Professor of Behavioral and Social Sciences,
Director of Doctoral Studies in the Department of Behavioral and Social Sciences
Kate Carey has been a member of the public health community at Brown since 2011, and is currently Professor of Behavioral and Social Sciences, Director of Doctoral Studies in the Department of Behavioral and Social Sciences, and a faculty member in the Center for Addiction and Alcohol Studies. She is regarded nationally for her work in addiction psychology, particularly in the areas of alcohol use and sexual risk behavior.
Dr. Carey teaches Health Communication, in the School of Public Health. For Dr. Carey, foundational understanding of health communications is not only important for informing the design of public health interventions, but also for communicating important research findings to policy makers and community members: “Just because something is published in a scientific journal does not mean that it will necessarily make a large impact. However, if we, as advocates, make sure the materials become part of a larger conversation, we can use that momentum to get the science into the hands of policymakers; at which point the policy makers themselves will have to determine how to best communicate the health information to the public.” The course Dr. Carey teaches, as well as her recent research activities, reflect the technological advancements that have made new approaches to health communication possible.
Dr. Carey, thank you for taking the time to speak with us. It would be great if you could describe your research interests, and perhaps one or two projects you are currently involved in.
My pleasure. For a long time now I have been interested in engaging people in brief interventions to reduce risk of negative consequences as a result of drinking. I have typically worked with individuals who are not seeking treatment, in more of a preventive or early intervention mode. Often we aim to raise awareness of harm reduction in contexts such as colleges and health clinics, where we find folks who are young and/or otherwise at elevated risk for adverse drinking consequences. Examples of current projects include a new R21 that uses text messaging to push out accurate and pro-moderation drinking norms to first year college students, with the goal of counterbalancing the pervasive social influences that lead to exaggerated drinking norms. Another is an R34 that is designing a combination brief intervention with technology support to jointly target reductions in alcohol risk and STI risk among young women at a reproductive health clinic.
With respect to data collection, how have recent developments in technology allowed you to answer your research questions in ways that were not possible before?
Over the course of my research career we have completely shifted away from designing paper and pencil survey assessments that require participants to physically be present to provide data, to using online survey software that allows the flexibility of reaching people at remote locations. Some of our descriptive projects have involved no face-to-face contact with participants and we have recruited, assessed, and paid out incentives completely using email and online survey software. We have also collected survey samples using Qualtrics Panels. Use of survey panels (also via mTurk and Facebook) has been growing in the research literature, as it offers additional reach, to national or even international samples, and the ability to screen and access special populations. I believe that we have been able to recruit more people in some studies because the time commitment for participants was reduced in this way, making the research study more attractive. Also, well-designed online surveys can afford added confidentiality and privacy, which is important. This shift in methodology does come with caveats however: We now need to design assessments that are robust to remote completion and that can detect invalid response patterns, and figure out how to motivate participants to engage meaningfully with our material in the absence of a human, personal relationship.
With respect to intervention development, how have recent developments in technology allowed you to design and deliver interventions that are more likely to be successful, sustainable, and scalable?
The ability to use technology to deliver all or part of interventions has changed the way we think about interventions. With regard to brief alcohol interventions, some can be delivered entirely over computer or mobile platforms. Those tend to have modest effects, but potentially large reach. They are quite appropriate in many prevention contexts, where small adjustments in behavior can have the desired effects; they also can be successful in some early intervention contexts because the thresholds for participation can be lowered so you can engage more people who might be starting to show some risky or negative outcomes. Technology-mediated interventions can be reliable, personalized/tailored, and don’t require trained interventionists. The major limitation is that they do less well when the participant is ambivalent or resistant to change; in those cases it can be easier to engage someone with a human involved. I am increasingly interested in using technology to extend the content and exposure to intervention that might have started in face-to-face mode. Economic pressures dictate that newly developed health behavior interventions be brief and scalable (as well as efficacious), but you can cover only so much in a 20-30 minute encounter. And many behavioral health issues are complicated. Our current research is trying to leverage the motivational opportunities afforded by a brief face-to-face conversation and the personalization and extended interactions afforded by a linked technology extender (text + website).
As the Director of Doctoral Studies in the Department of Behavioral and Social Sciences, you are largely involved with the curricular and educational environment for students. In what ways are you currently giving students the opportunity to learn more about technology and public health, and where should the department and the School be moving in the future?
mHealth is clearly an important content area for public health researchers and practitioners of the future. Within our department, BSS hosts the Innovations in Behavioral and Social Health Sciences (i-BSHS) lecture series, and mHealth is one of the four main organizational themes that drives speaker selection. So we have a couple of speakers each year talking about new developments in technology and health. With regard to curriculum, mHealth is addressed in courses like Health Communication and Designing, Implementing and Evaluating Public Health Interventions. Also within our School, use of online survey software is taught in Applied Research Methods. As Director of the Behavioral and Social Health Sciences doctoral program, I would love to see a course devoted to mHealth interventions so that our graduate students can all have a base understanding of the theory and logistics and ethics of using technology in public health intervention. It is on our “wishlist”! From a research training perspective, many of the BSS faculty are developing and evaluating technology-assisted public health interventions. BSS hosts a listserv devoted to Health Behavior Intervention Technologies (H-BIT), and Professor Nancy Barnett leads a long-standing special interest group that brings together staff and faculty and students using online survey software. I know that the BSS department is actively seeking to grow its footprint in the mHealth area, first by organizing existing and new research activities, but also by encouraging growth in that part of our portfolio so that we establish a presence in this field of public health.