INTERVENTION DESIGNS
What is a JITAI?
The JITAI is an intervention design that uses mobile and wireless technology to treat individuals in their natural environments. By monitoring moment-to-moment changes in an individual’s internal and contextual state, JITAIs are able to deliver the right type and amount of support at the right time, motivating health behavior change.
Why use JITAIs?
Treatment in the moment is powerful.
Health practitioners have limited opportunities to treat and engage with their patients, but patients’ mobile devices are always with them. Using mobile sensing, JITAIs identify moments in a person’s day when intervention is most likely to make an impact. These include moments of opportunity, in which the potential for positive change is the greatest, and moments of vulnerability, in which health behaviors are most likely to slip. Then, through the same mobile device, JITAIs deliver an intervention, influencing the patient to engage in behaviors that move them towards treatment goals.
JITAIs make treatment at scale simple.
The ubiquity of mobile devices means almost everyone is ready to receive treatment through a JITAI. As global demand for healthcare spreads resources thin, JITAIs offer a way to provide evidence-based, individualized care that scales quickly at a low cost per patient.
What are the key components of a JITAI?
Intervention Options
JITAIs deliver two main types of interventions, known in mobile health (mHealth) as push interventions and pull interventions. When a JITAI delivers an intervention based on a person’s internal and external status, this is called a push intervention. When a JITAI makes a resource available for a person to access at any time, this is a pull intervention. Push interventions may direct patients to interact with pull intervention content in a particular way at a particular time.
Tailoring Variables
A tailoring variable represents information about an individual that determines what conditions trigger the delivery of an intervention and which intervention is delivered in a JITAI. Tailoring variables are measured before and during the course of a JITAI through a combination of self-reporting and passive monitoring with mobile devices. At predetermined thresholds, tailoring variables trigger an intervention.
Proximal and Distal Outcomes
Proximal outcomes are the short-term goals intervention options are intended to achieve. JITAIs measure proximal outcomes shortly after an intervention is delivered to gauge whether the intervention had an effect.
A distal outcome is the long-term goal a JITAI is designed to achieve. Intervention options in a JITAI are designed to impact multiple proximal outcomes as a means of achieving a single distal outcome.
What are the key components of a JITAI?
Intervention Options
JITAIs deliver two main types of interventions, known in mobile health (mHealth) as push interventions and pull interventions. When a JITAI delivers an intervention based on a person’s internal and external status, this is called a push intervention. When a JITAI makes a resource available for a person to access at any time, this is a pull intervention. Push interventions may direct patients to interact with pull intervention content in a particular way at a particular time.
Tailoring Variables
A tailoring variable represents information about an individual that determines what conditions trigger the delivery of an intervention and which intervention is delivered in a JITAI. Tailoring variables are measured before and during the course of a JITAI through a combination of self-reporting and passive monitoring with mobile devices. At predetermined thresholds, tailoring variables trigger an intervention.
Proximal and Distal Outcomes
Proximal outcomes are the short-term goals intervention options are intended to achieve. JITAIs measure proximal outcomes shortly after an intervention is delivered to gauge whether the intervention had an effect.
A distal outcome is the long-term goal a JITAI is designed to achieve. Intervention options in a JITAI are designed to impact multiple proximal outcomes as a means of achieving a single distal outcome.
Where are JITAIs found?
JITAIs have been implemented and pilot tested in several domains of health behavior change.
Constructing optimized JITAIs.
During the development of a JITAI, researchers must investigate the utility of each component and how well different components work together. The d3center specializes in developing new methods for constructing adaptive interventions, including JITAIs. d3c pioneered the Micro-Randomized Trial, an experimental design for optimizing JITAIs, and methods for conducting and interpreting data from a Micro-Randomized Trial.
JITAI Resources
References
Carpenter, S. M., Menictas, M., Nahum-Shani, I., Wetter, D. W., & Murphy, S. A. Developments in Mobile Health Just-in-Time Adaptive Interventions for Addiction Science. Curr Addict Rep 7, 280–290 (2020).
Hiremath, S. V., Amiri, A. M., Thapa-Chhetry, B., Snethen, G., Schmidt-Read, M., Ramos-Lamboy, M., . . . Intille, S. S. (2019). Mobile health-based physical activity intervention for individuals with spinal cord injury in the community: A pilot study. PloS one, 14(10), e0223762.
Nahum-Shani, I., Hekler, E. B., & Spruijt-Metz, D. (2015). Building health behavior models to guide the development of just-in-time adaptive interventions: A pragmatic framework. Health Psychology, 34(S), 1209.
Nahum-Shani, I., Smith, S. N., Spring, B. J., Collins, L. M., Witkiewitz, K., Tewari, A., & Murphy, S. A. (2018). Just-in-Time Adaptive Interventions (JITAIs) in Mobile Health: Key Components and Design Principles for Ongoing Health Behavior Support. Annals of Behavioral Medicine, 52, 446-462. doi:10.1007/s12160-016-9830-8.
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