Massive Open Online Interventions

Massive open online interventions (MOOIs) are used to expand the reach, scalability, and affordability of psychological interventions. The proof of concept that MOOIs could substantially contribute to diminishing the burden of health problems was a participant -preference smoking cessation open trial. In this trial, the authors used the San Francisco Stop Smoking site to enroll Spanish- or English-speaking persons, 18 years of age or older, anywhere in the world, to enter the study. The study’s primary outcome was to demonstrate that internet interventions tested in previous randomized clinical trials could be promptly adapted to play as universal healthcare resources. Recruitmentwas predominantly a Google Adwords campaign that displayed sponsored links to the Web site’s English or Spanish versions (http://www.stopsmoking.ucsf.edu and http://www.dejardefumar.ucsf.edu) in response to Google searches related to smoking cessation. After entering the Web site, participants were given free access to two intervention elements, the most important ones, namely the Stop Smoking Guide and the Nicotine Replacement Therapy Guide. Thus, all visitors to the site had free access to active intervention materials without participating in the research study. Visitors interested in enrolling in the study and eligible provided informed consent online and answered questionnaires about their smoking history, mood, and demographics data. There were nine intervention elements: Pre-Quit Checklist, Stop Smoking Guide, Nicotine Replacement Therapy, Taking Control of Your Life, Mood Management Intervention, Individually Timed E-mail Messages, Virtual Group, Journal, and Cigarette Counter. This latter intervention was an online tool for participants to show how many cigarettes smoked the previous day. The total number of Web site visitors was 292.978 in 30 months. Consented research participators were 18.154, 4.801 English-speaking, and 13.353 Spanish-speaking. After 12-Month follow up 1.404 reported quit smoking.

I was impressed with digital delivering behavioral health intervention coverage, repeatability, and convenience without compromising effectiveness. Traditional behavioral face-to-face interventions are consumable and rely on the time spent by the care provider and patient. Two languages allowed individuals with different backgrounds from 152 countries and territories to visit the website and some of them to participate in the trial. Digital interventions, like smoking cessation, can be used as many times as necessary regarding high rates of dropout in this treatment. Additionally, the cost of reaching 292,978 participants was a total of $ 200,000, or less than a dollar per visitor.

However, MOOIs have many barriers and limitations. For instance, some interventions require reading, and they will not be open to preliterate persons. If the website is available in only one language or a specific software platform or device, it will not be free and will require Internet access. High-quality Internet access is still a considerable problem in developing and emerging countries. My concerns about limitations are the high rates of attrition. Few website visitors participate in the study, approximately 5%, and fewer quit smoking after 12 months follow up, about 0.5% of the total number of visitors. Behavioral interventions’ success is associated with the patient’s motivation, self-awareness, and dealing with psychological distress.

Moreover, behavioral interventions demand time, professional healthcare, and depending on the severity of the case, medical assistance, and medications. Therefore, MOOIs can be used as a tool for initial treatment and uncomplicated patients. For complicated situations, MOOIs should be associated with more specific and intensive care.

Surprisingly, there are very little data about MOOIs in the literature. In my opinion, it could be useful for psychological interventions in obesity, anxiety, and obsession in social networks. My expectations for the future, digital interventions will have more human dimensions as mutual visual contact, body language, modifications in voice and intonation, and physical contacts such as touch, kiss, and embrace.

References

Muñoz, R. F., Bunge, E. L., Chen, K., Schueller, S. M., Bravin, J. I., Shaughnessy, E. A., & Pérez-Stable, E. J. (2016). Massive Open Online Interventions: A Novel Model for Delivering Behavioral-Health Services Worldwide. Clinical Psychological Science, 4(2), 194-205. https://doi.org/10.1177/2167702615583840

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