International Journal of Behavioral Medicine

, Volume 24, Issue 5, pp 673–682 | Cite as

Return of the JITAI: Applying a Just-in-Time Adaptive Intervention Framework to the Development of m-Health Solutions for Addictive Behaviors

  • Stephanie P. Goldstein
  • Brittney C. Evans
  • Daniel Flack
  • Adrienne Juarascio
  • Stephanie Manasse
  • Fengqing Zhang
  • Evan M. Forman



Lapses are strong indicators of later relapse among individuals with addictive disorders, and thus are an important intervention target. However, lapse behavior has proven resistant to change due to the complex interplay of lapse triggers that are present in everyday life. It could be possible to prevent lapses before they occur by using m-Health solutions to deliver interventions in real-time.


Just-in-time adaptive intervention (JITAI) is an intervention design framework that could be delivered via mobile app to facilitate in-the-moment monitoring of triggers for lapsing, and deliver personalized coping strategies to the user to prevent lapses from occurring. An organized framework is key for successful development of a JITAI.


Nahum-Shani and colleagues (2014) set forth six core elements of a JITAI and guidelines for designing each: distal outcomes, proximal outcomes, tailoring variables, decision points, decision rules, and intervention options. The primary aim of this paper is to illustrate the use of this framework as it pertains to developing a JITAI that targets lapse behavior among individuals following a weight control diet.


We will detail our approach to various decision points during the development phases, report on preliminary findings where applicable, identify problems that arose during development, and provide recommendations for researchers who are currently undertaking their own JITAI development efforts. Issues such as missing data, the rarity of lapses, advantages/disadvantages of machine learning, and user engagement are discussed.


m-Health Just-in-time adaptive interventions Lapses Addictions 



The current study was funded by the Karen Miller-Kovach research grant from Weight Watchers and The Obesity Society awarded to Dr. Forman.

Compliance with Ethical Standards


The study was funded by the Karen Miller-Kovach research grant from Weight Watchers and The Obesity Society.

Conflict of Interest

Evan Forman received a research grant from Weight Watchers to support the development of DietAlert, a companion smartphone application to assist with dietary adherence.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© International Society of Behavioral Medicine 2017

Authors and Affiliations

  • Stephanie P. Goldstein
    • 1
  • Brittney C. Evans
    • 1
  • Daniel Flack
    • 1
  • Adrienne Juarascio
    • 1
  • Stephanie Manasse
    • 1
  • Fengqing Zhang
    • 1
  • Evan M. Forman
    • 1
  1. 1.Department of PsychologyDrexel UniversityPhiladelphiaUSA

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