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Movie talk technology to remotely quantify dietary, supplement, and medication adherence in clinical trials

Movie talk technology to remotely quantify dietary, supplement, and medication adherence in clinical trials

We conducted a pair of studies to test the validity, reliability, feasibility, and acceptability of using movie talk technology as a novel method to quantify dietary and pill-taking (i.e., supplement and medication) adherence. In the very first explore, we investigated whether movie talk technology can accurately quantify adherence to dietary and pill-taking interventions. Mock examine participants ate food items and guzzled pills while performing randomized scripted “cheating” behaviors design to mimic non-adherence. Monitoring was conducted in a crossover design, with two monitors watching in-person and two watching remotely by Skype on a smartphone. For the 2nd examine, a 22-question online survey was sent to an email listserv with more than 20,000 unique email addresses of past and present explore participants to assess the feasibility and acceptability of the technology. For the dietary adherence tests, monitors detected 86% of non-adherent events (sensitivity) in-person versus 78% of events via movie talk monitoring (p=0.12), with comparable inter-rater agreement (0.88 vs. 0.85; p=0.62). However, for pill-taking, non-adherence trended towards being more lightly detected in-person than by movie talk (77% vs. 60%; p=0.08), with non-significantly higher inter-rater agreement (0.85 vs. 0.Sixty nine; p=0.21). Survey results from the 2nd investigate (N=1,076 respondents; at least a 5% response rate) indicated that 86.4% of investigate participants had movie talking hardware, 73.3% were convenient using the technology; and 79.8% were willing to use it for clinical research. Given the capability of movie talk technology to reduce participant cargo and to outperform other adherence monitoring methods such as dietary self-report and pill counts, movie talking is a novel and very promising platform to quantify dietary and pill-taking adherence.

Since the very first generation of digital communications, electronic communication devices have become more affordable and increasingly sophisticated, leading to almost ubiquitous use of portable internet-connected devices in society (1) . Consequently, these technologies have increasingly been integrated into healthcare at a number of levels with positive results (Two) . Hospitals and medical schools now commonly use remote audio- and video-based technologies for instruction and training (Trio; Four; Five) , and many physicians provide movie consultations through real-time online consultation platforms such as MDLiveCare and SwiftMD (6) . Health care providers are even using digital real-time movie technology platforms to supply health care in rural and/or resource-limited areas (7; 8; 9; Ten; 11; 12) and to remotely diagnose, monitor, or treat medical conditions ranging from orthopedic trauma to neurologic disorders (1; Ten; 13; 14; 15; 16; 17; Legitimate; Nineteen; 20; 21) .

Despite the rapidly growing use of telehealth in clinical care, very few dietary, lifestyle, or pharmaceutical research studies use visual digital communication technologies as a clinical research contraption. A puny number of research studies have used movie talking platforms such as Skype and Facetime to conduct interviews, thereby supplanting telephone or in-person interviews (22; 23; 24) . Only a few clinical research studies have used visual electronic technologies to capture novel information, such as to collect health behavior data in real-world settings or to more accurately quantify intervention adherence (25) , which is the capability of participants to go after prescribed medication or lifestyle switches. An example of the novel application of visual communication technology to dietary research is food “photography” methods, such as the Remote Food Photography Method© (RFPM) and SmartIntake™ smartphone application (12; 26; 27; 28) . Using a smartphone app, examine participants take still pics of the food they eat and the smartphone photos are relayed back to researchers to estimate the quantity and quality of food consumed. This mechanism has been found to accurately measure the energy and nutrient intake of adults (12; 26; 27; 28) , and it can be used both for real-world studies of health behaviors and for monitoring of adherence to managed feeding interventions.

For the latter purpose—to monitor dietary adherence—RFPM is frequently thought to be better than data collection and monitoring methods such as self-report, which is widely known to be of limited accuracy (29; 30; 31; 32) . For monitoring adherence to other health behaviors—such as supplement or medication taking—visual monitoring technology has not yet been implemented, however novel technologies such as the Medication Event Monitoring System (MEMS; AARDEX Ltd., Zug, Switzerland) can accurately quantify when pill bottles are opened via a computer chip that is built into a bottle cap. MEMS is marginally better than standard pill counts and even unannounced telephone-based pill counts (33) , yet none of these methods can detect if pills were liquidated from the container and discarded/not consumed.

By contrast, movie talk technology has the potential to solve the problem of monitoring dietary and pill-taking (i.e., supplement and medication) adherence by providing movie of the behavior from begin to finish, minimizing the capability of participants to “cheat” or engage in non-adherent behaviors. While there are a multitude of studies investigating the feasibility and usability of movie talk technology to assess health behaviors, presently a petite number of clinical research studies have used the technology to monitor or enhance adherence to a clinical intervention (29; 34; 35; 36; 37; 38; 39; 40; 41; 42; 43; 44; 45; 46; 47) , and none have tested its validity and reliability for this purpose. We therefore designed a pilot investigate to empirically evaluate the validity and reliability of movie talk technology to quantify adherence to dietary and pill-taking interventions remotely compared to the gold standard of in-person monitoring. We hypothesized that diet and pill adherence could be quantified as reliably and accurately by webcam, as in-person. In parallel, we also administered a survey to determine the acceptability and feasibility of using movie talk technology to participate in clinical research. To our skill, this is the very first pair of studies to rigorously investigate the issues of the validity, reliability, acceptability, and accessibility of movie talk technology in the context of clinical intervention adherence.

METHODS

Both studies were conducted at Pennington Biomedical Research Center (Baton Rouge, LA), approved by the institution’s Institutional Review Board, and registered in the clinicaltrials.gov registry (www.clinicaltrials.gov; NCT # 02204540). The studies were conducted in accord with the Declaration of Helsinki, and no compensation was provided for either probe.

Validity and Reliability Examine

The aim of the very first explore was to assess the accuracy and reliability of detecting compliance to dietary and pill-taking interventions by movie talk, in comparison to in-person monitoring. To test validity, seven research center staff members were recruited (employee status was the only inclusion/exclusion criterion), and all seven provided written informed consent. Four of the volunteers served as monitors, and three of the volunteers served as mock probe participants while: (1) eating meals, as if they were participating in a dietary clinical investigate, and (Two) guzzling pills, mimicking participants in a supplement or pharmaceutical trial. The participants ate the meals and guzzled pills (Biotin vitamin capsules were used for this trial), while following behavioral scripts that outlined instructions to perform non-adherent behaviors (called “cheats”).

Cheating Behaviors

Non-adherent behaviors include perverted deeds such as not eating all of the food by slobbering food into a napkin, placing a pill under one’s tongue and discarding it, etc. We developed a list of common cheating behaviors by convening a group of six registered dieticians and staff members from Pennington Biomedical Research Center who professionally monitor probe participants for compliance in clinical studies. For reference, the concentrate group estimated that less than Five–10% of examine participants blatantly cheat, and that the most common reason for cheating is probe exhaustion. The cheating behaviors identified as common during dietary interventions included behaviors hiding food in a napkin and not eating it; stacking containers to hide unfinished food; and removing some of the food from a container before the meal monitoring starts.

The mock probe participants were given standardized instructions for eating and guzzling the pills (Supplementary Materials 1). These instructions were designed to be identical to those that would be given to real examine participants to make it lighter for monitors to accurately assess compliance. The instructions included displaying the pill to the camera; showcasing the participant’s empty palms to the camera after guzzling the pill; displaying each empty food container to the camera after eating; and keeping their mitts and head in the field-of-view of the webcam at all times. In addition, when scripted to cheat, participants were instructed to deliberately avoid being caught cheating.

The three mock explore participants together ate a combined total of thirty meals (192 food items), during which sixty cheating events were scripted to occur, and they gulped a total of sixty pills with thirty scripted cheating events. For plainness, the pill gulping tests were performed in conjunction with the dietary adherence tests: one pill was guzzled before each meal and a 2nd pill was guzzled after each meal. (Due to unforeseen switches in circumstances, one mock explore participant performed half of the cheating behaviors for both meals and pills, and the other half of cheating behaviors were unevenly divided among the other two mock participants.) The cheating events were scripted as goes after. Each meal was randomized to contain an average of two cheating behaviors (range 0–Four), and each example of pill gulping was randomized to have zero or one cheating behaviors. Which specific cheating behavior was performed in each example was also randomized. The monitors were blinded as to the total number of cheats. On uncommon occasions, participants accidentally left behind to cheat as instructed or performed extra cheats; thus, the results are voiced as a percentage of all behaviors that actually occurred.

Monitoring

During data collection, two monitors observed each meal or pill guzzle in-person and two extra evaluators rated each event remotely by watching the video-chat recorded movies. The monitoring was conducted in a crossover design, so that each pair of monitors observed both in-person and by movie talk in a balanced order. The monitors were employees of the research center but had no prior training in monitoring compliance for dietary or pill-taking intervention trials; monitors were not trained research dieticians so as to better generalize our results to trials conducted at research facilities without dieticians and so as to avoid any bias since our research dieticians were strongly involved in determining the cheating behaviors we tested. Similar to actual examine procedures, monitors were given photos of the actual meals to be consumed and the pill to be gulped about Five–Ten minutes ahead of time, and they documented any cheating behaviors on a standardized form. In-person monitors were seated 1.Five–1.8 meters away from the participant. A large divider was placed inbetween the two observers, and each wore earplugs, so that they could not see or hear each other. To movie record each example of eating a meal or gulping a pill, a smartphone was placed about 1–1.Five meters away from the participant. All recordings were performed using Skype and CallNote premium on either a Samsung smartphone or an iPhone, paired with both a tripod and wide-angle lens. We describe in detail how we identified this combination of software and hardware as being optimal in Supplementary Material Two, and we strongly encourage clinicians and researchers who want to implement movie talk technology to read this section for advice. The movie recordings were made by smartphone since more people have smartphones than other devices with webcams (see Results), but our methods were designed to generalize to movie talk technology in general. Lastly, an exit survey was given to monitors to gather feedback on their practices with monitoring compliance by movie talk technology, to determine what they liked and did not like about monitoring by movie talk and to determine what technical aspects of the movie quality made it lighter or firmer to detect cheating

Statistical Analysis

The accuracy (or validity) of detecting cheating by movie talk in comparison to in-person was quantified by sensitivity (percent of cheats that were detected) and specificity (1 – false positive rate, where each pill or food item consumed without cheating was counted as one event). The motivation for this manuscript was the dietary adherence sensitivity testing, which was powered at the 80% level to detect a 15% absolute difference inbetween in-person and movie talk monitoring, assuming 95% of cheats were detected in-person (one-sided test). The pill-taking testing was added later as an exploratory pilot analysis, since we could find no reasonable published or anecdotal data to formulate an estimate for the percentage of cheats that could be detected in-person. Reliability was operationally defined as inter-rater agreement adjusted for agreement by random chance, which was quantified primarily by Cohen’s kappa; Cronbach’s alpha was also calculated as a 2nd measure of inter-rater agreement. Statistical differences inbetween in-person and movie monitoring of compliance were assessed using Fisher’s Exact Test. The Type I error rate (α) was set at 0.05 for all analyses.

Feasibility and Acceptability Probe

To investigate the feasibility and acceptability of using movie talk technology to participate in clinical research, a 22-item survey that takes less than five minutes to accomplish was developed (Supplementary Material Trio).

Survey Respondents

The survey was administered through SurveyMonkey (www.surveymonkey.com) and was sent via a listserv that Pennington Biomedical Research Center uses to promote its clinical trials. The listserv contains more than 20,000 unique email addresses, albeit it is unknown how many of those are presently valid. Survey responses were collected primarily over the two-month period from December-January 2014. Because Probe two included an anonymous online survey, a waiver of informed consent was granted. There was no testing for legitimacy of email addresses or for validity of content.

Survey Design

We designed a close-ended survey to investigate whether probe participants have access to and practice with movie talk technology (feasibility), and whether they are willing to use the technology in clinical research (acceptability). In addition, since people often cite scheduling conflicts and commuting time as reasons for not participating in clinical research, we also investigated whether movie talk technology might reduce barriers to participating in clinical research in general. Section one of the questionnaire asked respondents about their past participation in clinical studies, whether scheduling difficulties prevented them from participating in studies, and whether suggesting examine visits on evenings or weekends would help them participate in more studies. Section two asked respondents to indicate their convenience with and prior use of movie talking, what movie talking software they have used, their access to webcams for movie talking (home and/or work), and what hardware that they own (e.g., smartphone). Section three asked participants about whether they choose to do probe visits by movie talk or in-person clinic visits (along with the reasons why), whether they dreamed behavioral support by movie talk, and whether they would be willing to use movie talk technology to participate in a clinical trial. Section four included demographic questions.

Statistical Analysis

Survey responses are voiced as a percentage of those who answered each question. Chi-squared tests were performed to test if survey responses differed by demographic variables. Given the multitude of association tests, the Bonferroni correction was applied. All statistical tests performed were two-tailed.

RESULTS

Validity and Reliability Probe

Dietary Adherence Monitoring

As shown in Table one , inter-rater agreement by Cohen’s kappa for dietary adherence monitoring was high for monitoring both in-person and by movie talk, at 0.88 and 0.85 (p=0.62), respectively. This was supported by values of 0.94 and 0.92, respectively, for Cronbach’s alpha. The sensitivity (true positive rate) for detecting cheating in-person was 86%; remarkably, in-person monitors did not detect about one of six cheats. The sensitivity of detecting cheating remotely through movie talk was 78%, which was not significantly different from in-person monitoring (p=0.12). When examining individual cheating behaviors ( Table one ), there were no statistically significant differences inbetween monitoring in-person versus by movie talk (p-values>0.Ten). Removing food before monitoring commenced was the most common cheating behavior not detected by the monitors, with the behavior detected less than 20% of the time. Slobbering food into a napkin was also difficult for raters to detect, with only about half of events detected by in-person and remote monitors. Monitors detected the remaining cheating behaviors most of the time. For both the in-person and remote monitoring, the false positive rate was very low (1%).

Pill-taking Adherence Monitoring

While the inter-rater agreement by Cohen’s kappa for in-person monitoring of pill-taking adherence (0.85) was comparable to that for dietary adherence, inter-rater agreement was somewhat lower for monitoring remotely through movie talk (0.Sixty nine); however, this difference did not reach statistical significance (p=0.21). Similarly, Cronbach’s alpha was 0.93 for in-person inter-rater agreements versus 0.82 for movie talk monitoring. The sensitivity of detecting cheating was 77% in-person, meaning that about one-quarter of cheating events were not detected by the gold-standard method of in-person monitoring. By comparison, the sensitivity tended to be lower at 60% for remote monitoring through movie talk (p=0.08). The cheating behavior least likely to be detected was hiding the pill in the mouth, such as under the tongue, instead of guzzling it. In-person monitors detected this behavior correctly 50% of the time, while the movie talk monitors did not detect it (0.0%; p=0.08). In addition, drooling the pill in a drinking glass instead of gulping it was effortless to detect in-person (100%), whereas when monitors detected this behavior significantly less frequently when they were monitoring by movie talk (38%; p=0.03). Similar to monitoring of dietary adherence, the false positive rates were very low (0.0% and 2%; p=0.50) for both in-person and remote monitoring, respectively.

Acceptability by Monitors

Three of the four monitors were somewhat more certain in their capability to detect cheating in-person versus recorded movies, with one monitor finding remote monitoring by movie talk lighter. Most monitors reported that the movie resolution and lighting were the two most significant factors that impacted their capability to detect cheating behaviors in the recorded movies. In the case of lighting, glare and identifying the correct food item/pill were the most common issues. In addition, it was clear that the framework rate (number of frames per 2nd) of the movie influenced the capability to detect cheating for the pill adherence tests. Framework rate and resolution are largely determined by the internet connection speed. As it happened, these varied in the area of the building where the validity and reliability tests were conducted, permitting us to qualitatively assess their influence on sensitivity. When the framework rate and resolution were low, it was lighter for participants to drop the pill or hide the pill without the monitor detecting it, thus reducing the sensitivity of detecting cheating remotely, whereas the sensitivity of monitoring dietary compliance was less affected by movie quality. All monitors reported that being able to pause, rewind, and fast-forward the movies was very or utterly helpful in detecting cheating.

Survey Respondents

For the 2nd examine—which investigated the feasibility and acceptability of movie talk technology—1,076 respondents ended the online survey. The respondents’ demographics are shown in Table two . Approximately three-quarters of participants were female. Almost 70% of respondents were Caucasian, and one-quarter were African or African-American, consistent with local demographics. Approximately half of respondents had participated in one or more clinical studies in the past, and all were interested in participating in clinical research in general. As shown in Table three , 48.0% of respondents reported that scheduling conflicts prevented them from participating in clinical research on at least one occasion. Importantly, approximately three-quarters of respondents reported that being able to schedule examine visits on evenings and/or weekends would enable them to participate in more research studies, with 32.6% of respondents preferring having the option of both evening and weekend visits. Transportation issues were less of a barrier to explore participation: almost three-quarters of respondents reported that transportation did not prevent them from participating in clinical research ( Table two ). Nonetheless, one-fifth (21.3%) reported that a long commute time/bad traffic made it difficult for them to be involved in clinical research. These data demonstrate that movie talk technology may also be useful to supplant in-person clinic visits and to reduce barriers to participating in clinical research in general.

Feasibility of Movie Talk Technology

Next, we investigated whether movie talk technology might be a feasible instrument for use in clinical research. As shown in Table two , 86.4% of respondents reported that they have the hardware necessary for movie talking. Since 81.8% reported possessing a smartphone with a webcam, a webcam-endowed smartphone was clearly the most widely accessible movie talk platform. In terms of convenience with movie talk technology, 73.3% of respondents are very convenient or convenient with using movie talk technology, whereas only 7.1% are awkward or very awkward ( Figure one ). As shown in Table two , this figure is higher than that for convenience with technology in general, for which only about 40% of respondents reported being very comfy or convenient. Importantly, almost 80% of respondents have participated in live movie talking before, with Skype (68.0%) and FaceTime (60.7%) being the two most popular movie talk software programs. Google Hangouts was in distant third place at 13.7% usage.

Acceptability of the Technology

Eventually, we queried participants to determine whether they would be willing to use movie talk technology to participate in research. When suggested an option to conduct a probe visit via movie talk or in-person, almost half (45.2%) preferred to conduct the visit remotely by webcam, with only 25.3% preferring to have the visit in-person ( Figure one ); the remaining had no preference. Of those preferring an in-person clinic visit ( Table three ), the most common two reasons were having in-person contact/accountability (68.6%) and disliking being observed by movie talk (39.3%); discomfort with or lack of the technology were minor contributing reasons (17.0%). Of those who instead choose doing remote visits via movie talk, most cited the commute (62.6%) and their work (59.6%) and family/social (44.2%) schedules as the reasons why. Extra reasons included liking using technology (39.5%), living or working too far away (35.0%), and preferring to save money on transportation (33.4%). Figure one shows that if suggested an option of receiving behavioral support to adhere to the examine intervention (i.e, encouragement and motivation to stick to the intervention) by movie talk, 57.7% would want it and another 33.3% announced they might want it. Lastly and most importantly, almost 80% of respondents were willing to use movie talk technology to participate in a clinical trial, whereas only Five.4% were opposed. About one-quarter of those willing to use movie talk technology would agree to using the software only if movie talk session was not recorded (data not shown).

Demographic Associations

We tested the survey results for demographic associations. There were no associations inbetween gender and the survey questions. There was one association with ethnicity—Hispanics were less convenient with using technology in general (p=0.0009) —albeit the number of Hispanics in our sample was puny (N=22), so we caution extrapolation of this one result. To test for associations with race, we limited testing to Caucasians and African-Americans because of low numbers of respondents in other racial groups. In comparison to Caucasians, African-Americans were more likely to report that scheduling conflicts prevent them from participating in research (73.5% vs. 60.2%; p=0.0001) and that being permitted to schedule explore visits on weekends would help them participate in more studies (63.2% vs. 52.5%; p<0.0001). African-Americans also were more likely to want behavioral support through movie talking than Caucasians (Sixty-nine.3% vs. 54.6%; p=0.0002). Interestingly, African-Americans were less likely to have a computer with internet access and a webcam (p=0.0001), but fortunately just as likely as Caucasians to have a smartphone tooled for movie talking (p=0.46).

Age was associated with the responses for almost all survey questions; however, a majority of associations were modest in effect size (i.e., <25 percentage-point difference in survey responses inbetween the very oldest and youngest cohorts). Older respondents were less likely to report that transportation or scheduling conflicts prevented them from participating in studies (p<0.0001); slightly less likely to have a webcam-enabled device for movie talking (p<0.0001); less convenient with technology in general and with movie talking (p<0.0001); and less inclined towards using (p<0.0001), and less willing (p=0.0003) to use movie talk technology to participate in clinical trials. In particular, 90% of respondents aged Legitimate–24 years old were willing to use movie talk technology to participate in clinical trials, whereas 62% of those aged 65+ years old were willing to use the technology. Similar numbers—99% and 62% of those aged Eighteen–24 and 65+ years old, respectively—had prior practice in movie talking. The one exception to these trends with enlargening age is that respondents in the middle two age groups (35–44 and 45–55 years old) were somewhat more likely to want motivational support by movie talk, than either their junior or older counterparts (p=0.0001).

DISCUSSION

Current methods of determining adherence to dietary and pill-taking interventions in free-living subjects rely on strategies such as self-report, pill counts, and returning empty food containers, which are well-known to be of limited accuracy. Conversely, the alternative of conducting managed studies in an inpatient setting or under staff supervision results in high participant cargo, excluding many would-be participants. We therefore propose using movie talk technology as a novel method that has the potential to solve both these problems by remotely quantifying intervention adherence. Movie talk technology could substitute self-report and pill counts in pharmaceutical and supplement trials, and in dietary studies, it could substitute self-report and “empty container” method of estimating adherence, such as counting yogurt lids in a probiotic yogurt explore. It could also reduce participant cargo in managed feeding studies by obviating the need to commute to the research center to eat meals under supervision. For example, in a meal timing investigate, participants could demonstrate that they followed the assigned eating schedule by logging onto movie talk software and eating the meals at the adequate times. Ultimately, movie talk technology could be used to substitute food diaries by capturing data on the type of food eaten, the time of day, and even an estimated amount.

However, whether the technology is effective and feasible to use in clinical research is an open question. Therefore, in this pair of studies, we investigated the validity, reliability, feasibility, and acceptability of using movie talk technology to quantify dietary and pill-taking (supplement and medication) adherence The very first explore was a pilot examine designed to test the capability of movie talk technology to detect non-adherence to dietary and pill-taking interventions, in comparison to the gold standard of in-person monitoring—the very first time such a probe has been performed. For dietary adherence monitoring, the reliability or agreement among raters calculated using Cohen’s kappa for both in-person and movie talk monitoring was excellent (0.88 vs. 0.85), with no statistical difference inbetween the two methods. The validity testing exposed that 86% and 78% of cheats were detected by in-person and remote meal monitoring, respectively, and the methods did not differ from each other. Interestingly, we found that the mock explore participants could successfully evade being caught cheating one in six times, even by the gold standard of in-person monitoring. One cheating method that was very difficult to detect using either monitoring method was the removal of food from the container prior to monitoring beginning. To address this limitation, meal monitors may need to be better trained (our volunteers were untrained staff members) or the way in which the foods are packaged may need to be modified to better indicate if the package was opened prior to the monitoring period. Additionally, slobbering food into napkins was also difficult to detect by either method, tho’ this limitation can be addressed by requiring probe participants to wiggle out their napkin after the meal. Overall, movie talk technology proved to be comparably valid and reliable to in-person monitoring of dietary adherence, and we therefore feel certain that it is ready for adoption as a widespread method for quantifying adherence in nutrition research, particularly for managed feeding studies.

However, our exploratory testing of pill adherence found that monitoring remotely by movie talk trended towards being inferior. Inter-rater agreement by Cohen’s kappa was higher for in-person monitoring (0.85) than movie talk (0.Sixty nine) monitoring. Unlike meal monitoring, detecting non-adherence when taking pills tended to be more difficult via movie talk (60% of cheats detected) versus in-person monitoring (77%), yet only two cheating behaviors were or tended to be significantly tighter to detect by movie talk (hiding the pill in the mouth and slobbering the pill into the cup without gulping it). The fact that these differences trended towards significance is likely due to the fact that our statistical power was more limited. Albeit our pilot explore for pill adherence was not statistically powered, the detection of only 77% of cheats in-person would have weakened post-hoc statistical power by almost a factor of two if the probe has been powered identically to the dietary adherence testing; thus, it is emerges that about dual the number of non-adherent events as in our dietary adherence testing is needed for future full-scale validity and reliability testing of pill-taking monitoring.

Additionally, detection of some cheating behaviors remained difficult for either method, such as hiding pills under the tongue. Closer examination of the recorded movies exposed that natural fluctuations in internet speed and latency lighting sometimes diminished the resolution and framework rate of the movie, making it lighter for the participants to avoid getting caught cheating during pill taking. This provides some insight into ways in which the capability to detect cheating during pill taking via movie talk can be improved. A swifter Internet connection, good lighting, and higher resolution movie may increase the sensitivity of monitoring pill adherence by movie talk, and such technical resources are expected to be more widely available over time.

Based on our pilot investigate of pill adherence monitoring, further optimization of the technical set-up and a larger sample size follow-up probe are needed to determine whether movie monitoring of pill-taking compliance is truly inferior to in-person monitoring. Unlike for monitoring of dietary adherence, we suspect that monitoring pill-taking adherence by movie talk technology will likely prove to be inferior to in-person monitoring, albeit this needs to be confirmed in a larger investigate. Despite these limitations, the platform is clearly superior to no monitoring at all and to self-reported adherence, pill counts, and studying empty food containers. These methods permit participants to discard pills and foods surreptitiously, while falsely pretending to have been compliant. Furthermore, even if the validity and reliability are slightly inferior to in-person monitoring for pill-taking adherence, it is significant to recall that in-person monitoring is uncommonly feasible because of the high cargo (e.g., scheduling constraints and commute time) it imposes on participants. Moreover, several managed studies have demonstrated that simply monitoring pill-taking adherence remotely by movie can increase adherence rates (34; 36; 39; 40; 45; 46; 48; 49) , relative to no form of visual monitoring or self-report, and it boosts adherence rates to levels similar to those achieved with in-person monitoring (15; 35) . Moreover, when no movie is received from a participant by a certain time each day, the participant’s non-adherence can be detected in real-time, and s/he can then be reminded to take the pill or go after his/her prescribed dietary intervention (47) . Therefore, this probe provides evidence that movie talk technology provides a valid and reliable platform for remotely quantifying diet and pill adherence and likely also for encouraging better adherence.

The 2nd probe investigated the feasibility and acceptability of using movie talk technology to participate in clinical research—the largest investigate to test the feasibility and acceptability of using webcam or movie talk technology either in clinical research or in patient care(>1,000 participants)—with the significant finding that it is a feasible and acceptable method for the terrific majority of potential examine participants. A majority (86.4%) of respondents had the hardware necessary to movie talk, with almost the same proportion having a smartphone configured for movie talking to occur at any location with either a WiFi Internet connection or a cellular signal. Also, approximately three-fourths of respondents were familiar with movie talk and almost half (45.2%) preferred to conduct explore visits via webcam or movie talk. Eventually, almost 80% of participants are willing to use movie talk technology to participate in clinical research. This concords with several clinical care studies conducted with petite numbers of patients that have similarly demonstrated very high satisfaction (range 65–93%) and good feasibility with remote movie monitoring (Ten; 13; 15; 44; 50; 51) . Collectively, these data indicate that few technological barriers exist to conducting examine visits via movie talk, participants are familiar with and accepting of the technology, and that in fact more respondents preferred to conduct explore visits via movie talk versus in-person.

Albeit not the concentrate our investigation, the survey also exposed that approximately one-half of former and potential investigate participants encountered scheduling difficulties that prevented them from participating in one or more research studies—a problem that may also be mitigated by movie talk technology. Importantly, the timing of clinic visits within people’s busy schedules, not transportation, was the primarily issue for most individuals. Movie talk technology offers a novel alternative that can reduce these barriers. Conducting explore visits remotely by movie talk reduces the inconvenience and expense of visiting the clinic. More specifically, it can permit appointments to be scheduled in inbetween commitments that are otherwise too close together to commute to the clinic, to be scheduled outside of business hours, or even to happen spontaneously at the participant’s convenience. The method particularly has value for managed feeding studies, where the high participant cargo has made such studies increasingly difficult to do and has resulted in fewer managed feeding studies. A related but unanticipated finding is that movie talk technology may particularly help reduce barriers to research participation experienced by African-Americans, a group that is frequently underrepresented in research studies (52) . African-Americans were more likely than Caucasians to report that scheduling conflicts prevented them from engaging in research and to want behavioral support through movie talking.

Our feasibility and acceptability explore is not without limitations. About three-quarters of our sample were women and all respondents had to have email addresses. As a result, our probe sample was likely enriched in technology-savvy female users, which somewhat compromises generalizability. Reassuringly, however, we found no gender differences in responses to any of the twenty two questions.

Furthermore, there are notable limitations to using movie talk technology to monitor adherence or conduct visits remotely that were not addressed by the survey. Most obviously, explore visits involving blood draws for bioactive compounds cannot be conducted remotely. In addition, examine participants must have a data plan or requisite internet access and must be in proximity of their webcam-enabled devices if their explore appointment is scheduled at a particular time.

In summary, the two studies reported herein were, to our skill, the very first of their kind to determine if movie talk technology is an acceptable and feasible method to participate in dietary or pharmaceutical/supplement clinical research, and to empirically evaluate the capability of movie talk technology to remotely quantify adherence. Validity and reliability by movie talk were excellent for dietary adherence and decent but less good for pill adherence. About 80% of participants have the technology and a similar percentage were willing to use the technology to participate in clinical research. It is therefore expected that movie talk technology will be increasingly used to monitor dietary adherence, to collect explore data, and even to conduct examine visits remotely in order to reduce participant cargo and barriers to participating in research. Movie talk technology is therefore a very promising instrument that is ripe for integration into clinical research methods.

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