The Geisel School of Medicine’s Center for Technology and Behavioral Health (CTBH) has been awarded a $5 million Common Fund grant that spans two funding phases across five years from the National Institutes of Health (NIH). Common Fund grants support projects that cut across disciplines and populations.
Alan I. Green, MD, chair of Psychiatry at Geisel and a co-investigator on the project, says this Dartmouth-based study, which includes investigators at Stanford University, Arizona State University, Massachusetts Institute of Technology, and elsewhere “aims to understand the mechanisms—psychological or biological—that underpin motivation, with an eye to developing better strategies that can help all of us improve our health.”
“I’m very excited about this funding opportunity,” adds Lisa Marsch, PhD, director of CTBH, an associate professor of Psychiatry at Geisel and the project’s Principal Investigator. “At CTBH we conduct all sorts of research using mobile interventions across a wide population—from teenagers to adults with behavioral health and physical health problems—and what we’ve seen in all of these populations is that changing health behavior changes health outcomes.”
Scientists have long studied behavior change and self-regulation, but those studies tend to be discipline specific—either from a psychological or neurological perspective. Although all of CTBH’s work based on the science of behavior change focuses on a wide array of populations and health behaviors, “we are only beginning to understand the nature of self-regulation, including how to best measure it and increase it,” Marsch notes.
“If you think about people who smoke, who don’t eat right, or who don’t take their medication, you have to ask yourself why they are doing it when they know it’s bad for them,” she observes. “How do all of these variables relate to each other to reveal a common self-regulation mechanism that leads to changing behavior? Advances in digital technologies have created unprecedented opportunities to assess and modify self-regulation and health behavior at the population level.”
Health-compromising behaviors, such as poor diet, physical inactivity, and smoking contribute to nearly 40 percent of all chronic diseases and early death rates. Add non-adherence to medical regimens—not taking prescribed medications, not following a physician’s medical advice—and you have a potent recipe for poor patient outcomes. With their repeated utilization of health care services, these patients account for a disproportionately high percentage of health care costs.
Understanding how people effectively self-regulate and knowing what leads to self-regulatory failure may limit the prevalence of non-adherence to medical advice and improve both outcomes and costs.
“Finding a way to enhance motivation toward increasing physical activity, eating the right foods, and limiting smoking is essential,” Green says. “If we were able to decrease cigarette smoking and obesity, we could dramatically improve overall health.”
By recruiting two bi-coastal population samples, people who smoke and people who are obese, researchers will observe brain functioning and neural circuitry in the lab, and use mobile assessment technology to track psychological variables, such as craving cigarettes or fatty foods, and mobile interventions to track behavioral variables—indulging those cravings—as people move through their daily lives. At the project’s conclusion, Marsch says they will have a comprehensive profile of the core principles of the science of behavior change independent of a specific disease group.
“This work expands our experimental focus on the core scientific principles of behavior change, and what we learn can be applied to the work we are doing with technology-based health-care delivery models,” she says. “It all intersects—we leverage technology because of its ability for personalization, but the more we understand how to effectively measure, initiate, and change behavior, the more effective our mobile interventions can be.”
"This grant highlights the innovative research program led by Dr. Marsch,” says Geisel Interim Dean Duane Compton, PhD. “The CTBH's work will demonstrate the intrinsic value of using technological tools, such as smartphones, to help people modify their behavior in order to improve health.”
NIH Common Fund projects are expected to lead to the development of novel tools and technologies and though CTBH has access to a ready-to-use mobile platform, they will be developing new assessment tools and methods of measuring self-regulation, which will be shared with the broader community at the project’s completion.