Ecological momentary interventions may provide important behavior changes regarding myopia
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Ecological momentary interventions have grown in popularity and offer individualized approaches to alter behavior in a medically meaningful way, according to a commentary in JAMA Ophthalmology.
Clair A. Enthoven, PhD, and colleagues propose that smartphone-based interventions may help interrupt the progression of myopia in children.
Healio/OSN: Can you explain the concept of an ecological momentary intervention (EMI)?
Enthoven: Ecological momentary interventions are treatments that are provided during everyday life and within an individual’s natural environment. It has been more often used in the field of psychology and behavioral sciences. It might be best explained by an example of a successful EMI: Young adults increased their fruit and vegetable intake after an EMI that consisted of two motivational, instructional and goal-oriented messages per day. In this way, the treatment was extended from the dietitian practice toward the natural environment and during everyday life.
Healio/OSN: How does smartphone integration help provide feedback encouraging positive behavior?
Enthoven: Ecological momentary interventions were previously provided using palmtop computers, which were inconvenient for the participant to carry around. Since the introduction of mobile phones, EMIs became increasingly popular. Almost everyone carries their smartphone all day. It is therefore a perfect medium to intervene with during daily life.
Healio/OSN: How can EMIs help to offset myopia progression?
Enthoven: Due to the measures to decrease COVID-19 infections such as social distancing, home confinement and online education, children tend to spend less time outdoors and more time on near work such as screen work. These changes in the lifestyles of children will increase their risk of becoming myopic or will increase their myopia progression.
Currently, lifestyle advice for myopic children is often provided by eye care providers during a regular checkup. We know that it is difficult to change someone’s lifestyle, and this may be even more difficult for children who might not fully understand the long-term consequences of myopia. EMIs have the potential to extend the advice from the quarterly or semiannually checkup in the eye clinic to every single day of the child’s life.
Healio/OSN: What is the next step for technology-based interventions to enforce positive behavior?
Enthoven: In a simple version of EMI, this could be an app that provides daily or even multiple times per day push notifications on a fixed time to encourage children or adolescents to go outdoors. When children are too young or do not have a smartphone yet, such a message could be sent to the parents. In more advanced/tailored versions of EMI, the number and content of the push notifications may differ between individuals. For example, and this is hypothetical because I do not think it already exists, by tracking screen time on multiple devices and/or measuring outdoor exposure continuously using lux meters, tailored notifications could be developed. After having a certain period of screen time, a push notification could be sent to remind them to stop using the screen. Or a message might say: “You’ve only been outdoors for 30 minutes today. Let’s go for a walk.” I honestly do not know the effect of such interventions, but I think it is worth exploring.
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Enthoven CA, et al. JAMA Ophthalmol. 2021;doi:10.1001/jamaophthalmol.2021.3705.
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