Triggering just-in-time adaptive interventions based on real-time detection of daily-life stress: Methodological...

Stress-related disorders present a significant global burden, highlighting the need for effective, preventive measures. Mobile just-in-time adaptive interventions (JITAI) can be applied in real time and context-specifically, precisely when individuals need them most. Yet, they are rarely applied in stress research. This study introduces a novel approach by performing real-time analysis of both psychological and physiological data to trigger interventions during moments of high stress. We evaluated the feasibility of this JITAI algorithm, which integrates ecological momentary assessments (EMA) and ecological physiological assessments (EPA) to generate a stress score that triggers interventions in real time by relating the score to a personalized stress threshold. The feasibility of the technical implementation, participant adherence, and user experience were assessed within a multicenter study with 215 participants conducted across five research sites. The JITAI algorithm successfully processed EMA and EPA data to trigger real-time interventions. A total of 68% (standard deviation [SD] = 29%) of EMA beeps contained extracted EPA features, demonstrating technical feasibility. The algorithm triggered 1.61 (SD = 1.26) interventions per day, with 43% (SD = 27%) of EMA beeps per week leading to triggered interventions. Compliance rates of 43% (SD = 22%) for EMA and 43% (SD = 30%) for the JITAI were achieved, with feedback indicating areas for improvement, particularly for daily-life integration. Our findings provide preliminary support for the feasibility of the developed JITAI algorithm, demonstrating effective data processing and intervention triggering in real time, while also highlighting areas for improvement. Future research should focus on minimizing participant burden, including the intensity of EMA protocols, to improve participant adherence and acceptability while maintaining the benefits of real-time intervention delivery.