Division of General Medicine, UC Davis Health, Sacramento, CA, United States.
School of Social Welfare, University of California, Berkeley, Berkeley, CA, United States.
Front Public Health. 2020 Jun 25;8:260. doi: 10.3389/fpubh.2020.00260. eCollection 2020.
Although group-level evidence supports the use of behavioral interventions to enhance cognitive and emotional well-being, different interventions may be more acceptable or effective for different people. N-of-1 trials are single-patient crossover trials designed to estimate treatment effectiveness in a single patient. We designed a mobile health (mHealth) supported N-of-1 trial platform permitting US adult volunteers to conduct their own 30-day self-experiments testing a behavioral intervention of their choice (deep breathing/meditation, gratitude journaling, physical activity, or helpful acts) on daily measurements of stress, focus, and happiness. We assessed uptake of the study, perceived usability of the N-of-1 trial system, and influence of results (both reported and perceived) on enthusiasm for the chosen intervention (defined as perceived helpfulness of the chosen intervention and intent to continue performing the intervention in the future). Following a social media and public radio campaign, 447 adults enrolled in the study and 259 completed the post-study survey. Most were highly educated. Perceived system usability was high (mean scale score 4.35/5.0, SD 0.57). Enthusiasm for the chosen intervention was greater among those with higher pre-study expectations that the activity would be beneficial for them ( < 0.001), those who more positive N-of-1 results (as directly reported to participants) ( < 0.001), and those who their N-of-1 study results more positively ( < 0.001). However, reported results did not significantly influence enthusiasm after controlling for participants' interpretations. The interaction between pre-study expectation of benefit and N-of-1 results interpretation was significant ( < 0.001), such that those with the lowest starting pre-study expectations reported greater intervention enthusiasm when provided with results they interpreted as positive. We conclude that N-of-1 behavioral trials can be appealing to a broad albeit highly educated and mostly female audience, that usability was acceptable, and that N-of-1 behavioral trials may have the greatest utility among those most skeptical of the intervention to begin with.
虽然群体水平的证据支持使用行为干预措施来提高认知和情绪健康，但不同的干预措施可能对不同的人更可接受或更有效。N-of-1 试验是一种单患者交叉试验，旨在估计单个患者的治疗效果。我们设计了一个移动健康 (mHealth) 支持的 N-of-1 试验平台，允许美国成年志愿者进行自己的 30 天自我试验，测试他们选择的行为干预措施（深呼吸/冥想、感恩日记、身体活动或有益行为）对压力、专注和幸福的日常测量。我们评估了研究的参与度、N-of-1 试验系统的感知可用性以及结果（报告和感知）对所选干预措施的热情的影响（定义为所选干预措施的感知有用性和继续进行干预的意图未来）。在社交媒体和公共广播活动之后，447 名成年人注册了该研究，其中 259 人完成了研究后的调查。大多数人受过高等教育。感知系统可用性很高（平均量表得分为 4.35/5.0，标准差为 0.57）。那些对活动对自己有益的期望较高的人、那些对 N-of-1 结果更为积极的人（如直接向参与者报告）（<0.001）以及那些对自己的 N-of-1 研究结果更为积极的人（<0.001），对所选干预措施的热情更高。然而，在控制参与者的解释后，报告的结果并没有显著影响热情。预先研究期望收益与 N-of-1 结果解释之间的相互作用非常显著（<0.001），以至于那些预先研究期望收益最低的人，当他们提供他们解释为积极的结果时，报告的干预热情更高。我们得出结论，N-of-1 行为试验可以吸引广泛的受众，尽管他们受教育程度较高，且大多数为女性，可用性可以接受，并且 N-of-1 行为试验可能对最开始对干预措施持怀疑态度的人最有用。
