile acceptance and commitment therapy (ACT) intervention in two independent cohorts. Authors hypothesized that participants would recognize that behaviors can be flexible in form and function and respond in an ACT process-aligned manner.MethodsMixed-methods analyses were performed on open-ended responses collected from initial participants (n = 49) in two parallel micro-randomized trials with: 1) first-generation college students (FGCSs) (n = 25) from a four-year public research university and 2) individuals diagnosed with bipolar disorder (BP) (n = 24). Twice each day over six weeks, participants responded to questions about mood and behavior, after which they had a 50-50 chance of receiving an ACT-based intervention. Participants identified current behavior and categorized behavior as values-based or avoidant. Interventions were selected randomly from 84 possible prompts, each targeting one ACT process: engagement with values, openness to internal experiences, or self-awareness. Participants were randomly assigned to either exploratory (10 FGCS, 9 BP) or confirmatory (15 FGCS, 15 BP) groups for analyses. Responses from the exploratory group were used to inductively derive a qualitative coding system. This system was used to code responses in the confirmatory group. Coded confirmatory data were used for final analyses.ResultsOver 50% of participants in both cohorts submitted a non-blank response 100% of the time. For over 50% of participants, intervention responses aligned with the target ACT process for at least 96% of the time (FGCS) and 91% of the time (BP), and current behavior was labeled as values-based 70% (FGCS) and 85% (BP) of the time. Participants labeled similar behaviors flexibly as either values-based or avoidant in different contexts. Dominant themes were needs-based behaviors, interpersonal and family relationships, education, and time as a cost.ConclusionsBoth cohorts were engaged with the app, as demonstrated by responses that aligned with ACT processes. This suggests that participants had some level of understanding that behavior can be flexible in form and function.

Participant Engagement in Microrandomized Trials of mHealth Interventions: Scoping Review

“…Sixteen (80%) out of the 20 studies that explicitly measured engagement included at least 1 measure of this category. Generally, researchers used 2 types of system usage data: (1) responsiveness to self-reports, logs, or EMAs [ 23 , 24 , 26 , 27 , 29 , 30 , 33 , 35 - 37 , 41 , 42 ] and (2) access or use of interventions [ 22 , 26 , 33 , 35 , 36 , 39 - 41 , 43 ].…”

“…Only 1 study measured engagement with qualitative methods. In this study, researchers sought to describe engagement with an Acceptance and Commitment Therapy (ACT)–based mobile app in a clinical and a nonclinical sample [ 42 ]. The researchers inferred participant engagement by assessing whether participant responses reflected an understanding of the ACT intervention content.…”

“…Similarly, only 1 study assessed the cognitive facet of engagement—recall that this involves the “selective attention and processing of information related to a task or activity” [ 11 ]. This processing of information related to a task was comprehensively measured by Hoel et al [ 42 ] using the qualitative measures described in Measures of Engagement section.…”

Participant Engagement in Microrandomized Trials of mHealth Interventions: Scoping Review

“…11 out of the 20 studies (55%) to measure engagement included at least one measure of this category. 10 out of 11 studies measured responsiveness in terms of survey completion (completion of single items, logs, diaries, or ecological momentary assessments) [18,19,21,22,25,28,30,31,36,37]. Aguilera et al [18] for example, measured engagement as response rates to daily text messages tasking participants to rate their mood.…”

“…Only one study out of the 20 studies (5%) operationalized engagement as comprehension. In this study, researchers sought to describe engagement with an Acceptance and Commitment Therapy (ACT) based mobile application in a clinical and a non-clinical sample [37]. In addition to measuring engagement as responsiveness, the researchers also inferred engagement by assessing if participant responses reflected an understanding of the ACT intervention content.…”