Computer -based interventions, health behavior change, and ethics.

Abstract

The relationship among technology, behavior change, and ethics is examined. The technology concerned is computer-related systems to promote and improve health behavior, in particular, computer-generated feedback reports from an expert system. Although smoking cessation, physical activity, and weight reduction are examined, the primary focus is on maintaining regular physical activity. A review of the literature demonstrates that computer-generated interventions can be applied to health needs and have many advantages over traditional alternatives. This review also showed that many ethical dilemmas are related to computer-based interventions. At issue is whether the ethical problems of using a computer-based treatment are worth the risk, especially when alternative traditional therapies are available. Participants' preference for computer-generated feedback delivered through the mail versus feedback via telephone from a human therapist was compared. This study examined whether this preference would affect behavior change success rates and addressed various ethical dilemmas. Subjects were asked about their compliance with the study if they did not receive the mode of intervention they preferred. The data on 263 participants showed that significantly more males than females preferred the computer-generated, personalized reports from an expert system via print. Regardless of preference, 88% of the sample felt they would remain an active participant in the study even if they received information in a manner they did not prefer. By the six-month follow-up the group receiving computer-generated reports through the mail was exercising 120.3 minutes per week versus 101.3 minutes for the telephone participants. Although there was no statistical difference between these two groups, the results were significantly better (p < .001) than the control group (n = 87), which averaged only 46.4 minutes of exercise per week. This dissertation has shown that computer-based interventions can be an effective, preferred, and cost-effective means of spreading healthcare information. The results of this study show that individualized feedback from an expert system, regardless of the means of delivery and participant preferences, produced significant increases in physical activity when compared to a control group. Ethical dilemmas pale in comparison to the benefits of computer-based interventions on behavior change. When compared to more traditional therapies, computer-based treatments hold much promise.

First Advisor

Eugene Lappin

Date of Award

1-1-2004

Document Type

Dissertation

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