Advancing Behavioral Intervention and Theory Development for Mobile Health: The HeartSteps II Protocol.

Background: Recent advances in mobile and wearable technologies have led to new forms of interventions, called "Just-in-Time Adaptive Interventions" (JITAI). JITAIs interact with the individual at the most appropriate time and provide the most appropriate support depending on the continuously acquired Intensive Longitudinal Data (ILD) on participant physiology, behavior, and contexts. These advances raise an important question: How do we model these data to better understand and intervene on health behaviors? The HeartSteps II study, described here, is a Micro-Randomized Trial (MRT) intended to advance both intervention development and theory-building enabled by the new generation of mobile and wearable technology. Methods: The study involves a year-long deployment of HeartSteps, a JITAI for physical activity and sedentary behavior, with 96 sedentary, overweight, but otherwise healthy adults. The central purpose is twofold: (1) to support the development of modeling approaches for operationalizing dynamic, mathematically rigorous theories of health behavior; and (2) to serve as a testbed for the development of learning algorithms that JITAIs can use to individualize intervention provision in real time at multiple timescales. Discussion and Conclusions: We outline an innovative modeling paradigm to model and use ILD in real- or near-time to individually tailor JITIAs.

A "Viral Epistolary" and Psychosocial Spirituality: Restoring Transcendental Meaning During COVID-19 Through a Digital Community Letter-Writing Project.

This article outlines the results of a three-month-long community letter-writing and letter-sharing project called "Viral Epistolary" (VE), which we completed online in Italy during the first wave of COVID-19 lockdowns. In it, we collected 340 digital letters from all over the country and connected thousands of people through epistolary exchanges. We used the genre of letters as a mediating, meaning-making, and (auto)biographical tool whereby people could share their experiences of domestic isolation and physical distancing, thus creating a community of support. Based on a well-documented understanding of meaning-making as a core human endeavor, especially in times of social disruption and personal crisis, this article frames sense-making as a transcendental and even spiritual process that yields broad principles for organizing life. Thus, the research adopts a psychosocial perspective on spirituality and applies thematic analysis to qualitatively analyze written narratives. The results reveal that many respondents underwent a three-part, not-necessarily-sequential process of collapsing, self-distancing, and transcending during lockdown, which allowed them to rearrange themselves according to the new total social fact of the pandemic. Through this process, respondents negotiated themes of semiotic crisis, striving for meaning, and beyond meaning (the essential). Finally, the article discusses the role of meaning as a transcendental component of psychosocial meaning-making coping processes and tries to highlight how shared writing experiences can stimulate personal and communal healing processes in the wake of social crises.

The Meaning of Living in the Time of COVID-19. A Large Sample Narrative Inquiry.

The spread of the COVID-19 pandemic has been a sudden, disruptive event that has strained international and local response capacity and distressed local populations. Different studies have focused on potential psychological distress resulting from the rupture of consolidated habits and routines related to the lockdown measures. Nevertheless, the subjective experience of individuals and the variations in the way of interpreting the lockdown measures remain substantially unexplored. Within the frame of Semiotic Cultural Psychosocial Theory, the study pursued two main goals: first, to explore the symbolic universes (SUs) through which Italian people represented the pandemic crisis and its meaning in their life; and second, to examine how the interpretation of the crisis varies over societal segments with different sociodemographic characteristics and specific life challenges. An online survey was available during the Italian lockdown. Respondents were asked to write a passage about the meaning of living in the time of COVID-19. A total of 1,393 questionnaires (mean = 35.47; standard deviation = 14.92; women: 64.8%; North Italy: 33%; Center Italy: 27%; South Italy: 40%) were collected. The Automated Method for Content Analysis procedure was applied to the collected texts to detect the factorial dimensions underpinning (dis)similarities in the respondents' discourses. Such factors were interpreted as the markers of latent dimensions of meanings defining the SUs active in the sample. A set of χ2 analysis allowed exploring the association between SUs and respondents' characteristics. Four SUs were identified, labeled "Reconsider social priorities," "Reconsider personal priorities," "Live with emergency," and "Surviving a war," characterized by the pertinentization of two extremely basic issues: what the pandemic consists of (health emergency versus turning point) and its extent and impact (daily life vs. world scenario). Significant associations were found between SUs and all the respondents' characteristics considered (sex, age, job status, job situation during lockdown, and place of living). The findings will be discussed in light of the role of the media and institutional scenario and psychosocial conditions in mediating the representation of the pandemic and in favoring or constraining the availability of symbolic resources underpinning people's capability to address the crisis.

Construcción y validación de un instrumento para medir la percepción de exclusión social en jóvenes / Development and validation of an instrument to measure social exclusion perception in young people

Resumen Introducción: La exclusión social es un fenómeno multifactorial que expone a las personas a desventajas económicas, institucionales y sociales. Frecuentemente los jóvenes padecen exclusión social que les genera amplias consecuencias negativas. Objetivo: Desarrollar y validar un instrumento para evaluar la percepción de exclusión social en jóvenes mexicanos. Método: Estudio centrado en la psicometría. En una primera fase se creó una versión preliminar del instrumento a partir de reactivos derivados de la literatura. La calidad de los reactivos fue evaluada por expertos y por un grupo de jóvenes de la población objetivo. En una segunda fase se incluyeron 415 jóvenes y se obtuvo la confiabilidad, validez y normas del instrumento. Resultados: La primera versión del instrumento contempló 60 reactivos evaluados en la segunda fase. La versión final del instrumento incluyó 35 reactivos agrupados en nueve factores que explicaron el 62,30 % de la varianza total. Esta estructura factorial mostró una consistencia interna alta (α= ,863). El análisis factorial confirmatorio indicó un adecuado ajuste (x2= 1,71; CFI= ,926; RMSEA= ,042) que brinda evidencia sobre la validez empírica del instrumento. Conclusión: El instrumento tiene adecuadas propiedades psicométricas para evaluar la percepción de exclusión social en jóvenes mexicanos, el cual puede ser empleado en la investigación psicosocial. El estudio de la exclusión social se lleva a cabo desde las ciencias políticas, la economía y la sociología; pero hasta el conocimiento de los autores, este estudio representa una de las primeras propuestas de su abordaje desde la psicología social considerando central la visión de los individuos y sus interacciones sociales con otros grupos.

Abstract Introduction: Social exclusion is a multifactorial phenomenon that involves economic, institutional and social disadvantages for diverse groups of people. Frequently, young people face social exclusion that causes them negative consequences. Objective: To develop and validate an instrument to evaluate social exclusion perception in young people from Mexico. Method: This is an article research result, which is based on psychometric principles. During the first phase, a preliminary instrument version was developed on the base of a literature review. Experts and a group of young Mexican people evaluate items' quality. During the second phase, 415 participants were enrolled and the instrument psychometric properties (reliability, validity, and interpretation) were estimated. Results: The first version instrument included 60 items which were evaluated in the second phase. The final version of the instrument has 35 items grouped in nine factors that explained 62,30 % of the total variance. This instrument's factorial structure showed high internal consistency (α=.863). The confirmatory factorial analysis indicated an acceptable fit (x2=1.71; CFI=.926; RMSEA=.042) which gave evidence of the instrument empirical validity. Conclusion: Instrument has good psychometric properties to evaluate social exclusion perception; therefore it can be used in the psychosocial investigation. Social exclusion phenomenon has been studied on base the politics, economic and sociology sciences; however until author knowledge, this is a pioneer proposal to study social exclusion based on the social psychology. This science is focused in the subject vision and their group social interactions.

Spotlight on the Patient Health Engagement model (PHE model): a psychosocial theory to understand people's meaningful engagement in their own health care.

The concept of patient engagement in health care is gaining more and more attention not only in the scientific literature, but also as a requirement in the everyday practices of health care organizations. In general terms, the growing body of literature devoted to patient engagement is mainly inspired by the sociological and public health perspectives, which have generated various theories and models trying to explain how people become active agents in their health and care management. However, theories focusing on the psychosocial dimensions intervening in the patient engagement experience are still limited. This paper proposes a psychosocial perspective on patient engagement and discusses the Patient Health Engagement model, which is an evidence-based psychological theory built on extensive qualitative narrative research and literature analysis aimed at explaining patient engagement and its development in the patients' perspective. The model has been applied to orient patient and professional educational interventions and has contributed to the generation of the first scientific measure of the psychological experience of patients' engagement in their own care (Patient Health Engagement scale). According to this theory, patient engagement is a developmental process that involves the recovered patients' ability to have a life projectuality and goal directedness - even if living with a disease. The paper will also discuss the theoretical origins of this model and will conduct a critical comparison of the theory with the Transtheoretical Model of Change developed by Prochaska and the five-stage grief theory by Kubler-Ross.

Absolute rather than relative income is a better socioeconomic predictor of chronic obstructive pulmonary disease in Swedish adults.

BACKGROUND: While psychosocial theory claims that socioeconomic status (SES), acting through social comparisons, has an important influence on susceptibility to disease, materialistic theory says that socioeconomic position (SEP) and related access to material resources matter more. However, the relative role of SEP versus SES in chronic obstructive pulmonary disease (COPD) risk has still not been examined. METHOD: We investigated the association between SES/SEP and COPD risk among 667 094 older adults, aged 55 to 60, residing in Sweden between 2006 and 2011. Absolute income in five groups by population quintiles depicted SEP and relative income expressed as quintile groups within each absolute income group represented SES. We performed sex-stratified logistic regression models to estimate odds ratios and the area under the receiver operator curve (AUC) to compare the discriminatory accuracy of SES and SEP in relation to COPD. RESULTS: Even though both absolute (SEP) and relative income (SES) were associated with COPD risk, only absolute income (SEP) presented a clear gradient, so the poorest had a three-fold higher COPD risk than the richest individuals. While the AUC for a model including only age was 0.54 and 0.55 when including relative income (SES), it increased to 0.65 when accounting for absolute income (SEP). SEP rather than SES demonstrated a consistent association with COPD. CONCLUSIONS: Our study supports the materialistic theory. Access to material resources seems more relevant to COPD risk than the consequences of low relative income.