Single-Case Experimental Designs to Evaluate Novel Technology-Based Health Interventions

Technology-based interventions to promote health are expanding rapidly. Assessing the preliminary efficacy of these interventions can be achieved by employing single-case experiments (sometimes referred to as n-of-1 studies). Although single-case experiments are often misunderstood, they offer excellent solutions to address the challenges associated with testing new technology-based interventions. This paper provides an introduction to single-case techniques and highlights advances in developing and evaluating single-case experiments, which help ensure that treatment outcomes are reliable, replicable, and generalizable. These advances include quality control standards, heuristics to guide visual analysis of time-series data, effect size calculations, and statistical analyses. They also include experimental designs to isolate the active elements in a treatment package and to assess the mechanisms of behavior change. The paper concludes with a discussion of issues related to the generality of findings derived from single-case research and how generality can be established through replication and through analysis of behavioral mechanisms.

[1]  M Stiernborg,et al.  Effect of didactic teaching and experiential learning on nursing students' AIDS-related knowledge and attitudes. , 1996, AIDS care.

[2]  M. Sidman Tactics of Scientific Research , 1960 .

[3]  J. Seeley,et al.  Methodological Issues in Research on Web-Based Behavioral Interventions , 2009, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[4]  Jacob Cohen The earth is round (p < .05) , 1994 .

[5]  Andrew Booth,et al.  Implementation Science BioMed Central Debate A conceptual framework for implementation fidelity , 2007 .

[6]  James H. Aylor,et al.  Computer for the 21st Century , 1999, Computer.

[7]  William R. Jenson,et al.  Statistical reform: Evidence‐based practice, meta‐analyses, and single subject designs , 2007 .

[8]  R. Echemendia,et al.  The Pennsylvania Practice Research Network and Future Possibilities for Clinically Meaningful and Scientifically Rigorous Psychotherapy Effectiveness Research , 2001 .

[9]  J. Cooper,et al.  Applied behavior analysis in education , 1982 .

[10]  Jesse Dallery,et al.  Internet-based contingency management to improve adherence with blood glucose testing recommendations for teens with type 1 diabetes. , 2010, Journal of applied behavior analysis.

[11]  Lisa A Marsch,et al.  Technology-Based Interventions Targeting Substance Use Disorders and Related Issues: An Editorial , 2011, Substance use & misuse.

[12]  T. Scruggs,et al.  Summarizing Single-Subject Research , 1998, Behavior modification.

[13]  A. Kazdin Mediators and mechanisms of change in psychotherapy research. , 2007, Annual review of clinical psychology.

[14]  Jesse Dallery,et al.  Internet-based contingency management increases walking in sedentary adults. , 2013, Journal of applied behavior analysis.

[15]  Richard I. Parker,et al.  Useful effect size interpretations for single case research. , 2007, Behavior therapy.

[16]  Ben A. Williams,et al.  Perils of Evidence-Based Medicine , 2010, Perspectives in biology and medicine.

[17]  Jesse Dallery,et al.  Delay discounting predicts cigarette smoking in a laboratory model of abstinence reinforcement , 2007, Psychopharmacology.

[18]  B. Gorman,et al.  Design and Analysis of Single-Case Research , 1996 .

[19]  Richard I. Parker,et al.  Phase Contrasts for Multiphase Single Case Intervention Designs. , 2006 .

[20]  S T Higgins,et al.  Increasing opiate abstinence through voucher-based reinforcement therapy. , 1996, Drug and alcohol dependence.

[21]  Jesse Dallery,et al.  An Internet-based abstinence reinforcement treatment for cigarette smoking. , 2007, Drug and alcohol dependence.

[22]  S. West,et al.  A comparison of methods to test mediation and other intervening variable effects. , 2002, Psychological methods.

[23]  R. Parrila,et al.  Examining the effectiveness of peer-mediated and video-modeling social skills interventions for children with autism spectrum disorders: A meta-analysis in single-case research using HLM , 2011 .

[24]  M. Hersen Single case experimental designs , 1992 .

[25]  Jesse Dallery,et al.  A web-based contingency management program with adolescent smokers. , 2008, Journal of applied behavior analysis.

[26]  Jesse Dallery,et al.  Contingency Management in the 21st Century: Technological Innovations to Promote Smoking Cessation , 2011, Substance use & misuse.

[27]  F. Butterfoss,et al.  Social Validation of Goals, Procedures, and Effects in Public Health , 2007, Health promotion practice.

[28]  C. Heriza,et al.  Single‐subject research design: recommendations for levels of evidence and quality rating , 2008, Developmental medicine and child neurology.

[29]  Susan A Murphy,et al.  Developing multicomponent interventions using fractional factorial designs , 2009, Statistics in medicine.

[30]  W. Nilsen,et al.  Health behavior models in the age of mobile interventions: are our theories up to the task? , 2011, Translational behavioral medicine.

[31]  Stephen S. Intille,et al.  Design of a wearable physical activity monitoring system using mobile phones and accelerometers , 2011, 2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[32]  Leland Wilkinson,et al.  Statistical Methods in Psychology Journals Guidelines and Explanations , 2005 .

[33]  Kimberly J. Vannest,et al.  Effective Intervention for Behavior With a Daily Behavior Report Card: A Meta-Analysis , 2010 .

[34]  D M Baer,et al.  Some still-current dimensions of applied behavior analysis. , 1987, Journal of applied behavior analysis.

[35]  Matthew J Carpenter,et al.  Does smoking reduction increase future cessation and decrease disease risk? A qualitative review. , 2006, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[36]  Michael Barkham,et al.  Practice research networks for effective psychological therapies , 2001 .

[37]  Richard I. Parker,et al.  Impact of the Picture Exchange Communication System: Effects on Communication and Collateral Effects on Maladaptive Behaviors , 2009, Augmentative and alternative communication.

[38]  Jesse Dallery,et al.  Internet-based group contingency management to promote abstinence from cigarette smoking: a feasibility study. , 2011, Drug and alcohol dependence.

[39]  Donald M. Baer,et al.  The Visual Analysis of Data, and Current Research into the Stimuli Controlling It , 2015 .

[40]  Jeffrey J. Borckardt,et al.  Time-series statistical analysis of single-case data. , 2013 .

[41]  Robin K. Morgan,et al.  Single-participant research design. Bringing science to managed care. , 2001, The American psychologist.

[42]  Michael A Rapoff,et al.  Editorial: Assessing and enhancing clinical significance/social validity of intervention research in pediatric psychology. , 2010, Journal of pediatric psychology.

[43]  Matthew K Nock,et al.  Conceptual and design essentials for evaluating mechanisms of change. , 2007, Alcoholism, clinical and experimental research.

[44]  R A Winett,et al.  Extending the concept of social validity: behavior analysis for disease prevention and health promotion. , 1991, Journal of applied behavior analysis.

[45]  Seth M. Noar,et al.  Computer technology-based interventions in HIV prevention: state of the evidence and future directions for research , 2011, AIDS care.

[46]  R. Steele,et al.  An evaluation of a personal electronic device to enhance self-monitoring adherence in a pediatric weight management program using a multiple baseline design. , 2011, Journal of pediatric psychology.

[47]  M. Wolery,et al.  The Use of Single-Subject Research to Identify Evidence-Based Practice in Special Education , 2005 .

[48]  Margaret Epp,et al.  The earth is round , 1998 .

[49]  Darlene E. Crone-Todd,et al.  A randomized trial of employment-based reinforcement of cocaine abstinence in injection drug users. , 2007, Journal of applied behavior analysis.

[50]  Fred D. Davis Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology , 1989, MIS Q..

[51]  Rosalind W. Picard,et al.  Wireless Technologies, Ubiquitous Computing and Mobile Health: Application to Drug Abuse Treatment and Compliance with HIV Therapies , 2010, Journal of Medical Toxicology.

[52]  P. Killeen Stability criteria. , 1978, Journal of the experimental analysis of behavior.

[53]  Leanne Togher,et al.  Rating the methodological quality of single-subject designs and n-of-1 trials: Introducing the Single-Case Experimental Design (SCED) Scale , 2008, Neuropsychological rehabilitation.

[54]  D H Barlow,et al.  Single-case experimental designs. Uses in applied clinical research. , 1973, Archives of general psychiatry.

[55]  Alan E. Kazdin,et al.  Single-Case Research Designs: Methods for Clinical and Applied Settings , 2010 .

[56]  E. Mash,et al.  Assessing social validity in clinical treatment research: issues and procedures. , 1999, Journal of consulting and clinical psychology.

[57]  Stanley R. Aeschleman,et al.  Single-subject research designs: Some misconceptions. , 1991 .

[58]  Cory Cornelius,et al.  On Usable Authentication for Wireless Body Area Networks , 2010 .

[59]  James M. Johnston,et al.  Strategies and tactics of behavioral research , 1993 .

[60]  Rosalind W. Picard,et al.  Preliminary Efforts Directed Toward the Detection of Craving of Illicit Substances: The iHeal Project , 2012, Journal of Medical Toxicology.

[61]  Jesse Dallery,et al.  Advances in the psychosocial treatment of addiction: the role of technology in the delivery of evidence-based psychosocial treatment. , 2012, The Psychiatric clinics of North America.

[62]  Roger O. Smith,et al.  Single Subject Designs: Current Methodologies and Future Directions , 2010 .

[63]  M. Dermer,et al.  Improving Descriptions of Single-Subject Experiments in Research Texts Written for Undergraduates , 1999 .

[64]  Todd R. Risley CHAPTER 8 – Strategies for Analyzing Behavioral Change Over Time , 1973 .

[65]  G. Guyatt,et al.  Users' guides to the medical literature. , 1993, JAMA.

[66]  Paul Barnett,et al.  Voucher reinforcement improves medication adherence in HIV-positive methadone patients: a randomized trial. , 2007, Drug and alcohol dependence.

[67]  B. Rounsaville,et al.  A Stage Model of Behavioral Therapies Research: Getting Started and Moving on From Stage I , 2006 .

[68]  G. Guyatt,et al.  Users' Guides to the Medical Literature: XXV. Evidence-based medicine: principles for applying the Users' Guides to patient care. Evidence-Based Medicine Working Group. , 2000, JAMA.

[69]  D. A. Kenny,et al.  The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. , 1986, Journal of personality and social psychology.

[70]  Lauren Terhorst,et al.  An Intervention Fidelity Framework for Technology-Based Behavioral Interventions , 2011, Nursing research.

[71]  William V. Dube,et al.  APA Handbook of Behavior Analysis , 2011 .

[72]  Peter Sturmey,et al.  Component analyses using single-subject experimental designs: a review. , 2010, Journal of applied behavior analysis.

[73]  D. Dunn,et al.  Experiential Learning , 2019, High Impact Teaching for Sport and Exercise Psychology Educators.

[74]  R. Hubbard,et al.  Why P Values Are Not a Useful Measure of Evidence in Statistical Significance Testing , 2008 .

[75]  Wim Van Den Noortgate,et al.  The Aggregation of Single-Case Results Using Hierarchical Linear Models. , 2007 .

[76]  Bethany M. Wootton,et al.  An Internet administered treatment program for obsessive-compulsive disorder: a feasibility study. , 2011, Journal of anxiety disorders.

[77]  D. Barlow,et al.  Single Case Experimental Designs: Strategies for Studying Behavior Change , 1976 .

[78]  L. Ransdell,et al.  A Systematic Review of Information and Communication Technology–Based Interventions for Promoting Physical Activity Behavior Change in Children and Adolescents , 2011, Journal of medical Internet research.

[79]  Brenda K. Wiederhold,et al.  ECG to identify individuals , 2005, Pattern Recognit..

[80]  J. Baird Callicott,et al.  Issues and applications , 2005 .

[81]  Alexander C. Wagenaar,et al.  The Value of Interrupted Time-Series Experiments for Community Intervention Research , 2000, Prevention Science.

[82]  Matthew S. Goodwin,et al.  Telemetric monitoring in the behavior sciences , 2008, Behavior research methods.

[83]  Eric Granholm,et al.  Examining a cognitive model of persecutory ideation in the daily life of people with schizophrenia: a computerized experience sampling study. , 2011, Schizophrenia bulletin.

[84]  K. Carroll,et al.  Cost-effectiveness of computer-assisted training in cognitive-behavioral therapy as an adjunct to standard care for addiction. , 2010, Drug and alcohol dependence.

[85]  Rumen Manolov,et al.  Choosing among techniques for quantifying single-case intervention effectiveness. , 2011, Behavior therapy.

[86]  H. S. Pennypacker,et al.  Generality and generalization of research findings. , 2013 .

[87]  D M Baer,et al.  Social validity assessments: is current practice state of the art? , 1991, Journal of applied behavior analysis.

[88]  Eugene S. Edgington,et al.  Randomized Single-Subject Experiments and Statistical Tests. , 1987 .

[89]  Michael E Kelley,et al.  Visual aids and structured criteria for improving visual inspection and interpretation of single-case designs. , 2003, Journal of applied behavior analysis.

[90]  Charles Lambdin,et al.  Significance tests as sorcery: Science is empirical—significance tests are not , 2012 .

[91]  S. Murphy,et al.  The multiphase optimization strategy (MOST) and the sequential multiple assignment randomized trial (SMART): new methods for more potent eHealth interventions. , 2007, American journal of preventive medicine.

[92]  Kimberly J. Vannest,et al.  An improved effect size for single-case research: nonoverlap of all pairs. , 2009, Behavior therapy.

[93]  Dawn E. Sugarman,et al.  Coping strategy use following computerized cognitive-behavioral therapy for substance use disorders. , 2010, Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors.

[94]  D M Baer,et al.  Some current dimensions of applied behavior analysis. , 1968, Journal of applied behavior analysis.

[95]  M. E. Boyle Single Case Experimental Designs: Strategies for Studying Behavior Change , 1983 .