While mobile applications, a type of mobile health (mHealth), have been widely used for achieving physical and mental health objectives, evidence on the effectiveness of mobile applications is limited. This study aimed to examine the effectiveness, cost-effectiveness, and durability of three reinforcement systems that are applicable to mHealth applications. For this purpose, a total of 66 college students (16 males and 50 females) were randomly assigned to the following three groups: the big initial magnitude-10% escalating rate group (Group 1), the moderate initial magnitude-25% escalating rate group (Group 2), and the small initial magnitude-100% escalating rate (Group 3). After 66 days of intervention, the results showed that participants in Group 2 had significantly increased walking behavior compared to participants in Group 1 and significantly increased total physical activity compared to participants in Group 3. In terms of cost-effectiveness, participants in Group 2 and Group 3 showed significantly increased walking behavior per provided reinforcer amount compared to participants in Group 1. In addition, durability of the effects on walking behavior in all groups was found at 66 days after the intervention, but durability of the effects on self-reported total physical activity and walking was not found. Implications and limitations are further discussed.
이서이 (2019). 강화 계획 개입이 대학생의 걷기 행동증진에 미치는 효과성: 비율강화 계획과 증가강화계획을 중심으로. 연세대학교 대학원 석사학위청구논문.
Adams, M. A., Sallis, J. F., Norman, G. J., Hovell, M. F., Hekler, E. B., & Perata, E. (2013). An adaptive physical activity intervention for overweight adults: a randomized controlled trial. PloS One, 8(12), e82901.
Ainsworth, B. E., Haskell, W. L., Herrmann, S. D., Meckes, N., Bassett Jr, D. R., Tudor-Locke, C., … Leon, A. S. (2011). 2011 Compendium of Physical Activities: a second update of codes and MET values. Medicine & Science in Sports &Exercise, 43(8), 1575-1581.
Altschuler, A., Picchi, T., Nelson, M., Rogers, J. D., Hart, J., & Sternfeld, B. (2009). Physical activity questionnaire comprehension-lessons from cognitive interviews. Medicine and Science in Sports and Exercise, 41(2), 336-343..
Andrade, L. F., Barry, D., Litt, M. D., & Petry, N. M. (2014). Maintaining high activity levels in sedentary adults with a reinforcement‐thinning schedule. Journal of Applied Behavior Analysis, 47(3), 523-536.
Ball, K., Hunter, R. F., Maple, J.-L., Moodie, M., Salmon, J., Ong, K.-L., … Crawford, D. (2017). Can an incentive-based intervention increase physical activity and reduce sitting among adults? the ACHIEVE (Active Choices IncEntiVE) feasibility study. International Journal of Behavioral Nutrition and Physical Activity, 14(1), 35.
Barnett, N. P., Celio, M. A., Tidey, J. W., Murphy, J. G., Colby, S. M., & Swift, R. M. (2017). A preliminary randomized controlled trial of contingency management for alcohol use reduction using a transdermal alcohol sensor. Addiction, 112(6), 1025-1035.
Barry, D., Sullivan, B., & Petry, N. M. (2009). Comparable efficacy of contingency management for cocaine dependence among African American, Hispanic, and White methadone maintenance clients. Psychology of Addictive Behaviors, 23(1), 168-174.
Benishek, L. A., Dugosh, K. L., Kirby, K. C., Matejkowski, J., Clements, N. T., Seymour, B. L., & Festinger, D. S. (2014). Prize‐based contingency management for the treatment of substance abusers: A meta‐analysis. Addiction, 109(9), 1426-1436.
Benishek, L. A., Kirby, K. C., Dugosh, K. L., &Padovano, A. (2010). Beliefs about the empirical support of drug abuse treatment interventions: A survey of outpatient treatment providers. Drug and Alcohol Dependence, 107(2-3), 202-208.
Buijink, A. W. G., Visser, B. J., & Marshall, L. (2013). Medical apps for smartphones: lack of evidence undermines quality and safety. BMJ Evidence-Based Medicine, 18(3), 90-92.
Carroll, K. M., Nich, C., Petry, N. M., Eagan, D. A., Shi, J. M., & Ball, S. A. (2016). A randomized factorial trial of disulfiram and contingency management to enhance cognitive behavioral therapy for cocaine dependence. Drug and Alcohol Dependence, 160, 135-142.
Cassidy, R. N., Jackson, K. M., Rohsenow, D. J., Tidey, J. W., Barnett, N. P., Monti, P. M., …Colby, S. M. (2018). Contingency management for college student smokers: The role of drinking as a moderator and mediator of smoking abstinence during treatment. Addictive Behaviors, 80, 95-101.
Celis-Morales, C. A., Perez-Bravo, F., Ibanez, L., Salas, C., Bailey, M. E. S., & Gill, J. M. R. (2012). Objective vs. self-reported physical activity and sedentary time: effects of measurement method on relationships with risk biomarkers. PloS One, 7(5), e36345.
Conway, J. M., Seale, J. L., Jacobs Jr, D. R., Irwin, M. L., & Ainsworth, B. E. (2002). Comparison of energy expenditure estimates from doubly labeled water, a physical activity questionnaire, and physical activity records. The American Journal of Clinical Nutrition, 75(3), 519-525.
Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis(2nd ed.). Upper Saddle River, NJ: Pearson/Merrill-Prentice Hall.
Dallery, J., & Raiff, B. (2012). Monetary-based consequences for drug abstinence: Methods of implementation and some considerations about the allocation of finances in substance abusers. The American Journal of Drug and Alcohol Abuse, 38(1), 20-29.
Dallery, J., Silverman, K., Chutuape, M. A., Bigelow, G. E., & Stitzer, M. L. (2001). Voucher-based reinforcement of opiate plus cocaine abstinence in treatment-resistant methadone patients: effects of reinforcer magnitude. Experimental and Clinical Psychopharmacology, 9(3), 317-325.
Edwards, E. A., Lumsden, J., Rivas, C., Steed, L., Edwards, L. A., Thiyagarajan, A., … Munafò, M. R. (2016). Gamification for health promotion:systematic review of behaviour change techniques in smartphone apps. BMJ Open, 6(10), e012447.
Ferster, C. B., & Skinner, B. F. (1957). Schedules of reinforcement. Englewood Cliffs, NJ: Prentice Hall.
Fogel, V. A., Miltenberger, R. G., Graves, R., &Koehler, S. (2010). The effects of exergaming on physical activity among inactive children in a physical education classroom. Journal of Applied Behavior Analysis, 43(4), 591-600.
Foster, C., Richards, J., Thorogood, M., & Hillsdon, M. (2013). Remote and web 2.0 interventions for promoting physical activity. Cochrane Database of Systematic Reviews, 9, CD010395.
Frank-Crawford, M. A., Borrero, J. C., Newcomb, E. T., Chen, T., & Schmidt, J. D. (2019). Preference for and Efficacy of Accumulated and Distributed Response-Reinforcer Arrangements During Skill Acquisition. Journal of Behavioral Education, 28(2), 227-257.
Hackenberg, T. D. (2009). Token reinforcement: A review and analysis. Journal of the Experimental Analysis of Behavior, 91(2), 257-286.
Hayes, L. B., & Van Camp, C. M. (2015). Increasing physical activity of children during school recess. Journal of Applied Behavior Analysis, 48(3), 690-695.
Herbeck, D. M., Hser, Y.-I., & Teruya, C. (2008). Empirically supported substance abuse treatment approaches: A survey of treatment providers’perspectives and practices. Addictive Behaviors, 33(5), 699-712.
Hoeppner, B. B., Hoeppner, S. S., Seaboyer, L., Schick, M. R., Wu, G. W. Y., Bergman, B. G., &Kelly, J. F. (2015). How smart are smartphone apps for smoking cessation? A content analysis. Nicotine & Tobacco Research, 18(5), 1025-1031.
Hoeppner, B. B., Schick, M. R., Kelly, L. M., Hoeppner, S. S., Bergman, B., & Kelly, J. F. (2017). There is an app for that-Or is there? A content analysis of publicly available smartphone apps for managing alcohol use. Journal of Substance Abuse Treatment, 82, 67-73.
IPAQ Research Committee. (2005). Guidelines for data processing and analysis of the International Physical Activity Questionnaire (IPAQ)-short and long forms. Retrieved December 10, 2019, from https://docs.google.com/viewer?a=v&pid=site s&srcid=ZGVmYXVsdGRvbWFpbnx0aGVpcGFxfG d4OjE0NDgxMDk3NDU1YWRlZTM.
Iwane, M., Arita, M., Tomimoto, S., Satani, O., Matsumoto, M., Miyashita, K., & Nishio, I. (2000). Walking 10, 000 steps/day or more reduces blood pressure and sympathetic nerve activity in mild essential hypertension. Hypertension Research, 23(6), 573-580.
Jeffery, R. W. (2012). Financial incentives and weight control. Preventive Medicine, 55, S61-S67.
Kendzor, D. E., Businelle, M. S., Poonawalla, I. B., Cuate, E. L., Kesh, A., Rios, D. M., … Balis, D. S. (2015). Financial incentives for abstinence among socioeconomically disadvantaged individuals in smoking cessation treatment. American Journal of Public Health, 105(6), 1198-1205.
Kocher, C. P., Howard, M. R., & Fienup, D. M. (2015). The effects of work-reinforcer schedules on skill acquisition for children with autism. Behavior Modification, 39(4), 600-621.
Kollins, S. H., McClernon, F. J., & Van Voorhees, E. E. (2010). Monetary incentives promote smoking abstinence in adults with attention deficit hyperactivity disorder (ADHD). Experimental and Clinical Psychopharmacology, 18(3), 221-228.
Krishnan-Sarin, S., Duhig, A. M., McKee, S. A., McMahon, T. J., Liss, T., McFetridge, A., &Cavallo, D. A. (2006). Contingency management for smoking cessation in adolescent smokers. Experimental and Clinical Psychopharmacology, 14(3), 306-310.
Kumar, N., Khunger, M., Gupta, A., & Garg, N. (2015). A content analysis of smartphone-based applications for hypertension management. Journal of the American Society of Hypertension, 9(2), 130-136.
Kurti, A. N., & Dallery, J. (2013). Internet‐based contingency management increases walking in sedentary adults. Journal of Applied Behavior Analysis, 46(3), 568-581.
Lally, P., Van Jaarsveld, C. H. M., Potts, H. W. W., & Wardle, J. (2010). How are habits formed:Modelling habit formation in the real world. European Journal of Social Psychology, 40(6), 998-1009.
Lattal, K. A., & Neef, N. A. (1996). Recent reinforcement‐schedule research and applied behavior analysis. Journal of Applied Behavior Analysis, 29(2), 213-230.
Lewis, Z. H., Swartz, M. C., & Lyons, E. J. (2016). What’s the point?: a review of reward systems implemented in gamification interventions. Games for Health Journal, 5(2), 93-99.
Lussier, J. P., Heil, S. H., Mongeon, J. A., Badger, G. J., & Higgins, S. T. (2006). A meta‐analysis of voucher‐based reinforcement therapy for substance use disorders. Addiction, 101(2), 192-203.
Mahoney, A. (2017). A Comparison of Escalating Versus Fixed Reinforcement Schedules on Undergraduate Quiz Taking. Journal of Behavioral Education, 26(3), 264-276.
McDonell, M. G., Howell, D. N., McPherson, S., Cameron, J. M., Srebnik, D., Roll, J. M., & Ries, R. K. (2012). Voucher‐based reinforcement for alcohol abstinence using the ethyl‐glucuronide alcohol biomarker. Journal of Applied Behavior Analysis, 45(1), 161-165.
McGovern, M. P., Fox, T. S., Xie, H., & Drake, R. E. (2004). A survey of clinical practices and readiness to adopt evidence-based practices:Dissemination research in an addiction treatment system. Journal of Substance Abuse Treatment, 26(4), 305-312.
Morrissey, E. C., Corbett, T. K., Walsh, J. C., &Molloy, G. J. (2016). Behavior change techniques in apps for medication adherence: a content analysis. American Journal of Preventive Medicine, 50(5), e143-e146.
Olmstead, T. A., & Petry, N. M. (2009). The cost-effectiveness of prize-based and voucherbased contingency management in a population of cocaine-or opioid-dependent outpatients. Drug and Alcohol Dependence, 102(1-3), 108-115.
Olmstead, T. A., Sindelar, J. L., Easton, C. J., &Carroll, K. M. (2007). The cost‐effectiveness of four treatments for marijuana dependence. Addiction, 102(9), 1443-1453.
Patel, M. S., Asch, D. A., Rosin, R., Small, D. S., Bellamy, S. L., Eberbach, K., … Wesby, L. (2016). Individual versus team-based financial incentives to increase physical activity: a randomized, controlled trial. Journal of General Internal Medicine, 31(7), 746-754.
Petry, N. M. (2010). Contingency management treatments: controversies and challenges. Addiction (Abingdon, England), 105(9), 1507-1509.
Petry, N. M., Alessi, S. M., Olmstead, T. A., Rash, C. J., & Zajac, K. (2017). Contingency management treatment for substance use disorders: How far has it come, and where does it need to go? Psychology of Addictive Behaviors, 31(8), 897-906.
Petry, N. M., & Simcic Jr, F. (2002). Recent advances in the dissemination of contingency management techniques: clinical and research perspectives. Journal of Substance Abuse Treatment, 23(2), 81-86.
Pope, L., & Harvey-Berino, J. (2013). Burn and earn:A randomized controlled trial incentivizing exercise during fall semester for college first-year students. Preventive Medicine, 56(3-4), 197-201.
Prendergast, M., Podus, D., Finney, J., Greenwell, L., & Roll, J. (2006). Contingency management for treatment of substance use disorders: A metaanalysis. Addiction, 101(11), 1546-1560.
Prince, S. A., Adamo, K. B., Hamel, M. E., Hardt, J., Gorber, S. C., & Tremblay, M. (2008). A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review. International Journal of Behavioral Nutrition and Physical Activity, 5(1), 56.
Rash, C. J., DePhilippis, D., McKay, J. R., Drapkin, M., & Petry, N. M. (2013). Training workshops positively impact beliefs about contingency management in a nationwide dissemination effort. Journal of Substance Abuse Treatment, 45(3), 306-312.
Research2guidance. (2016). mHealth App Developer Economics 2016: the curent status and trends of the mHealth app market.. Retrieved December 10, 2019, from http://research2guidance.com/product/mhealth-app-developer-economics-2016.
Roll, J. M., & Higgins, S. T. (2000). A within-subject comparison of three different schedules of reinforcement of drug abstinence using cigarette smoking as an exemplar. Drug and Alcohol Dependence, 58(1-2), 103-109.
Roll, J. M., Huber, A., Sodano, R., Chudzynski, J. E., Moynier, E., & Shoptaw, S. (2006). A comparison of five reinforcement schedules for use in contingency management-based treatment of methamphetamine abuse. The Psychological Record, 56(1), 67-81.
Roll, J. M., Madden, G. J., Rawson, R., & Petry, N. M. (2009). Facilitating the adoption of contingency management for the treatment of substance use disorders. Behavior Analysis in Practice, 2(1), 4-13.
Roll, J. M., & Shoptaw, S. (2006). Contingency management: schedule effects. Psychiatry Research, 144(1), 91-93.
Romanowich, P., & Lamb, R. J. (2010). Effects of escalating and descending schedules of incentives on cigarette smoking in smokers without plans to quit. Journal of Applied Behavior Analysis, 43(3), 357-367.
Romanowich, P., & Lamb, R. J. (2015). The effects of fixed versus escalating reinforcement schedules on smoking abstinence. Journal of Applied Behavior Analysis, 48(1), 25-37.
Russell, D., Ingvarsson, E. T., Haggar, J. L., &Jessel, J. (2018). Using progressive ratio schedules to evaluate tokens as generalized conditioned reinforcers. Journal of Applied Behavior Analysis, 51(1), 40-52.
Sharma, S., Hryhorczuk, C., & Fulton, S. (2012). Progressive-ratio responding for palatable high-fat and high-sugar food in mice. JoVE (Journal of Visualized Experiments), (63), e3754.
Shoptaw, S., Rotheram‐Fuller, E., Yang, X., Frosch, D., Nahom, D., Jarvik, M. E., … Ling, W. (2002). Smoking cessation in methadone maintenance. Addiction, 97(10), 1317-1328.
Silverman, K., Chutuape, M. A., Bigelow, G. E., &Stitzer, M. L. (1999). Voucher-based reinforcement of cocaine abstinence in treatment-resistant methadone patients: Effects of reinforcement magnitude. Psychopharmacology, 146(2), 128-138.
Sorensen, J. L., Haug, N. A., Delucchi, K. L., Gruber, V., Kletter, E., Batki, S. L., … Hall, S. (2007). Voucher reinforcement improves medication adherence in HIV-positive methadone patients: a randomized trial. Drug and Alcohol Dependence, 88(1), 54-63.
Stitzer, M., & Petry, N. (2006). Contingency management for treatment of substance abuse. Annual Review of Clinical Psychology, 2, 411-434.
Tudor-Locke, C. (2010). Steps to better cardiovascular health: how many steps does it take to achieve good health and how confident are we in this number? Current Cardiovascular Risk Reports, 4(4), 271-276.
Tudor-Locke, C., Williams, J. E., Reis, J. P., & Pluto, D. (2004). Utility of pedometers for assessing physical activity. Sports Medicine, 34(5), 281-291.
Tuten, M., Svikis, D. S., Keyser-Marcus, L., O’Grady, K. E., & Jones, H. E. (2012). Lessons learned from a randomized trial of fixed and escalating contingency management schedules in opioiddependent pregnant women. The American Journal of Drug and Alcohol Abuse, 38(4), 286-292.
VanWormer, J. J. (2004). Pedometers and brief e-counseling: Increasing physical activity for overweight adults. Journal of Applied Behavior Analysis, 37(3), 421-425.
Ward‐Horner, J. C., Pittenger, A., Pace, G., &Fienup, D. M. (2014). Effects of reinforcer magnitude and distribution on preference for work schedules. Journal of Applied Behavior Analysis, 47(3), 623-627.
Webb, T., Joseph, J., Yardley, L., & Michie, S. (2010). Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. Journal of Medical Internet Research, 12(1), e4.
Weinstock, J., Barry, D., & Petry, N. M. (2008). Exercise-related activities are associated with positive outcome in contingency management treatment for substance use disorders. Addictive Behaviors, 33(8), 1072-1075.
Weiss, L. M., & Petry, N. M. (2011). Interaction effects of age and contingency management treatments in cocaine-dependent outpatients. Experimental and Clinical Psychopharmacology, 19(2), 173-181.
Wobbrock, J. O., Findlater, L., Gergle, D., and Higins, J. J. (2011). “The aligned Rank Transfromation for nonparametric factorial analysis using only ANOVA procedures,” in Proceedings of the ACM Conference on Human Factors in Computing Systems (CHI’11), Vancouver, BC, 143-146.
World Health Organization. (2011). mHealth: New horizons for health through mobile technologies. Global Observatory for eHealth series, 3.