Just-in-Time Adaptive Interventions (JITAIs) in Mobile Health: Key Components and Design Principles for Ongoing Health Behavior Support.
The just-in-time adaptive intervention (JITAI) is an intervention design aiming to provide the right type/amount of support, at the right time, by adapting to an individual's changing internal and contextual state. The availability of increasingly powerful mobile and sensing technologies underpins the use of JITAIs to support health behavior, as in such a setting an individual's state can change rapidly, unexpectedly, and in his/her natural environment.



Despite the increasing use and appeal of JITAIs, a major gap exists between the growing technological capabilities for delivering JITAIs and research on the development and evaluation of these interventions. Many JITAIs have been developed with minimal use of empirical evidence, theory, or accepted treatment guidelines. Here, we take an essential first step towards bridging this gap.



Building on health behavior theories and the extant literature on JITAIs, we clarify the scientific motivation for JITAIs, define their fundamental components, and highlight design principles related to these components. Examples of JITAIs from various domains of health behavior research are used for illustration.



As we enter a new era of technological capacity for delivering JITAIs, it is critical that researchers develop sophisticated and nuanced health behavior theories capable of guiding the construction of such interventions. Particular attention has to be given to better understanding the implications of providing timely and ecologically sound support for intervention adherence and retention.
Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
Inbal
I
Nahum-Shani
Division of General Medicine, Department of Internal Medicine and Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
Shawna N
SN
Smith
Feinberg School of Medicine, Northwestern University, Evanston, IL, USA.
Bonnie J
BJ
Spring
TheMethodology Center andDepartment ofHuman Development & Family Studies, Penn State, State College, PA, USA.
Linda M
LM
Collins
Department of Psychology, University of New Mexico, Albuquerque, NM, USA.
Katie
K
Witkiewitz
Department of Statistics and Department of EECS, University of Michigan, Ann Arbor, MI, USA.
Ambuj
A
Tewari
Department of Statistics, and Institute for Social Research,University of Michigan, Ann Arbor, MI, USA.
Susan A
SA
Murphy
D001524:Behavioral Medicine / Q000379:methods*; D015438:Health Behavior; D006801:Humans; D010349:Patient Compliance; D012107:Research Design; D017216:Telemedicine / Q000379:methods*
Behav Res Methods. 2008 Aug;40(3):879-91
18697684
Gen Hosp Psychiatry. 2013 Jul-Aug;35(4):332-8
23664503
Schizophr Bull. 2014 Nov;40(6):1244-53
24609454
Nicotine Tob Res. 2014 May;16 Suppl 2:S71-2
24711628
Psychol Health. 2012;27(2):128-40
22348326
Psychol Methods. 2012 Dec;17(4):457-477
23025433
Transl Behav Med. 2011 Mar;1(1):53-71
21796270
Ann Intern Med. 2014 Nov 18;161(10 Suppl):S5-12
25402403
Public Health Nurs. 2012 May-Jun;29(3):232-40
22512424
Prev Sci. 2004 Sep;5(3):185-96
15470938
Obesity (Silver Spring). 2011 Jun;19(6):1205-12
21164502
Annu Rev Psychol. 2004;55:745-74
14744233
Schizophr Bull. 2009 Jul;35(4):696-703
19491314
Curr Opin Psychol. 2015 Oct 1;5:31-36
26086031
Subst Abus. 2015;36(4):486-92
25310057
Health Psychol. 2011 Mar;30(2):186-94
21401252
Annu Int Conf IEEE Eng Med Biol Soc. 2014;2014:6880-3
25571577
Am J Prev Med. 2013 Aug;45(2):228-36
23867031
J Med Internet Res. 2010 Feb 17;12(1):e4
20164043
J Ment Health. 2012 Aug;21(4):404-14
22251028
Transl Behav Med. 2015 Sep;5(3):335-46
26327939
Br J Health Psychol. 2010 Feb;15(Pt 1):1-39
19646331
BMC Psychiatry. 2012 Nov 24;12:209
23176560
Proc Am Control Conf. 2013;:1964-1969
24362946
Psychol Assess. 2009 Dec;21(4):486-97
19947783
Health Psychol. 2015 Dec;34S:1261-7
26651467
Patient Educ Couns. 2013 Dec;93(3):381-8
23579041
J Pers. 2005 Dec;73(6):1715-48
16274451
Pers Soc Psychol Bull. 2006 Aug;32(8):1024-36
16861307
Neurobiol Learn Mem. 2011 Jan;95(1):24-36
20969968
J Abnorm Psychol. 1977 Apr;86(2):103-26
858828
Proc ACM Int Conf Ubiquitous Comput. 2014;2014:909-920
25798455
ACM BCB. 2014;2014:479-488
25821861
J Med Internet Res. 2009 Jan 13;11(1):e1
19141433
JAMA Psychiatry. 2014 May;71(5):566-72
24671165
Health Educ Res. 2003 Apr;18(2):156-70
12729175
Annu Rev Psychol. 2013;64:471-98
22994919
J Dual Diagn. 2012;8(4):294-304
23316127
J Pers. 2005 Dec;73(6):1539-68
16274445
Clin Trials. 2014 May 1;11(4):393-399
24784487
Child Adolesc Ment Health. 2014 Feb;19(1):2-8
32878365
Health Educ Behav. 2004 Apr;31(2):143-64
15090118
Am Psychol. 2004 May-Jun;59(4):224-35
15149263
Curr Obes Rep. 2015 Dec;4(4):510-9
26364308
Clin Psychol Rev. 2010 Aug;30(6):794-804
20619520
Telemed J E Health. 2009 Nov;15(9):907-9
19919198
PLoS One. 2015 May 29;10(5):e0125457
26024379
Psychol Addict Behav. 2014 Sep;28(3):639-50
25000269
Cognition. 2009 Mar;110(3):380-94
19121518
J Appl Psychol. 2010 Sep;95(5):834-48
20836586
Stat Med. 2016 May 30;35(12):1944-71
26707831
J Med Internet Res. 2005 Mar 31;7(1):e11
15829473
J Med Internet Res. 2011 Mar 10;13(1):e30
21393123
Health Psychol. 2015 Dec;34S:1209-19
26651462
Health Psychol. 2008 May;27(3):379-87
18624603
JMIR Res Protoc. 2014 Mar 12;3(1):e14
24622344
J Med Internet Res. 2005 Jul 01;7(3):e23
15998614
Annu Rev Public Health. 2010;31:399-418
20070207
Health Educ Q. 1995 May;22(2):190-200
7622387
JMIR Mhealth Uhealth. 2015 May 14;3(2):e42
25977197
Psychiatr Rehabil J. 2013 Dec;36(4):289-296
24015913
Am J Prev Med. 2008 Feb;34(2):138-42
18201644
Psychol Methods. 2014 Jun;19(2):175-87
24079929
J Am Coll Health. 2008 Sep-Oct;57(2):245-8
18809542
Patient Educ Couns. 2009 Jul;76(1):25-30
19110395
Trends Cogn Sci. 2009 Sep;13(9):372-80
19716751
J Ment Health. 2017 Oct;26(5):483
28914576
JMIR Mhealth Uhealth. 2015 Feb 18;3(1):e19
25693595
JAMA. 2005 Dec 14;294(22):2906-8
16352801
J Med Internet Res. 2012 Jun 14;14(3):e80
22698679
Psychol Bull. 1995 May;117(3):497-529
7777651
JMIR Mhealth Uhealth. 2013 Apr 17;1(1):e3
25100672
Alcohol Clin Exp Res. 2012 Mar;36(3):552-60
22168137
Clin Trials. 2014 Jun 5;11(4):426-434
24902922
J Abnorm Psychol. 2012 Feb;121(1):173-86
21604824
PLoS One. 2013 Dec 09;8(12):e82901
24349392
JMIR Ment Health. 2015 Mar 25;2(1):e7
26543913
JMIR Mhealth Uhealth. 2015 Apr 13;3(2):e34
25872754
J Abnorm Psychol. 2005 Nov;114(4):661-75
16351387