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

Background: Stress-related disorders present a significant global burden. There is great need for effective, preventive measures. Mobile just-in-time adaptive interventions (JITAI) have the potential to be applied in real time and context-specifically, precisely when individuals need them most. However, they have not been widely implemented in the context of stress research. This study introduces a novel approach by performing real-time analysis of both psychological and physiological data to trigger timely interventions during moments of high stress.Objective: This paper evaluates the feasibility of a JITAI algorithm designed to trigger interventions during moments of heightened stress. Methods: The JITAI algorithm integrates features from ecological momentary assessments (EMA) and ecological physiological assessments (EPA) into a combined stress score that can trigger interventions in real time by relating the score to an a priori personalized stress threshold. Feasibility of the technical implementation, participant adherence, and user experience were assessed within a multicenter study with 215 participants conducted across five research sites.Results: The JITAI algorithm successfully processed EMA and EPA data to trigger interventions based on daily-life stress. On average, 68% (± 29%) of completed EMA beeps per week contained successfully extracted EPA features, demonstrating effective technical implementation. The algorithm triggered an average of 1.61 (± 1.26) interventions per day, with 43% (± 27%) of completed EMA beeps per week leading to interventions. Participant adherence was reasonable, with an EMA compliance rate of 43% (± 22%) and an EMI compliance rate of 43% (± 30%). User feedback highlighted the potential for system improvements and better integration into daily life.Conclusion: Feasibility of the developed JITAI algorithm was demonstrated, with effective data processing and intervention triggering in real time. Future research should focus on minimizing participant burden to improve participant adherence and acceptability. In conclusion, our study highlights the potential of JITAI by providing timely support during moments of heightened stress.