51
|
Schwob JT, Newman MG. Brief imaginal exposure exercises for social anxiety disorder: A randomized controlled trial of a self-help momentary intervention app. J Anxiety Disord 2023; 98:102749. [PMID: 37542755 PMCID: PMC10493899 DOI: 10.1016/j.janxdis.2023.102749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION Emerging technological interventions for psychological disorders are being developed continually. Offering imaginal exposure exercises as a self-help intervention presents the opportunity to acquire foundational skills to address social anxiety. The current study evaluates the feasibility and effectiveness of a novel smartphone application for social interaction anxiety. METHODS Participants (n = 82) were adults meeting criteria for social anxiety disorder. They were randomly assigned to imaginal exposure (IE; n = 39) or self-monitoring (n = 43) delivered multiple times daily via a smartphone application for a one-week trial. It was expected that participants using the IE exercises would demonstrate significantly greater declines in social anxiety in addition to increases in self-efficacy and that compliance would serve as a predictor of outcome. Mixed-effects models were utilized. RESULTS Participants using IE (vs. self-monitoring) evidenced significantly greater reductions in social anxiety from pre- to post-treatment and at 1-month follow-up. Similarly, IE (vs. self-monitoring) led to significantly greater increases in self-efficacy from pre- to post-treatment and 1-month follow-up. Further, more completed IE exercises predicted significantly greater changes in social anxiety and self-efficacy at subsequent timepoints compared with self-monitoring. CONCLUSIONS Findings suggest that a brief IE self-help intervention was effective in targeting social interaction anxiety.
Collapse
|
52
|
Litvin S, Saunders R, Jefferies P, Seely H, Pössel P, Lüttke S. The Impact of a Gamified Mobile Mental Health App (eQuoo) on Resilience and Mental Health in a Student Population: Large-Scale Randomized Controlled Trial. JMIR Ment Health 2023; 10:e47285. [PMID: 37477955 PMCID: PMC10403802 DOI: 10.2196/47285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/02/2023] [Accepted: 06/20/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND With many digital mental health interventions failing to engage clients for enough time to demonstrate substantive changes to their well-being and with only 2% of all digital solutions on app stores having undergone randomized controlled trials, the rising demand for mental health prevention and early intervention care is not being met. Young adults in particular struggle to find digital well-being apps that suit their needs. OBJECTIVE This study explored the effects of eQuoo, an evidence-based mental health game that teaches psychological skills through gamification, on resilience, depression, anxiety, and attrition in a student population. METHODS In total, 1165 students from 180 universities in the United Kingdom participated in a 5-week, 3-armed randomized controlled trial. Participants were randomly allocated into 1 of 3 groups: eQuoo users, users of a treatment-as-usual evidence-based cognitive behavioral health app called Sanvello, and a no-intervention waitlist. The Rugged Resilience Scale, Generalized Anxiety Disorder-7, and Patient Health Questionnaire-8 were administered to all participants at baseline and every 7 days until completion. RESULTS A repeated measures-ANOVA revealed statistically significant increases in resilience scores in the test group (P<.001) compared with both control groups (Sanvello: P=.10 and waitlist: P=.82) over 5 weeks. The app also significantly decreased anxiety and depression scores (both P<.001). With 64.5% (251/389) adherence, the eQuoo group retained 42% more participants than the control groups. CONCLUSIONS Digital health interventions such as eQuoo are effective, scalable, and low-cost solutions for supporting young adults and are available on all leading mobile platforms. Further investigation could clarify the extent to which specific elements of the eQuoo app (including gamification) led to better outcomes. TRIAL REGISTRATION German Clinical Trials Register (DRKS) DRKS00027638; https://drks.de/search/en/trial/DRKS00027638.
Collapse
Affiliation(s)
- Silja Litvin
- Department Psychologie, Ludwig-Maximilians-Universität, München, Germany
| | - Rob Saunders
- Division of Psychology and Language Sciences, Clinical Education and Health Psychology, University College London, London, United Kingdom
| | - Philip Jefferies
- Resilience Research Centre, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Hayley Seely
- Department of Counseling and Human Development, College of Education and Human Development, University of Louisville, Kentucky, KY, United States
| | - Patrick Pössel
- Department of Counseling and Human Development, College of Education and Human Development, University of Louisville, Kentucky, KY, United States
| | - Stefan Lüttke
- Department für Klinische Psychologie und Psychotherapie, Institute für Psychologie, Universität Greifswald, Greifswald, Germany
| |
Collapse
|
53
|
Collier AF, Hagemann S, Trinidad SB, Vigil-Hayes M. Human-to-Computer Interactivity Features Incorporated Into Behavioral Health mHealth Apps: Systematic Search. JMIR Form Res 2023; 7:e44926. [PMID: 37389916 PMCID: PMC10365630 DOI: 10.2196/44926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND While there are thousands of behavioral health apps available to consumers, users often quickly discontinue their use, which limits their therapeutic value. By varying the types and number of ways that users can interact with behavioral health mobile health apps, developers may be able to support greater therapeutic engagement and increase app stickiness. OBJECTIVE The main objective of this analysis was to systematically characterize the types of user interactions that are available in behavioral health apps and then examine if greater interactivity was associated with greater user satisfaction, as measured by app metrics. METHODS Using a modified PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) methodology, we searched several different app clearinghouse websites and identified 76 behavioral health apps that included some type of interactivity. We then filtered the results to ensure we were examining behavioral health apps and further refined our search to include apps that identified one or more of the following terms: peer or therapist forum, discussion, feedback, professional, licensed, buddy, friend, artificial intelligence, chatbot, counselor, therapist, provider, mentor, bot, coach, message, comment, chat room, community, games, care team, connect, share, and support in the app descriptions. In the final group of 34 apps, we examined the presence of 6 types of human-machine interactivities: human-to-human with peers, human-to-human with providers, human-to-artificial intelligence, human-to-algorithms, human-to-data, and novel interactive smartphone modalities. We also downloaded information on app user ratings and visibility, as well as reviewed other key app features. RESULTS We found that on average, the 34 apps reviewed included 2.53 (SD 1.05; range 1-5) features of interactivity. The most common types of interactivities were human-to-data (n=34, 100%), followed by human-to-algorithm (n=15, 44.2%). The least common type of interactivity was human-artificial intelligence (n=7, 20.5%). There were no significant associations between the total number of app interactivity features and user ratings or app visibility. We found that a full range of therapeutic interactivity features were not used in behavioral health apps. CONCLUSIONS Ideally, app developers would do well to include more interactivity features in behavioral health apps in order to fully use the capabilities of smartphone technologies and increase app stickiness. Theoretically, increased user engagement would occur by using multiple types of user interactivity, thereby maximizing the benefits that a person would receive when using a mobile health app.
Collapse
Affiliation(s)
| | - Shelby Hagemann
- School of Informatics, Computing, and Cyber Systems, Northern Arizona University, Flagstaff, AZ, United States
| | - Susan Brown Trinidad
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, WA, United States
| | - Morgan Vigil-Hayes
- School of Informatics, Computing, and Cyber Systems, Northern Arizona University, Flagstaff, AZ, United States
| |
Collapse
|
54
|
Palermo EH, Young AV, Deswert S, Brown A, Goldberg M, Sultanik E, Tan J, Mazefsky CA, Brookman-Frazee L, McPartland JC, Goodwin MS, Pennington J, Marcus SC, Beidas RS, Mandell DS, Nuske HJ. A Digital Mental Health App Incorporating Wearable Biosensing for Teachers of Children on the Autism Spectrum to Support Emotion Regulation: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e45852. [PMID: 37358908 PMCID: PMC10337316 DOI: 10.2196/45852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND As much as 80% of children on the autism spectrum exhibit challenging behaviors (ie, behaviors dangerous to the self or others, behaviors that interfere with learning and development, and behaviors that interfere with socialization) that can have a devastating impact on personal and family well-being, contribute to teacher burnout, and even require hospitalization. Evidence-based practices to reduce these behaviors emphasize identifying triggers (events or antecedents that lead to challenging behaviors); however, parents and teachers often report that challenging behaviors surface with little warning. Exciting recent advances in biometric sensing and mobile computing technology allow the measurement of momentary emotion dysregulation using physiological indexes. OBJECTIVE We present the framework and protocol for a pilot trial that will test a mobile digital mental health app, the KeepCalm app. School-based approaches to managing challenging behaviors in children on the autism spectrum are limited by 3 key factors: children on the autism spectrum often have difficulties in communicating their emotions; it is challenging to implement evidence-based, personalized strategies for individual children in group settings; and it is difficult for teachers to track which strategies are successful for each child. KeepCalm aims to address those barriers by communicating children's stress to their teachers using physiological signaling (emotion dysregulation detection), supporting the implementation of emotion regulation strategies via smartphone pop-up notifications of top strategies for each child according to their behavior (emotion regulation strategy implementation), and easing the task of tracking outcomes by providing the child's educational team with a tool to track the most effective emotion regulation strategies for that child based on physiological stress reduction data (emotion regulation strategy evaluation). METHODS We will test KeepCalm with 20 educational teams of students on the autism spectrum with challenging behaviors (no exclusion based on IQ or speaking ability) in a pilot randomized waitlist-controlled field trial over a 3-month period. We will examine the usability, acceptability, feasibility, and appropriateness of KeepCalm as primary outcomes. Secondary preliminary efficacy outcomes include clinical decision support success, false positives or false negatives of stress alerts, and the reduction of challenging behaviors and emotion dysregulation. We will also examine technical outcomes, including the number of artifacts and the proportion of time children are engaged in high physical movement based on accelerometry data; test the feasibility of our recruitment strategies; and test the response rate and sensitivity to change of our measures, in preparation for a future fully powered large-scale randomized controlled trial. RESULTS The pilot trial will begin by September 2023. CONCLUSIONS Results will provide key data about important aspects of implementing KeepCalm in preschools and elementary schools and will provide preliminary data about its efficacy to reduce challenging behaviors and support emotion regulation in children on the autism spectrum. TRIAL REGISTRATION ClinicalTrials.gov NCT05277194; https://www.clinicaltrials.gov/ct2/show/NCT05277194. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/45852.
Collapse
Affiliation(s)
- Emma H Palermo
- Penn Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Amanda V Young
- Penn Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Sky Deswert
- Penn Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Alyssa Brown
- Penn Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Miranda Goldberg
- Penn Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Jessica Tan
- School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | | | - Matthew S Goodwin
- Bouvé College of Health Sciences, Northeastern University, Boston, MA, United States
| | - Jeffrey Pennington
- Children's Hospital of Philadelphia Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Steven C Marcus
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, United States
| | - Rinad S Beidas
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - David S Mandell
- Penn Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Heather J Nuske
- Penn Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| |
Collapse
|
55
|
Maechling C, Yrondi A, Cambon A. Mobile health in the specific management of first-episode psychosis: a systematic literature review. Front Psychiatry 2023; 14:1137644. [PMID: 37377474 PMCID: PMC10291100 DOI: 10.3389/fpsyt.2023.1137644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Purpose The purpose of this systematic literature review is to assess the therapeutic efficacy of mobile health methods in the management of patients with first-episode psychosis (FEP). Method The participants are patients with FEP. The interventions are smartphone applications. The studies assess the preliminary efficacy of various types of application. Results One study found that monitoring symptoms minimized relapses, visits to A&E and hospital admissions, while one study showed a decrease in positive psychotic symptoms. One study found an improvement in anxiety symptoms and two studies noted an improvement in psychotic symptoms. One study demonstrated its efficacy in helping participants return to studying and employment and one study reported improved motivation. Conclusion The studies suggest that mobile applications have potential value in the management of young patients with FEP through the use of various assessment and intervention tools. This systematic review has several limitations due to the lack of randomized controlled studies available in the literature.
Collapse
Affiliation(s)
- Claire Maechling
- Pôle de Psychiatrie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Antoine Yrondi
- Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante Fonda Mental, CHU de Toulouse, Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, Toulouse, France
| | - Amandine Cambon
- Programme d'intervention précoce RePeps, réseau Transition, Clinique Aufrery, Toulouse, France
| |
Collapse
|
56
|
Dingwall KM, Povey J, Sweet M, Friel J, Shand F, Titov N, Wormer J, Mirza T, Nagel T. Feasibility and Acceptability of the Aboriginal and Islander Mental Health Initiative for Youth App: Nonrandomized Pilot With First Nations Young People. JMIR Hum Factors 2023; 10:e40111. [PMID: 37285184 DOI: 10.2196/40111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 02/13/2023] [Accepted: 04/17/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Despite young First Nations Australians being typically healthy, happy, and connected to family and culture, high rates of emotional distress, suicide, and self-harm are also observed. Differing worldviews of service providers and First Nations young people regarding illness and treatment practices, language differences, culturally inappropriate service models, geographical remoteness, and stigma can all inhibit access to appropriate mental health support. Mental health treatments delivered digitally (digital mental health; dMH) offer flexible access to evidence-based, nonstigmatizing, low-cost treatment and early intervention on a broad scale. There is a rapidly growing use and acceptance of these technologies among young First Nations people. OBJECTIVE The objective was to assess the feasibility, acceptability, and use of the newly developed Aboriginal and Islander Mental Health Initiative for Youth (AIMhi-Y) app and determine the feasibility of study procedures in preparation for future assessments of effectiveness. METHODS This was a nonrandomized pre-post study using mixed methods. First Nations young people aged 12-25 years who provided consent (with parental consent where appropriate) and possessed the ability to navigate a simple app with basic English literacy were included. Researchers conducted one face-to-face 20-minute session with participants to introduce and orient them to the AIMhi-Y app. The app integrates culturally adapted low-intensity cognitive behavioral therapy (CBT), psychoeducation, and mindfulness-based activities. Participants received supportive text messages weekly throughout the 4-week intervention period and completed assessments of psychological distress, depression, anxiety, substance misuse, help-seeking, service use, and parent-rated strengths and difficulties at baseline and 4 weeks. Qualitative interviews and rating scales were completed at 4 weeks to gain feedback on subjective experience, look and style, content, overall rating, check-ins, and involvement in the study. App use data were collected. RESULTS Thirty young people (17 males and 13 females) aged between 12 and 18 (mean 14.0, SD 1.55) years were assessed at baseline and 4 weeks. Repeated measures 2-tailed t tests showed improvements in well-being measures that were statistically and clinically significant for psychological distress (Kessler Psychological Distress Scale, 10-item) and depressive symptoms (Patient Health Questionnaire, 2-item). Participants spent on average 37 minutes in the app. The app was rated positively, with mean ratings of 4 out of 5 points (on scales of 1-5). Participants reported that they found the app easy to use, culturally relevant, and useful. The feasibility of the study was demonstrated with a 62% recruitment rate, a 90% retention rate, and high study acceptability ratings. CONCLUSIONS This study supports earlier research suggesting that dMH apps that are appropriately designed with and for the target populations are a feasible and acceptable means of lowering symptoms for mental health disorders among First Nations youth.
Collapse
Affiliation(s)
- Kylie M Dingwall
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Australia
| | - Josie Povey
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Michelle Sweet
- Menzies School of Health Research, Charles Darwin University, Adelaide, Australia
| | - Jaylene Friel
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Fiona Shand
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Nickolai Titov
- MindSpot Clinic, Macquarie University, Sydney, Australia
| | - Julia Wormer
- headspace Darwin, Anglicare NT, Darwin, Australia
| | - Tamoor Mirza
- headspace Darwin, Anglicare NT, Darwin, Australia
| | - Tricia Nagel
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| |
Collapse
|
57
|
O'Sullivan S, van Berkel N, Kostakos V, Schmaal L, D'Alfonso S, Valentine L, Bendall S, Nelson B, Gleeson JF, Alvarez-Jimenez M. Understanding What Drives Long-term Engagement in Digital Mental Health Interventions: Secondary Causal Analysis of the Relationship Between Social Networking and Therapy Engagement. JMIR Ment Health 2023; 10:e44812. [PMID: 37213197 DOI: 10.2196/44812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/02/2023] [Accepted: 04/01/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Low engagement rates with digital mental health interventions are a major challenge in the field. Multicomponent digital interventions aim to improve engagement by adding components such as social networks. Although social networks may be engaging, they may not be sufficient to improve clinical outcomes or lead users to engage with key therapeutic components. Therefore, we need to understand what components drive engagement with digital mental health interventions overall and what drives engagement with key therapeutic components. OBJECTIVE Horyzons was an 18-month digital mental health intervention for young people recovering from first-episode psychosis, incorporating therapeutic content and a private social network. However, it is unclear whether use of the social network leads to subsequent use of therapeutic content or vice versa. This study aimed to determine the causal relationship between the social networking and therapeutic components of Horyzons. METHODS Participants comprised 82 young people (16-27 years) recovering from first-episode psychosis. Multiple convergent cross mapping was used to test causality, as a secondary analysis of the Horyzons intervention. Multiple convergent cross mapping tested the direction of the relationship between each pair of social and therapeutic system usage variables on Horyzons, using longitudinal usage data. RESULTS Results indicated that the social networking aspects of Horyzons were most engaging. Posting on the social network drove engagement with all therapeutic components (r=0.06-0.36). Reacting to social network posts drove engagement with all therapeutic components (r=0.39-0.65). Commenting on social network posts drove engagement with most therapeutic components (r=0.11-0.18). Liking social network posts drove engagement with most therapeutic components (r=0.09-0.17). However, starting a therapy pathway led to commenting on social network posts (r=0.05) and liking social network posts (r=0.06), and completing a therapy action led to commenting on social network posts (r=0.14) and liking social network posts (r=0.15). CONCLUSIONS The online social network was a key driver of long-term engagement with the Horyzons intervention and fostered engagement with key therapeutic components and ingredients of the intervention. Online social networks can be further leveraged to engage young people with therapeutic content to ensure treatment effects are maintained and to create virtuous cycles between all intervention components to maintain engagement. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12614000009617; https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12614000009617.
Collapse
Affiliation(s)
- Shaunagh O'Sullivan
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Orygen, Parkville, Australia
| | - Niels van Berkel
- Department of Computer Science, Aalborg University, Aalborg, Denmark
| | - Vassilis Kostakos
- School of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - Lianne Schmaal
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Orygen, Parkville, Australia
| | - Simon D'Alfonso
- School of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - Lee Valentine
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Orygen, Parkville, Australia
| | - Sarah Bendall
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Orygen, Parkville, Australia
| | - Barnaby Nelson
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Orygen, Parkville, Australia
| | - John F Gleeson
- Healthy Brain and Mind Research Centre, Australian Catholic University, Melbourne, Australia
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Orygen, Parkville, Australia
| |
Collapse
|
58
|
Quirk HD, Nagar R, Anderson PL. A qualitative exploration of college students' experiences using mobile apps to improve self-care during the COVID-19 pandemic. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-9. [PMID: 37053590 DOI: 10.1080/07448481.2023.2198033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/09/2023] [Accepted: 03/19/2023] [Indexed: 06/19/2023]
Abstract
Objective: This project examines students' experiences using a mental health mobile application (app) as part of a class assignment developed to support student well-being. Participants: Data was collected from 265 undergraduate students enrolled in a psychology course during the COVID-19 pandemic. Methods: Students developed a self-care goal and used an app to support progress toward it. Thematic analysis was applied to students' written reflections about their experiences using the app and practicing self-care. Results: Students reported using an app for self-care was 1) more helpful than expected for improving focus, productivity, motivation, sleep, and mental health symptoms; 2) challenging due to loss of interest, slow improvement, difficulty integrating into routine, or negative feelings triggered; and 3) influenced by the pandemic and transition to remote learning. Conclusions: A classroom assignment designed to promote self-care using a mental health app shows promise. Future research is needed to better understand engagement and impact.
Collapse
Affiliation(s)
| | - Ria Nagar
- Psychology, Georgia State University, Atlanta, Georgia, USA
| | | |
Collapse
|
59
|
Valinskas S, Nakrys M, Aleknavicius K, Jonusas J. Sensa Mobile App for Managing Stress, Anxiety, and Depression Symptoms: Pilot Cohort Study. JMIR Form Res 2023; 7:e40671. [PMID: 37052990 PMCID: PMC10141277 DOI: 10.2196/40671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/04/2022] [Accepted: 03/07/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND An increase in depression, anxiety, and stress symptoms worldwide, attributed to the COVID-19 pandemic, has been reported. If not treated, it may negatively affect a person's everyday life by altering physical and social well-being and productivity and increasing expenditure on health care. Cognitive behavioral therapy (CBT)-based interventions are gaining popularity as a means to reduce stress and alleviate anxiety and depression symptoms. Moreover, CBT delivered through a mobile app has the same elements as traditional CBT training (eg, guided discovery). However, unlike conventional training, users of mobile apps are allowed to tailor their own experience at their own speed and schedule. OBJECTIVE This study aims to analyze Sensa users' retrospective data and explore the dose-duration effect to find the optimal usage time when the user showed results. METHODS The study cohort comprised 381 consecutive community-based nonclinical users who started using Sensa between October 2021 and March 2022. All users included in the study took the Depression Anxiety Stress Scale-21 (DASS-21) assessment at least 2 times. Other parameters from the database containing all self-reported data were gender, number of active days, total time of use, and age. The primary outcome of the study was a change in the DASS-21 score. Statistical analyses were performed using GraphPad Prism (version 9, GraphPad Software). In addition, a logistic regression model was created to predict how the obtained independent parameters influenced the DASS-21 score. RESULTS The main finding of our study was that the majority of participants who started using Sensa were experiencing depression, anxiety, and stress symptoms (92.13%, 80.05%, and 87.93%, respectively). There was a statistically significant decrease of the DASS-21 subdomain scores after the use of the application (anxiety: mean 7.25, SD 4.03 vs mean 6.12, SD 4.00; P=.001; depression: mean 11.05, SD 4.26 vs mean 9.01, SD 4.77; P=.001; stress: mean 11.42, SD 3.44 vs mean 9.96, SD 3.65; P<.001). Finally, the logistic regression model showed that users who were using the app for more than 24 days and had at least 12 active days during that time had 3.463 (95% CI 1.142-11.93) and 2.644 (95% CI 1.024-7.127) times higher chances to reduce their DASS-21 subdomain scores of depression and anxiety, respectively. CONCLUSIONS Using the Sensa mobile app was related to decreased depression, anxiety, and stress symptoms.
Collapse
Affiliation(s)
| | | | | | - Justinas Jonusas
- KiloHealth, Vilnius, Lithuania
- Lithuania Business University of Applied Sciences, Klaipėda, Lithuania
| |
Collapse
|
60
|
González-Pérez A, Matey-Sanz M, Granell C, Diaz-Sanahuja L, Bretón-López J, Casteleyn S. AwarNS: A framework for developing context-aware reactive mobile applications for health and mental health. J Biomed Inform 2023; 141:104359. [PMID: 37044134 DOI: 10.1016/j.jbi.2023.104359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/10/2023] [Accepted: 04/05/2023] [Indexed: 04/14/2023]
Abstract
In recent years, interest and investment in health and mental health smartphone apps have grown significantly. However, this growth has not been followed by an increase in quality and the incorporation of more advanced features in such applications. This can be explained by an expanding fragmentation of existing mobile platforms along with more restrictive privacy and battery consumption policies, with a consequent higher complexity of developing such smartphone applications. To help overcome these barriers, there is a need for robust, well-designed software development frameworks which are designed to be reliable, power-efficient and ethical with respect to data collection practices, and which support the sense-analyse-act paradigm typically employed in reactive mHealth applications. In this article, we present the AwarNS Framework, a context-aware modular software development framework for Android smartphones, which facilitates transparent, reliable, passive and active data sampling running in the background (sense), on-device and server-side data analysis (analyse), and context-aware just-in-time offline and online intervention capabilities (act). It is based on the principles of versatility, reliability, privacy, reusability, and testability. It offers built-in modules for capturing smartphone and associated wearable sensor data (e.g. IMU sensors, geolocation, Wi-Fi and Bluetooth scans, physical activity, battery level, heart rate), analysis modules for data transformation, selection and filtering, performing geofencing analysis and machine learning regression and classification, and act modules for persistence and various notification deliveries. We describe the framework's design principles and architecture design, explain its capabilities and implementation, and demonstrate its use at the hand of real-life case studies implementing various mobile interventions for different mental disorders used in clinical practice.
Collapse
Affiliation(s)
- Alberto González-Pérez
- GEOTEC Research Group, Institute of New Imaging Technologies, Universitat Jaume I, Castellon, 12071, Spain.
| | - Miguel Matey-Sanz
- GEOTEC Research Group, Institute of New Imaging Technologies, Universitat Jaume I, Castellon, 12071, Spain.
| | - Carlos Granell
- GEOTEC Research Group, Institute of New Imaging Technologies, Universitat Jaume I, Castellon, 12071, Spain.
| | - Laura Diaz-Sanahuja
- Department of Basic Psychology, Clinical and Psychobiology, Universitat Jaume I, Castellon, 12071, Spain.
| | - Juana Bretón-López
- Department of Basic Psychology, Clinical and Psychobiology, Universitat Jaume I, Castellon, 12071, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain.
| | - Sven Casteleyn
- GEOTEC Research Group, Institute of New Imaging Technologies, Universitat Jaume I, Castellon, 12071, Spain.
| |
Collapse
|
61
|
Prochaska JJ, Vogel EA, Chieng A, Baiocchi M, Pajarito S, Pirner M, Darcy A, Robinson A. A relational agent for treating substance use in adults: Protocol for a randomized controlled trial with a psychoeducational comparator. Contemp Clin Trials 2023; 127:107125. [PMID: 36813084 PMCID: PMC10065942 DOI: 10.1016/j.cct.2023.107125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Substance use disorders (SUDs) are prevalent and compromise health and wellbeing. Scalable solutions, such as digital therapeutics, may offer a population-based strategy for addressing SUDs. Two formative studies supported the feasibility and acceptability of the relational agent Woebot, an animated screen-based social robot, for treating SUDs (W-SUDs) in adults. Participants randomized to W-SUDs reduced their substance use occasions from baseline to end-of-treatment (EOT) relative to a waitlist control. OBJECTIVE To further develop the evidence base, the current randomized trial extends follow-up to 1-month post-treatment and will test the efficacy of W-SUDs relative to a psychoeducational control. METHODS This study will recruit, screen, and consent 400 adults online reporting problematic substance use. Following baseline assessment, participants will be randomized to 8 weeks of W-SUDs or a psychoeducational control. Assessments will be conducted at weeks 4, 8 (EOT), and 12 (1-month post-treatment). Primary outcome is past-month number of substance use occasions, summed across all substances. Secondary outcomes are number of heavy drinking days, the percent of days abstinent from all substances, substance use problems, thoughts about abstinence, cravings, confidence to resist substance use, symptoms of depression and anxiety, and work productivity. If significant group differences are found, we will explore moderators and mediators of treatment effects. CONCLUSIONS The current study builds upon emerging evidence of a digital therapeutic for reducing problematic substance use by examining sustained effects and testing against a psychoeducational control condition. If efficacious, the findings have implications for scalable mobile health interventions for reducing problematic substance use. TRIAL REGISTRATION NCT04925570.
Collapse
Affiliation(s)
- Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, United States of America.
| | - Erin A Vogel
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, United States of America
| | - Amy Chieng
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, United States of America
| | - Michael Baiocchi
- Department of Epidemiology & Population Health, School of Medicine, Stanford University, United States of America
| | | | | | | | | |
Collapse
|
62
|
Salamanca-Sanabria A, Jabir AI, Lin X, Alattas A, Kocaballi AB, Lee J, Kowatsch T, Tudor Car L. Exploring the Perceptions of mHealth Interventions for the Prevention of Common Mental Disorders in University Students in Singapore: Qualitative Study. J Med Internet Res 2023; 25:e44542. [PMID: 36939808 PMCID: PMC10131767 DOI: 10.2196/44542] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/08/2023] [Accepted: 02/24/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Mental health interventions delivered through mobile health (mHealth) technologies can increase the access to mental health services, especially among university students. The development of mHealth intervention is complex and needs to be context sensitive. There is currently limited evidence on the perceptions, needs, and barriers related to these interventions in the Southeast Asian context. OBJECTIVE This qualitative study aimed to explore the perception of university students and mental health supporters in Singapore about mental health services, campaigns, and mHealth interventions with a focus on conversational agent interventions for the prevention of common mental disorders such as anxiety and depression. METHODS We conducted 6 web-based focus group discussions with 30 university students and one-to-one web-based interviews with 11 mental health supporters consisting of faculty members tasked with student pastoral care, a mental health first aider, counselors, psychologists, a clinical psychologist, and a psychiatrist. The qualitative analysis followed a reflexive thematic analysis framework. RESULTS The following 6 main themes were identified: a healthy lifestyle as students, access to mental health services, the role of mental health promotion campaigns, preferred mHealth engagement features, factors that influence the adoption of mHealth interventions, and cultural relevance of mHealth interventions. The interpretation of our findings shows that students were reluctant to use mental health services because of the fear of stigma and a possible lack of confidentiality. CONCLUSIONS Study participants viewed mHealth interventions for mental health as part of a blended intervention. They also felt that future mental health mHealth interventions should be more personalized and capable of managing adverse events such as suicidal ideation.
Collapse
Affiliation(s)
- Alicia Salamanca-Sanabria
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise, Singapore, Singapore
| | - Ahmad Ishqi Jabir
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Xiaowen Lin
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Aishah Alattas
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise, Singapore, Singapore
| | - A Baki Kocaballi
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- School of Computer Science, University of Technology Sydney, Sydney, Australia
| | - Jimmy Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Research Division, Institute of Mental Health, Singapore, Singapore
- Department of Psychosis, Institute of Mental Health, Singapore, Singapore
| | - Tobias Kowatsch
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise, Singapore, Singapore
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St. Gallen, St. Gallen, Switzerland
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| |
Collapse
|
63
|
Nogueira-Leite D, Cruz-Correia R. Attitudes of Physicians and Individuals Toward Digital Mental Health Tools: Protocol for a Web-Based Survey Research Project. JMIR Res Protoc 2023; 12:e41040. [PMID: 36917172 PMCID: PMC10131781 DOI: 10.2196/41040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 12/20/2022] [Accepted: 01/09/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Digital transformation is impacting health care delivery. Great market dynamism is bringing opportunities and concerns alike into public discussion. Digital health apps are a vibrant segment where regulation is emerging, with Germany paving the way with its DiGA (Digitale Gesundheitsanwendungen, in German, meaning digital health apps) program. Simultaneously, mental ill-health constitutes a global health concern, and prevalence is expected to worsen due to the COVID-19 pandemic and its containment measures. Portugal and its National Health System may be a useful testbed for digital health interventions. OBJECTIVE The paper outlines the protocol for a research project on the attitudes of physicians and potential users toward digital mental health apps to improve access to care, patient outcomes, and reduce the burden of disease of mental ill-health. METHODS Web surveys will be conducted to acquire data from the main stakeholders (physicians and the academic community). Data analysis will replicate the statistical analysis performed in the studies from Dahlhausen and Borghouts to derive conclusions regarding the relative acceptance and likelihood of successful implementation of digital mental health apps in Portugal. RESULTS The findings of the proposed studies will elicit important information on how physicians and individuals perceive digital mental health app interventions to improve access to care, patient outcomes, and reduce the burden of disease of mental ill-health. Data collection ran between September 26 and November 6, 2022, for the first study and September 20 and October 20, 2022, for the second study. We obtained 160 responses to the first study's survey and 539 answers to the second study's survey. Data analysis is concluded, and both studies' results are expected to be published in 2023. CONCLUSIONS The results of the studies projected in this research protocol will have implications for researchers and academia, industry, and policy makers concerning the adoption and implementation of digital health mental apps and associated interventions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/41040.
Collapse
Affiliation(s)
- Diogo Nogueira-Leite
- Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Porto, Portugal.,Nova School of Business and Economics Health and Economics Knowledge Center, New University of Lisbon, Lisbon, Portugal.,Programme in Health Data Science, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ricardo Cruz-Correia
- Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Porto, Portugal.,Center for Health Technology and Services Research, Porto, Portugal
| |
Collapse
|
64
|
Wepa D, Neal M, Abo-Gazala W, Cusworth S, Hargan J, Mistry M, Vaughan J, Giles S, Khan M, Power L. Codesign of a digital health tool for suicide prevention: protocol for a scoping review. BMJ Open 2023; 13:e070329. [PMID: 36898754 PMCID: PMC10008351 DOI: 10.1136/bmjopen-2022-070329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
INTRODUCTION The role of digital health in providing psychological treatment and support for the prevention of suicide is well documented. Particular emphasis has been placed on digital health technologies during the COVID-19 pandemic. Providing psychological support reduces the burden of mental health conditions. The challenge is to provide support in the context of patient isolation, which highlights the role of digital technology (video conferencing, smartphone apps and social media). There is, however, a dearth of literature where experts by experience have been involved in the end-to-end process of developing digital health tools for suicide prevention. METHODS AND ANALYSIS This study aims to codesign a digital health tool for suicide prevention focusing on the enablers and barriers. The scoping review protocol is phase I within a three-phase study. The protocol will inform the second phase of the study which is the scoping review. The results of the review will inform a funding application to National Institute for Health and Care Research to codesign a digital health tool for suicide prevention (the third phase). The search strategy will follow the Joanna Briggs Institute Reviewer's Manual for Scoping Reviews and incorporates the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist to ensure reporting standards are maintained. The methodology will be supplemented by frameworks by Arksey and O'Malley and Levac et al. The search strategy dates for screening are from November 2022 to March 2023. Five databases will be searched: Medline, Scopus, CINAHL, PsycInfo and Cochrane Database of Systematic Reviews. Grey literature searches include government and non-government health websites, Google and Google Scholar. The data will be extracted and organised into relevant categories. The results will be synthesised into themes and inform phase II of the study. ETHICS AND DISSEMINATION Ethics granted by the University of Bradford on 15 August 2022, reference E995. The project team will design a digital health tool, results will be published in a peer-review journal and disseminated through conferences. STUDY REGISTRATION NUMBER Safety (Mental Health) Innovation Challenge Fund 2022-2023 Protocol RM0223/42079 Ver 0.1.
Collapse
Affiliation(s)
- Dianne Wepa
- School of Nursing & Healthcare Leadership, Faculty of Health Studies, University of Bradford, Bradford, UK
- School of Public Health & Interdisciplinary Studies, Auckland University of Technology Faculty of Health and Environmental Sciences, Auckland, New Zealand
| | - Martin Neal
- School of Nursing & Healthcare Leadership, Faculty of Health Stuidies, University of Bradford, Bradford, UK
| | - Waseem Abo-Gazala
- School of Nursing & Healthcare Leadership, Faculty of Health Stuidies, University of Bradford, Bradford, UK
| | - Sally Cusworth
- School of Nursing & Healthcare Leadership, Faculty of Health Stuidies, University of Bradford, Bradford, UK
| | - Jae Hargan
- School of Allied Health & Midwifery, Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Manoj Mistry
- School of Nursing & Healthcare Leadership, Faculty of Health Stuidies, University of Bradford, Bradford, UK
| | - Jimmy Vaughan
- School of Nursing & Healthcare Leadership, Faculty of Health Stuidies, University of Bradford, Bradford, UK
| | - Stephen Giles
- School of Nursing & Healthcare Leadership, Faculty of Health Stuidies, University of Bradford, Bradford, UK
| | - Mehnaz Khan
- School of Nursing & Healthcare Leadership, Faculty of Health Stuidies, University of Bradford, Bradford, UK
| | - Lucy Power
- School of Nursing & Healthcare Leadership, Faculty of Health Stuidies, University of Bradford, Bradford, UK
| |
Collapse
|
65
|
Xie EB, Freeman M, Penner-Goeke L, Reynolds K, Lebel C, Giesbrecht GF, Rioux C, MacKinnon A, Sauer-Zavala S, Roos LE, Tomfohr-Madsen L. Building Emotional Awareness and Mental Health (BEAM): an open-pilot and feasibility study of a digital mental health and parenting intervention for mothers of infants. Pilot Feasibility Stud 2023; 9:27. [PMID: 36800982 PMCID: PMC9938356 DOI: 10.1186/s40814-023-01245-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/13/2023] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Maternal mental health concerns and parenting stress in the first few years following childbirth are common and pose significant risks to maternal and child well-being. The COVID-19 pandemic has led to increases in maternal depression and anxiety and has presented unique parenting stressors. Although early intervention is crucial, there are significant barriers to accessing care. METHODS To inform a larger randomized controlled trial, the current open-pilot trial investigated initial evidence for the feasibility, acceptability, and efficacy of a newly developed online group therapy and app-based mental health and parenting program (BEAM) for mothers of infants. Forty-six mothers 18 years or older with clinically elevated depression scores, with an infant aged 6-17 months old, and who lived in Manitoba or Alberta were enrolled in the 10-week program (starting in July 2021) and completed self-report surveys. RESULTS The majority of participants engaged in each of the program components at least once and participants indicated relatively high levels of app satisfaction, ease of use, and usefulness. However, there was a high level of attrition (46%). Paired-sample t-tests indicated significant pre- to post-intervention change in maternal depression, anxiety, and parenting stress, and in child internalizing, but not externalizing symptoms. Effect sizes were in the medium to high range, with the largest effect size observed for depressive symptoms (Cohen's d = .93). DISCUSSION This study shows moderate levels of feasibility and strong preliminary efficacy of the BEAM program. Limitations to program design and delivery are being addressed for testing in adequately powered follow-up trials of the BEAM program for mothers of infants. TRIAL REGISTRATION NCT04772677 . Registered on February 26 2021.
Collapse
Affiliation(s)
- E. Bailin Xie
- grid.22072.350000 0004 1936 7697Department of Psychology, University of Calgary, Calgary, AB Canada
| | - Makayla Freeman
- grid.17091.3e0000 0001 2288 9830Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, BC Canada
| | - Lara Penner-Goeke
- grid.21613.370000 0004 1936 9609Department of Psychology, University of Manitoba, Winnipeg, MB Canada
| | - Kristin Reynolds
- grid.21613.370000 0004 1936 9609Department of Psychology, University of Manitoba, Winnipeg, MB Canada
| | - Catherine Lebel
- grid.413571.50000 0001 0684 7358Alberta Children’s Hospital Research Institute (ACHRI), Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Radiology, University of Calgary, Calgary, AB Canada
| | - Gerald F. Giesbrecht
- grid.22072.350000 0004 1936 7697Department of Psychology, University of Calgary, Calgary, AB Canada ,grid.413571.50000 0001 0684 7358Alberta Children’s Hospital Research Institute (ACHRI), Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Pediatrics, University of Calgary, Calgary, AB Canada
| | - Charlie Rioux
- grid.266900.b0000 0004 0447 0018Department of Psychology, University of Oklahoma, Norman, OK USA
| | - Anna MacKinnon
- grid.14848.310000 0001 2292 3357Department of Psychiatry and Addictology, Université de Montréal, Montréal, QC Canada ,grid.411418.90000 0001 2173 6322CHU Sainte-Justine Research Center, Montréal, QC Canada
| | - Shannon Sauer-Zavala
- grid.266539.d0000 0004 1936 8438Department of Psychology, University of Kentucky, Lexington, KY USA
| | - Leslie E. Roos
- grid.21613.370000 0004 1936 9609Department of Psychology, University of Manitoba, Winnipeg, MB Canada ,grid.460198.20000 0004 4685 0561Children’s Hospital Research Institute of Manitoba, Winnipeg, MB Canada
| | - Lianne Tomfohr-Madsen
- grid.17091.3e0000 0001 2288 9830Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, BC Canada
| |
Collapse
|
66
|
Leung T, Gulliver A, Sunderland M, Farrer L, Kay-Lambkin F, Trias A, Calear A. Factors Influencing Community Participation in Internet Interventions Compared With Research Trials: Observational Study in a Nationally Representative Adult Cohort. J Med Internet Res 2023; 25:e41663. [PMID: 36729613 PMCID: PMC9936370 DOI: 10.2196/41663] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Digital mental health (DMH) programs can be effective in treating and preventing mental health problems. However, community engagement with these programs can be poor. Understanding the barriers and enablers of DMH program use may assist in identifying ways to increase the uptake of these programs, which have the potential to provide broad-scale prevention and treatment in the community. OBJECTIVE In this study, we aimed to identify and compare factors that may influence participation in DMH programs in practice and research trials, identify any respondent characteristics that are associated with these factors, and assess the relationship between intentions to use DMH programs and actual uptake. METHODS Australian adults aged ≥18 years were recruited from market research panels to participate in the study. The sample was representative of the Australian adult population based on age, gender, and location. Participants completed a cross-sectional web-based survey assessing demographic characteristics, mental health symptom measures, attitudes and use of DMH programs in practice and in research studies, and the factors influencing their use in both settings. RESULTS Across both research and practice, trust in the organization delivering the service or trial was the top-ranked factor influencing participation, followed by anonymity or privacy and adequate information. There was little variation in rankings across demographic groups, including intentions to use DMH programs or mental health status. Intentions to use DMH programs were a strong predictor of both current (odds ratio 2.50, 99% CI 1.41-4.43; P<.001) and past (odds ratio 2.98, 99% CI 1.71-5.19; P<.001) use behaviors. CONCLUSIONS Efforts to increase the uptake of DMH programs or participation in research trials should focus on clearly communicating the following to users: the legitimacy of the organization delivering the program, security and use of participant data, and effectiveness of DMH programs.
Collapse
Affiliation(s)
| | - Amelia Gulliver
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Acton ACT, Australia
| | - Matthew Sunderland
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia
| | - Louise Farrer
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Acton ACT, Australia
| | | | - Angelica Trias
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Acton ACT, Australia
| | - Alison Calear
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Acton ACT, Australia
| |
Collapse
|
67
|
Oh E, Gang M. [Effect of Digital Health Interventions on Psychotic Symptoms among Persons with Severe Mental Illness in Community: A Systematic Review and Meta-Analysis]. J Korean Acad Nurs 2023; 53:69-86. [PMID: 36898686 DOI: 10.4040/jkan.22121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/28/2022] [Accepted: 01/31/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE This study aimed to evaluate the effects of digital health interventions on the psychotic symptoms among people with severe mental illness in the community. METHODS A systematic review and meta-analysis were conducted in accordance with the Cochrane Intervention Research Systematic Review Manual and PRISMA. A literature search was conducted of published randomized controlled trials (RCTs) for digital health interventions from January 2022 to April 2022. RevMan software 5.3 was used for quality assessment and meta-analysis. RESULTS A total 14 studies out of 9,864 studies were included in the review, and 13 were included in meta-analysis. The overall effect size of digital health interventions on psychotic symptoms was -0.21 (95% CI = -0.32 to -0.10). Sub-analysis showed that the reduction of the psychotic symptoms was effective in the schizophrenia spectrum group (SMD = -.0.22; 95% CI = -.0.36 to -0.09), web (SMD = -0.41; 95% CI = -0.82 to 0.01), virtual reality (SMD = -0.33; 95% CI = -0.56 to -0.10), mobile (SMD = -0.15; 95% CI = -0.28 to -0.03), intervention period of less than 3 months (SMD = -0.23; 95% CI = -0.35 to -0.11), and non-treatment group (SMD = -0.23; 95% CI = -0.36 to -0.11). CONCLUSION These findings suggest that digital health interventions alleviate psychotic symptoms in patients with severe mental illnesses. However, well-designed digital health studies should be conducted in the future.
Collapse
Affiliation(s)
- Eunjin Oh
- Department of Nursing, Songwon University, Gwangju, Korea
| | - Moonhee Gang
- College of Nursing, Chungnam National University, Daejeon, Korea.
| |
Collapse
|
68
|
Balaskas A, Schueller SM, Cox AL, Rashleigh C, Doherty G. Examining young adults daily perspectives on usage of anxiety apps: A user study. PLOS DIGITAL HEALTH 2023; 2:e0000185. [PMID: 36812622 PMCID: PMC9931254 DOI: 10.1371/journal.pdig.0000185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/14/2022] [Indexed: 01/27/2023]
Abstract
The growing number of mental health smartphone applications has led to increased interest in how these tools might support users in different models of care. However, research on the use of these interventions in real-world settings has been scarce. It is important to understand how apps are used in a deployment setting, especially among populations where such tools might add value to current models of care. The objective of this study is to explore the daily use of commercially-available mobile apps for anxiety that integrate CBT, with a focus on understanding reasons for and barriers for app use and engagement. This study recruited 17 young adults (age M = 24.17 years) while on a waiting list to receive therapy in a Student Counselling Service. Participants were asked to select up to two of a list of three selected apps (Wysa, Woebot, and Sanvello) and instructed to use the apps for two weeks. Apps were selected because they used techniques from cognitive behavioral therapy, and offer diverse functionality for anxiety management. Qualitative and quantitative data were gathered through daily questionnaires to capture participants' experiences with the mobile apps. In addition, eleven semi-structured interviews were conducted at the end of the study. We used descriptive statistics to analyze participants' interaction with different app features and used a general inductive approach to analyze the collected qualitative data. The results highlight that users form opinions about the apps during the first days of app use. A number of barriers to sustained use are identified including cost-related issues, inadequate content to support long-term use, and a lack of customization options for different app functions. The app features used differ among participants with self-monitoring and treatment elements being the most used features.
Collapse
Affiliation(s)
- Andreas Balaskas
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
- * E-mail:
| | - Stephen M. Schueller
- Department of Psychological Science, University of California, Irvine, Irvine, California, United States of America
| | - Anna L. Cox
- UCLIC, University College London, London, United Kingdom
| | - Chuck Rashleigh
- Student Counselling Services, Trinity College Dublin, Dublin, Ireland
| | - Gavin Doherty
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
69
|
Gan DZQ, McGillivray L, Larsen ME, Torok M. Promoting engagement with self-guided digital therapeutics for mental health: Insights from a cross-sectional survey of end-users. J Clin Psychol 2023; 79:1386-1397. [PMID: 36693234 DOI: 10.1002/jclp.23486] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/06/2022] [Accepted: 01/08/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Poor engagement has hindered the dissemination of self-guided digital therapeutics for mental health. Evidence on the efficacy of technology-supported strategies designed for increasing engagement with these interventions is currently inconclusive. Few studies have examined user perceptions of such strategies, which could yield key insights for enhancing their effectiveness. METHODS Two hundred and eleven participants completed a cross-sectional online survey. All participants were aged 18 years and above, living in Australia, fluent in English, and self-reported prior use of digital therapeutics for mental health needs. Survey items elicited participants' views on factor(s) contributing to their engagement/disengagement with digital therapeutics, and perceptions of engagement strategies, including: automated electronic reminders, fun facts, quizzes, and social media platforms. χ2 tests of independence were used to analyse nominal data. Inductive thematic analysis was used to analyse free-text data. RESULTS Factors facilitating engagement included digestible content, assurance of confidentiality, and esthetically appealing design. Factors hindering engagement included lack of time, forgetfulness, and lack of perceived intervention efficacy. Participants had mixed views over the feasibility and acceptability of the strategies explored toward promoting engagement. CONCLUSIONS Regardless of strategy type, succinct and easily applicable content was identified as an important feature for promoting engagement. Conversely, content that could trigger psychological distress among intervention users should be avoided. Overall, the diverse range of user perspectives highlighted that engagement strategies for any specific digital intervention should be co-designed with individuals with lived experience of mental health difficulties.
Collapse
Affiliation(s)
- Daniel Z Q Gan
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | | | - Mark E Larsen
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Sydney, Australia
| |
Collapse
|
70
|
Kilic K, Weck S, Kampik T, Lindgren H. Argument-based human-AI collaboration for supporting behavior change to improve health. Front Artif Intell 2023; 6:1069455. [PMID: 36872933 PMCID: PMC9979214 DOI: 10.3389/frai.2023.1069455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/20/2023] [Indexed: 02/18/2023] Open
Abstract
This article presents an empirical requirement elicitation study for an argumentation-based digital companion for supporting behavior change, whose ultimate goal is the promotion and facilitation of healthy behavior. The study was conducted with non-expert users as well as with health experts and was in part supported by the development of prototypes. It focuses on human-centric aspects, in particular user motivations, as well as on expectations and perceptions regarding the role and interaction behavior of a digital companion. Based on the results of the study, a framework for person tailoring the agent's roles and behaviors, and argumentation schemes are proposed. The results indicate that the extent to which a digital companion argumentatively challenges or supports a user's attitudes and chosen behavior and how assertive and provocative the companion is may have a substantial and individualized effect on user acceptance, as well as on the effects of interacting with the digital companion. More broadly, the results shed some initial light on the perception of users and domain experts of "soft," meta-level aspects of argumentative dialogue, indicating potential for future research.
Collapse
Affiliation(s)
- Kaan Kilic
- Department of Computing Science, Umeå University, Umeå, Sweden
| | - Saskia Weck
- Department of Computing Science, Umeå University, Umeå, Sweden
| | | | - Helena Lindgren
- Department of Computing Science, Umeå University, Umeå, Sweden
| |
Collapse
|
71
|
Chang C, Palermo E, Deswert S, Brown A, Nuske HJ. Money can't buy happiness: A randomized controlled trial of a digital mental health app with versus without financial incentives. Digit Health 2023; 9:20552076231170693. [PMID: 37361441 PMCID: PMC10286537 DOI: 10.1177/20552076231170693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 04/03/2023] [Indexed: 06/28/2023] Open
Abstract
Mental health disorders are prevalent among college students and increasing in frequency and severity. However, there is a significant gap between those who need treatment and those who engage in treatment. Given the documented efficacy of financial incentives for promoting health behavior change and engagement in treatment, financial incentives may help, along with nonfinancial behavioral incentives such as motivational messaging, gamification, and loss aversion techniques. We compared brief (28-day) use of two versions of a behavioral economics-inspired digital mental health app, NeuroFlow: (1) the full app including financial incentives and nonfinancial behavioral incentives (treatment group) and (2) a version of the app with nonfinancial behavioral incentives only (control group). In our intent-to-treat analyses, in order to examine the primary outcome of app engagement, a one-way analysis of variance (ANOVA) (treatment vs. control) was conducted, and to examine the secondary outcomes (depression, anxiety, emotion dysregulation, and wellbeing), a two-way repeated measures ANOVAs (treatment vs. control × baseline vs. post-trial) were conducted. We found that there were no differences between treatment groups on app engagement or the change in the mental health/wellness outcome measures. There was a main effect of timepoint on symptoms of anxiety and emotion dysregulation, such that there were significantly lower self-reported symptoms at post-trial relative to baseline. Our results suggest that financial incentives in digital mental health apps over and above nonfinancial behavioral incentives do not have an impact on app engagement or mental health/wellness outcomes.
Collapse
Affiliation(s)
- Cheryl Chang
- College of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Emma Palermo
- College of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Penn Center for Mental Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sky Deswert
- Department of Psychiatry, Penn Center for Mental Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Alyssa Brown
- Department of Psychiatry, Penn Center for Mental Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Heather J Nuske
- Department of Psychiatry, Penn Center for Mental Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| |
Collapse
|
72
|
Braun P, Schwientek AK, Angerer P, Guthardt L, Icks A, Loerbroks A, Apolinário-Hagen J. Investigating information needs and preferences regarding digital mental health services among medical and psychology students in Germany: A qualitative study. Digit Health 2023; 9:20552076231173568. [PMID: 37256006 PMCID: PMC10226173 DOI: 10.1177/20552076231173568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 04/17/2023] [Indexed: 06/01/2023] Open
Abstract
Background Since 2020, physicians and psychotherapists in Germany can prescribe digital mental health services (dMHSs). However, even future healthcare professionals (HCPs), such as medical and psychology students, remain reluctant to use dMHSs, although they are a risk group for mental health issues themselves. Reasons include scepticism and lacking awareness of dMHSs, which can be addressed by acceptance-facilitating interventions (AFIs) such as information strategies. To date, though, little is known about their information needs. Methods Semi-structured interviews with n = 21 students were conducted between August and September 2021. Students of legal age studying psychology or medicine at a German university could participate. Interview recordings were transcribed verbatim and content-analyzed according to Mayring, using deductive and inductive coding. Results Most students reported having little experience with dMHSs. Digital health has barely been raised in their study, even though it was perceived as crucial for personal needs as well as in preparation for their work as HCPs. Students favoured receiving information on and recommendations for dMHSs from their university via, e.g. social media or seminars. Among others, information about data safety, scientific evidence base and application scope were preferred. Additionally, information on costs as well as user reviews seemed to be essential components of information strategies because students were concerned that high costs or low usability would hinder uptake. Conclusions The results give first insights on how future HCPs would like to be informed on dMHSs. Future research should focus on systematic variations of AFIs' components mimicking real-world decision scenarios to increase the adoption of dMHSs.
Collapse
Affiliation(s)
- Pia Braun
- Institute of Occupational, Social and
Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University
Düsseldorf, Dusseldorf, Germany
| | - Ann-Kathrin Schwientek
- Institute of Occupational, Social and
Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University
Düsseldorf, Dusseldorf, Germany
- Department of Psychiatry and
Psychotherapy, University Hospital rechts der Isar, School of Medicine, Technical
University of Munich, Munchen, Germany
| | - Peter Angerer
- Institute of Occupational, Social and
Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University
Düsseldorf, Dusseldorf, Germany
| | - Lisa Guthardt
- Institute of Occupational, Social and
Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University
Düsseldorf, Dusseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research
and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich Heine University
Düsseldorf, Dusseldorf, Germany
| | - Adrian Loerbroks
- Institute of Occupational, Social and
Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University
Düsseldorf, Dusseldorf, Germany
| | - Jennifer Apolinário-Hagen
- Institute of Occupational, Social and
Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University
Düsseldorf, Dusseldorf, Germany
| |
Collapse
|
73
|
Cheung BS, Murphy JK, Michalak EE, Liu J, Yang X, Wang X, Chen J, Lam RW. Barriers and facilitators to technology-enhanced measurement based care for depression among Canadian clinicians and patients: Results of an online survey. J Affect Disord 2023; 320:1-6. [PMID: 36162664 DOI: 10.1016/j.jad.2022.09.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/12/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Measurement-based care (MBC) is an evidence-based approach that can improve management of depression, but its use in clinical settings remains low. The use of digital technology, or technology-enhanced MBC (eMBC), may address some of the barriers to implementation of MBC by enabling patients to easily complete outcome assessments. This study aims to identify the perceived facilitators and barriers to MBC and eMBC from both patient and provider perspectives in Canada. METHODS The study recruited 108 clinicians and 131 patients with a self-reported diagnosis of depression to participate in an online survey about the acceptability of both MBC and eMBC. RESULTS Most clinicians (90/108, 83.3 %) agreed that MBC is important for clinical judgement, and felt trained to interpret their scores; however, only 43/108 (39.8 %) use MBC routinely. Clinicians (95/108, 88.0 %) felt they would be more likely to use MBC if it was automated and available to use electronically. Most patients (117/131, 89.3 %) felt MBC would be helpful for their treatment and were willing to use a mobile app to track their symptoms. LIMITATIONS Recruitment was done online and, hence, this study may not capture the perspective of patients who are not already familiar with using online programs to complete questionnaires. CONCLUSIONS Clinicians and patients in Canada would be willing to utilize MBC and eMBC in their psychiatric care, but barriers to implementation include perceptions about efficiency, ease of use, and accessibility. These results highlight the importance of engaging both clinicians and patients to effectively implement MBC and eMBC for depression.
Collapse
Affiliation(s)
- Bennett Sw Cheung
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jill K Murphy
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jing Liu
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Xiaorui Yang
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xing Wang
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Chen
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
| |
Collapse
|
74
|
Eaves ER, Doerry E, Lanzetta SA, Kruithoff KM, Negron K, Dykman K, Thoney O, Harper CC. Applying User-Centered Design in the Development of a Supportive mHealth App for Women in Substance Use Recovery. Am J Health Promot 2023; 37:56-64. [PMID: 35815770 PMCID: PMC9771986 DOI: 10.1177/08901171221113834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE AND APPROACH Women in recovery describe stigma, negative treatment, and limited support as barriers to achieving their health and parenting goals. Mobile health technologies carefully tailored to support the unique needs of recovery communities can provide less burdensome alternatives to in-person services for women transitioning out of substance use treatment. An iterative design process integrated women's interests into the structure, content, and interaction flow of a mobile health (mHealth) app. SETTING AND PARTICIPANTS Participants included women in recovery from opioid, alcohol, and polysubstance use disorders in a comprehensive housing program in urban Arizona. METHODS Five focus groups with 3-7 participants each (n = 27 total) informed creation of the mHealth app. Informed by theoretical models of usability and person-centered design, development involved an iterative series of focus groups in which we asked women to comment on interest in using each feature. This provided a qualitative priority framework for feature development. We then modified the app and repeated the process to gauge consensus and continually refine our prototype. RESULTS Women were interested in access to resources, such as housing, counseling, and parenting advice in settings known to treat women in recovery with respect. They also asked for positive messages, chatting with peers, and access to expert answers. They were less interested in points-based learning modules and "scored" activities, leading us to develop a "daily challenges" concept that builds good habits, but does not feel like "classwork". Women's recommendations shaped an mHealth app tailored to maximize utility, access, and safety for this at-risk population. CONCLUSION Integration of user-centered design with applied ethnographic techniques guided the development of a custom-tailored mHealth app responsive to lived experiences and needs of women in recovery. Future research should evaluate the potential for user-centered apps to increase self-efficacy, perceived social support, and to reduce risk of relapse.
Collapse
Affiliation(s)
- Emery R Eaves
- Department of Anthropology, 3356Northern Arizona University, Flagstaff, AZ, USA
- Center for Health Equity Research, 3356Northern Arizona University, Flagstaff, AZ, USA
| | - Eck Doerry
- School of Informatics, Computing, and Cyber Systems, 3356Northern Arizona University, Flagstaff, AZ, USA
| | - Shana A Lanzetta
- Center for Health Equity Research, 3356Northern Arizona University, Flagstaff, AZ, USA
| | - Kathryn M Kruithoff
- Center for Health Equity Research, 3356Northern Arizona University, Flagstaff, AZ, USA
| | - Kayla Negron
- Center for Health Equity Research, 3356Northern Arizona University, Flagstaff, AZ, USA
| | - Kaitlyn Dykman
- Center for Health Equity Research, 3356Northern Arizona University, Flagstaff, AZ, USA
| | - Olivia Thoney
- School of Informatics, Computing, and Cyber Systems, 3356Northern Arizona University, Flagstaff, AZ, USA
| | - Calvin C Harper
- School of Informatics, Computing, and Cyber Systems, 3356Northern Arizona University, Flagstaff, AZ, USA
| |
Collapse
|
75
|
Badawi E, Coursaris CK, Sénécal S, Léger PM. Facilitating engagement of universal school-based digital mental health solutions through user experience: A qualitative exploration. Front Digit Health 2023; 5:1040739. [PMID: 37035481 PMCID: PMC10075357 DOI: 10.3389/fdgth.2023.1040739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
Digital mental health intervention (DMHI) programs offered in schools present a readily-accessible and flexible means for educating, empowering, and supporting adolescents in maintaining a balanced mental health, especially during uncertain and stressful times such as the COVID-19 pandemic. Recent studies indicate that the effectiveness of DMHI programs in improving students' mental well-being and in preventing from their mental health complications depends on the users' engagement. This study focuses on identifying the user experience factors that can facilitate user engagement with universal school-based DMHI programs (i.e., the DMHI programs delivered to the students regardless of their mental health risks or conditions). To identify said factors, we sought to gain a deeper understanding of perceptions, opinions, and preferences of actual end-users (i.e., the adolescents) regarding their experiences with both digital and non-digital mental health resources. Specifically, interviews were conducted with two participant groups to uncover the reasons that could lead the adolescents to better engage with school-based DMHI programs, as well as the shortcomings that could prevent that from happening: (a) adolescent users who had either a high or a low level of engagement with universal DMHI programs of a specific school-based digital mental health solution; and (b) adolescents who had voluntarily used non-digital or non-school-based digital mental health resources for purposes other than treatment. Through a thematic analysis of interview data, the most important (or primary) and the additionally desirable (or secondary) factors that could lead to a higher engagement level for school-based DMHI programs were identified. Lastly, using the evidence gathered from our interviews, specific recommendations are proposed that could help in targeting each identified engagement factor and in increasing the likelihood that school-based DMHI programs achieve their desired outcome for high school students.
Collapse
Affiliation(s)
- Erfan Badawi
- Department of Information Technologies, HEC Montréal, Montréal, QC, Canada
- Correspondence: Erfan Badawi
| | | | | | | |
Collapse
|
76
|
Schillings C, Meissner D, Erb B, Schultchen D, Bendig E, Pollatos O. A chatbot-based intervention with ELME to improve stress and health-related parameters in a stressed sample: Study protocol of a randomised controlled trial. Front Digit Health 2023; 5:1046202. [PMID: 36937250 PMCID: PMC10014895 DOI: 10.3389/fdgth.2023.1046202] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/25/2023] [Indexed: 03/06/2023] Open
Abstract
Background Stress levels in the general population had already been increasing in recent years, and have subsequently been exacerbated by the global pandemic. One approach for innovative online-based interventions are "chatbots" - computer programs that can simulate a text-based interaction with human users via a conversational interface. Research on the efficacy of chatbot-based interventions in the context of mental health is sparse. The present study is designed to investigate the effects of a three-week chatbot-based intervention with the chatbot ELME, aiming to reduce stress and to improve various health-related parameters in a stressed sample. Methods In this multicenter, two-armed randomised controlled trial with a parallel design, a three-week chatbot-based intervention group including two daily interactive intervention sessions via smartphone (á 10-20 min.) is compared to a treatment-as-usual control group. A total of 130 adult participants with a medium to high stress levels will be recruited in Germany. Assessments will take place pre-intervention, post-intervention (after three weeks), and follow-up (after six weeks). The primary outcome is perceived stress. Secondary outcomes include self-reported interoceptive accuracy, mindfulness, anxiety, depression, personality, emotion regulation, psychological well-being, stress mindset, intervention credibility and expectancies, affinity for technology, and attitudes towards artificial intelligence. During the intervention, participants undergo ecological momentary assessments. Furthermore, satisfaction with the intervention, the usability of the chatbot, potential negative effects of the intervention, adherence, potential dropout reasons, and open feedback questions regarding the chatbot are assessed post-intervention. Discussion To the best of our knowledge, this is the first chatbot-based intervention addressing interoception, as well as in the context with the target variables stress and mindfulness. The design of the present study and the usability of the chatbot were successfully tested in a previous feasibility study. To counteract a low adherence of the chatbot-based intervention, a high guidance by the chatbot, short sessions, individual and flexible time points of the intervention units and the ecological momentary assessments, reminder messages, and the opportunity to postpone single units were implemented. Trial registration The trial is registered at the WHO International Clinical Trials Registry Platform via the German Clinical Trials Register (DRKS00027560; date of registration: 06 January 2022). This is protocol version No. 1. In case of important protocol modifications, trial registration will be updated.
Collapse
Affiliation(s)
- C. Schillings
- Department of Clinical and Health Psychology, Ulm University, Ulm, Germany
- Correspondence: C. Schillings @stineschillings
| | - D. Meissner
- Institute of Distributed Systems, Ulm University, Ulm, Germany
| | - B. Erb
- Institute of Distributed Systems, Ulm University, Ulm, Germany
| | - D. Schultchen
- Department of Clinical and Health Psychology, Ulm University, Ulm, Germany
| | - E. Bendig
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - O. Pollatos
- Department of Clinical and Health Psychology, Ulm University, Ulm, Germany
| |
Collapse
|
77
|
White BK, Martin A, White JA. User Experience of COVID-19 Chatbots: Scoping Review. J Med Internet Res 2022; 24:e35903. [PMID: 36520624 PMCID: PMC9822175 DOI: 10.2196/35903] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 06/02/2022] [Accepted: 12/08/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has had global impacts and caused some health systems to experience substantial pressure. The need for accurate health information has been felt widely. Chatbots have great potential to reach people with authoritative information, and a number of chatbots have been quickly developed to disseminate information about COVID-19. However, little is known about user experiences of and perspectives on these tools. OBJECTIVE This study aimed to describe what is known about the user experience and user uptake of COVID-19 chatbots. METHODS A scoping review was carried out in June 2021 using keywords to cover the literature concerning chatbots, user engagement, and COVID-19. The search strategy included databases covering health, communication, marketing, and the COVID-19 pandemic specifically, including MEDLINE Ovid, Embase, CINAHL, ACM Digital Library, Emerald, and EBSCO. Studies that assessed the design, marketing, and user features of COVID-19 chatbots or those that explored user perspectives and experience were included. We excluded papers that were not related to COVID-19; did not include any reporting on user perspectives, experience, or the general use of chatbot features or marketing; or where a version was not available in English. The authors independently screened results for inclusion, using both backward and forward citation checking of the included papers. A thematic analysis was carried out with the included papers. RESULTS A total of 517 papers were sourced from the literature, and 10 were included in the final review. Our scoping review identified a number of factors impacting adoption and engagement including content, trust, digital ability, and acceptability. The papers included discussions about chatbots developed for COVID-19 screening and general COVID-19 information, as well as studies investigating user perceptions and opinions on COVID-19 chatbots. CONCLUSIONS The COVID-19 pandemic presented a unique and specific challenge for digital health interventions. Design and implementation were required at a rapid speed as digital health service adoption accelerated globally. Chatbots for COVID-19 have been developed quickly as the pandemic has challenged health systems. There is a need for more comprehensive and routine reporting of factors impacting adoption and engagement. This paper has shown both the potential of chatbots to reach users in an emergency and the need to better understand how users engage and what they want.
Collapse
Affiliation(s)
- Becky K White
- School of Population Health, Curtin University, Perth, Australia
- Reach Health Promotion Innovations, Perth, Australia
| | | | | |
Collapse
|
78
|
Balcombe L, De Leo D. Evaluation of the Use of Digital Mental Health Platforms and Interventions: Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010362. [PMID: 36612685 PMCID: PMC9819791 DOI: 10.3390/ijerph20010362] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 05/28/2023]
Abstract
BACKGROUND The increasing use of digital mental health (DMH) platforms and digital mental health interventions (DMHIs) is hindered by uncertainty over effectiveness, quality and usability. There is a need to identify the types of available evidence in this domain. AIM This study is a scoping review identifying evaluation of the (1) DMH platform/s used; and (2) DMHI/s applied on the DMH platform/s. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guided the review process. Empirical studies that focused on evaluation of the use and application of DMH platforms were included from journal articles (published 2012-2022). A literature search was conducted using four electronic databases (Scopus, ScienceDirect, Sage and ACM Digital Library) and two search engines (PubMed and Google Scholar). RESULTS A total of 6874 nonduplicate records were identified, of which 144 were analyzed and 22 met the inclusion criteria. The review included general/unspecified mental health and/or suicidality indications (n = 9, 40.9%), followed by depression (n = 5, 22.7%), psychosis (n = 3, 13.6%), anxiety and depression (n = 2, 9.1%), as well as anxiety, depression and suicidality (n = 1, 4.5%), loneliness (n = 1, 4.5%), and addiction (n = 1, 4.5%). There were 11 qualitative studies (50%), 8 quantitative studies (36.4%), and 3 mixed-methods studies (n = 3, 13.6%). The results contained 11 studies that evaluated the DMH platform/s and 11 studies that evaluated the DMHI/s. The studies focused on feasibility, usability, engagement, acceptability and effectiveness. There was a small amount of significant evidence (1 in each 11), notably the (cost-)effectiveness of a DMHI with significant long-term impact on anxiety and depression in adults. CONCLUSION The empirical research demonstrates the feasibility of DMH platforms and DMHIs. To date, there is mostly heterogeneous, preliminary evidence for their effectiveness, quality and usability. However, a scalable DMHI reported effectiveness in treating adults' anxiety and depression. The scope of effectiveness may be widened through targeted strategies, for example by engaging independent young people.
Collapse
|
79
|
Qualitative study of user perspectives and experiences of digital inhaler technology. NPJ Prim Care Respir Med 2022; 32:57. [PMID: 36550136 PMCID: PMC9780314 DOI: 10.1038/s41533-022-00320-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
Electronic monitoring devices (EMDs) have been trialled in interventions to improve inhaled corticosteroid adherence and clinical outcomes. This study sought to understand the perceptions and experiences of EMD end-users. Participants recruited into a six-month EMD study were invited to a semi-structured interview. Interviews were audio-recorded, transcribed verbatim and analysed using the framework approach. Twenty-eight participants (68% female, median age 47) were interviewed. Individuals described feeling responsible for their asthma control. Recent attacks motivated a desire to maintain control. Study participation led to increased awareness of asthma status and medication use. Several individuals were open to integrating digital monitoring data with other mHealth inputs, perceiving the potential to enhance communication with clinicians and empower self-management. Openness to data sharing was tied to expectations of transparent data use. Data supported integrating beliefs and habit formation to achieve behaviour change. There was a willingness for an integrated, platform-based approach to digital self-management.
Collapse
|
80
|
Garrido S, Oliver E, Chmiel A, Doran B, Boydell K. Encouraging help-seeking and engagement in a mental health app: What young people want. Front Digit Health 2022; 4:1045765. [PMID: 36620186 PMCID: PMC9810815 DOI: 10.3389/fdgth.2022.1045765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
Although many young people evince a preference for digital mental health support over face to face, engagement with smartphone apps for mental health remains relatively low, particularly in young people not accessing professional support services. While some of this can be attributed to stigma or embarrassment, there is also a need for developers and researchers to investigate features which promote long-term usage. MoodyTunes is a music-based smartphone app that has been co-designed with young people to help them develop effective self-management strategies for mood through music listening. Four focus groups with young people (N = 24, aged 13-25) were conducted to workshop how MoodyTunes could promote help-seeking behaviours and long-term engagement with the app. Online discussions following a broad topic guide were held in groups of 4-7 in which participants explored topics including the use of social features, promoting help-seeking behaviour, gamification and mood tracking. Participants also viewed visual materials and offered ideas about visual design both verbally and on paper. A general inductive approach was taken to analysis of qualitative data. Three primary themes were identified in the data: privacy; user empowerment; and engagement vs. achievement. Participants voiced a strong desire to remain anonymous and to feel empowered to make their own decisions about accessing professional help. Sensitive use of language was noted as critical, with some participants noting that the use of more directive language could have a negative impact on their mental health and that motivational features should focus on engagement with the primary aim of the app rather than rewarding achievement. Findings highlight the benefits of a co-design approach and provide key insights into how mental health apps may be able to improve long-term user engagement with young people.
Collapse
Affiliation(s)
- Sandra Garrido
- The MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Sydney, NSW, Australia
| | - Eliza Oliver
- The MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Sydney, NSW, Australia
| | - Anthony Chmiel
- The MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Sydney, NSW, Australia
| | - Barbara Doran
- Faculty of Transdisciplinary Innovation, University of Technology, Sydney, NSW, Australia
| | - Katherine Boydell
- Black Dog Institute, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
81
|
Mavragani A, Tan JHY, Kosasih FR, Sündermann O. Efficacy of the Mental Health App Intellect to Reduce Stress: Randomized Controlled Trial With a 1-Month Follow-up. JMIR Form Res 2022; 6:e40723. [PMID: 36515984 PMCID: PMC9798264 DOI: 10.2196/40723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/20/2022] [Accepted: 11/24/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Excessive stress is a major global health concern, particularly in young adults. Short skills-focused self-guided interventions (SGIs) on smartphones are a scalable way to improve stress-coping skills at the population level. OBJECTIVE In this randomized controlled trial, we aimed to examine the possible efficacy of a recently developed stress-coping SGI (Intellect) in improving psychological distress, relative to an active control group and 2 potential moderators of this predicted relationship (ie, psychological mindedness [PM] and coping self-efficacy [CSE]). METHODS University students (N=321) were randomly assigned to either an 8-day SGI on stress-coping or an active control group. Self-reported measures were obtained at baseline, after the intervention, and at the 1-month follow-up. The primary outcome was psychological stress (Psychological Stress Measure-9). Secondary outcomes were anxiety (Generalized Anxiety Disorder-7) and depressive symptoms (Patient Health Questionnaire-9). PM and CSE were assessed as potential moderators at baseline. RESULTS The final sample (n=264) included 188 (71.2%) female, 66 (25%) male, 7 (2.7%) nonbinary, and 3 (1.1%) others participants with a mean age of 22.5 (SD 5.41) years. The intervention group reported significantly lower perceived stress (partial eta-squared [ηp2]=0.018; P=.03) and anxiety (ηp2=0.019; P=.03) levels after intervention relative to the active control group. The effects on perceived stress levels remained statistically significant at the 1-month follow-up (ηp2=0.015; P=.05). Students with the lowest CSE and highest PM experienced the fastest decline in perceived stress levels (β=6.37, 95% Cl 2.98-9.75). Improvements in anxiety levels were not observed at 1-month follow-up. Similarly, no intervention effects were found for depression levels at postintervention and follow-up periods. CONCLUSIONS This study provides evidence that the Intellect stress-coping SGI is effective in reducing perceived stress and anxiety levels among university students. Mobile health apps are brief, scalable, and can make important contributions to public mental health. TRIAL REGISTRATION ClinicalTrials.gov NCT04978896; https://www.clinicaltrials.gov/ct2/show/NCT04978896.
Collapse
Affiliation(s)
| | - Jessalin Hui Yan Tan
- Department of Psychology, National University of Singapore, Singapore, Singapore
| | | | | |
Collapse
|
82
|
Camacho E, Torous J. Introducing an implementation framework for augmenting care with digital technology for early psychosis patients: theory and motivation. J Ment Health 2022; 31:816-824. [PMID: 34057008 DOI: 10.1080/09638237.2021.1922634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Treatment programs for early-course psychosis are evidence-based interventions that provide specialty care to improve outcomes in patients. Digital technologies offer the potential to augment services and meet the growing demand for care. AIMS We introduce a framework to guide the assessment of site readiness for technology and their ability to successfully introduce, implement, and sustain digital technology use. While broader in use that early course psychosis, we focus on this use case to introduce the theory and clinical application. METHODS Adapting the replicating effective programs framework, we present an early psychosis focused model. Considering the unique opportunities and challenges of these programs, we present a five-stage evaluation framework. Informed by our clinical experience and recent literature, we present tools and examples to help programs plan and execute successful technology implementation. RESULTS The AACCS framework is comprised of five stages: (1) Access (e.g. identifying access to and comfort with technology), (2) Align (e.g. understanding aspects technology can augment), (3) Connect (e.g. customizing technology to stakeholder needs), (4) Care (e.g. implementing technology into treatment), and (5) Sustain (e.g. creating sustainable services). Site visits revealed patients have access to digital tools and are open to implementation into care, while staff prefers digital skills training. CONCLUSIONS This framework assists programs in identifying clinical targets to be augmented with technology, stages of implementation, and recommendations for sustaining meaningful technology use.
Collapse
Affiliation(s)
- Erica Camacho
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - John Torous
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
83
|
Wiberg AC, Ghaderi A, Danielsson HB, Safarzadeh K, Parling T, Carlbring P, Jansson M, Welch E. Internet-based cognitive behavior therapy for eating disorders - Development and feasibility evaluation. Internet Interv 2022; 30:100570. [PMID: 36110307 PMCID: PMC9468502 DOI: 10.1016/j.invent.2022.100570] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/20/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Eating disorders (ED) are severe psychiatric conditions, characterized by decreased quality of life and high mortality. However, only a minority of patients with ED seek care and very few receive treatment. Internet-delivered cognitive behavioral therapy (ICBT) has the potential to increase access to evidence-based treatments. AIMS The aims of the present study were to (1) develop and evaluate the usability of an Internet-delivered guided self-help treatment based on Enhanced Cognitive Behavioral Therapy (ICBT-E) for patients with full or subthreshold bulimia nervosa (BN) or binge eating disorder (BED) with a user centered design process, and (2) to evaluate its feasibility and preliminary outcome in a clinical environment. METHOD The study was undertaken in two stages. In Stage I, a user-centered design approach was applied with iterative phases of prototype development and evaluation. Participants were eight clinicians and 30 individuals with current or previous history of ED. In Stage II, 41 patients with full or subthreshold BN or BED were recruited to a single-group open trial to evaluate the feasibility and preliminary outcome of ICBT-E. Primary outcome variables were diagnostic status and self-rated ED symptoms. RESULTS The user-centered design process was instrumental in the development of the ICBT-E, by contributing to improvements of the program and to the content being adapted to the needs and preferences of end-users. The overall usability of the program was found to be good. ICBT-E targets key maintaining factors in ED by introducing healthy eating patterns and addressing over-evaluation of weight and shape. The results indicate that ICBT-E, delivered in a clinical setting, is a feasible and promising treatment for full or subthreshold BN or BED, with a high level of acceptability observed and treatment completion of 73.2 %. Participation in ICBT-E was associated with significant symptom reductions in core ED symptomology, functional impairment as well as depressive symptoms, and the results were maintained at the 3-month follow-up. CONCLUSIONS ICBT-E was developed with end-users' preferences in mind, in accordance with the identified recommendations, and the program was perceived as usable by end-users. The study demonstrated the potential of ICBT-E, which marks a step forward in the effort to make powerful, empirically supported psychological interventions targeting ED more widely available and accessible.
Collapse
Affiliation(s)
- Anne-Charlotte Wiberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 17177 Stockholm, Sweden
| | | | - Kousha Safarzadeh
- Student Health Center, Lund University, Sandgatan 3, 22350 Lund, Sweden
| | - Thomas Parling
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, 106 91 Stockholm, Sweden
| | - Magdalena Jansson
- Stockholm Center for Eating Disorders, Stockholm County Council, Wollmar Yxkullsgatan 27B, 118 50 Stockholm, Sweden
| | - Elisabeth Welch
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| |
Collapse
|
84
|
Kwasnicka D, Keller J, Perski O, Potthoff S, Ten Hoor GA, Ainsworth B, Crutzen R, Dohle S, van Dongen A, Heino M, Henrich JF, Knox L, König LM, Maltinsky W, McCallum C, Nalukwago J, Neter E, Nurmi J, Spitschan M, Van Beurden SB, Van der Laan LN, Wunsch K, Levink JJJ, Sanderman R. White Paper: Open Digital Health - accelerating transparent and scalable health promotion and treatment. Health Psychol Rev 2022; 16:475-491. [PMID: 35240931 DOI: 10.1080/17437199.2022.2046482] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In this White Paper, we outline recommendations from the perspective of health psychology and behavioural science, addressing three research gaps: (1) What methods in the health psychology research toolkit can be best used for developing and evaluating digital health tools? (2) What are the most feasible strategies to reuse digital health tools across populations and settings? (3) What are the main advantages and challenges of sharing (openly publishing) data, code, intervention content and design features of digital health tools? We provide actionable suggestions for researchers joining the continuously growing Open Digital Health movement, poised to revolutionise health psychology research and practice in the coming years. This White Paper is positioned in the current context of the COVID-19 pandemic, exploring how digital health tools have rapidly gained popularity in 2020-2022, when world-wide health promotion and treatment efforts rapidly shifted from face-to-face to remote delivery. This statement is written by the Directors of the not-for-profit Open Digital Health initiative (n = 6), Experts attending the European Health Psychology Society Synergy Expert Meeting (n = 17), and the initiative consultant, following a two-day meeting (19-20th August 2021).
Collapse
Affiliation(s)
- Dominika Kwasnicka
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wrocław, Poland
| | - Jan Keller
- Department of Education and Psychology; Freie Universität Berlin, Berlin, Germany
| | - Olga Perski
- Department of Behavioural Science and Health, University College London, London, UK
| | - Sebastian Potthoff
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Gill A Ten Hoor
- Department of Work & Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Ben Ainsworth
- Department of Psychology, University of Bath, Bath, UK
| | - Rik Crutzen
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, the Netherlands
| | - Simone Dohle
- Department of Psychology, University of Cologne, Cologne, Germany and Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Anne van Dongen
- Department of Psychology, Health, and Technology, University of Twente, Enschede, the Netherlands
| | - Matti Heino
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Julia F Henrich
- Faculty of Social and Behavioural Sciences, Leiden University, Institute of Psychology, Unit of Health-, Medical- and Neuropsychology, Leiden, The Netherlands
| | - Liam Knox
- Sheffield Institute for Translational Neuroscience, The University of Sheffield, Sheffield, UK
| | - Laura M König
- Faculty of Life Sciences, University of Bayreuth, Bayreuth, Germany
| | - Wendy Maltinsky
- Faculty of Natural Sciences, Division of Psychology, University of Stirling, Stirling, UK
| | - Claire McCallum
- Centre for Digital Health and Care, Faculty of Engineering, University of Bristol, Bristol, UK
| | - Judith Nalukwago
- Center for Communication Programs, USAID-Social and Behavior Change Activity, Johns Hopkins University Bloomberg School of Public Health, Kampala, Uganda
| | - Efrat Neter
- Department of Behavioral Sciences, Ruppin Academic Center, Emeq Hefer, Israel
| | - Johanna Nurmi
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.,University of Cambridge, Behavioural Science Group, Primary Care Unit, Institute of Public Health, Forvie Site, Cambridge, UK
| | - Manuel Spitschan
- TUM Department of Sport and Health Sciences (TUM SG), Technical University of Munich, Munich, Germany and Translational Sensory and Circadian Neuroscience, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | | | - L Nynke Van der Laan
- Department of Communication and Cognition, Tilburg University, Tilburg, The Netherlands
| | - Kathrin Wunsch
- Karlsruhe Institute of Technology, Institute of Sports and Sports Science, Karlsruhe, Germany
| | - Jasper J J Levink
- Levink Life Sciences BV & Stichting Feniks Ontwikkelingsbegeleiding, Utrecht, The Netherlands
| | - Robbert Sanderman
- Department of Psychology, Health, and Technology, University of Twente, Enschede, the Netherlands.,Department of Health Psychology, University Medical Center Groningen University of Groningen, Groningen, The Netherlands
| |
Collapse
|
85
|
Sawrikar V, Mote K. Technology acceptance and trust: Overlooked considerations in young people's use of digital mental health interventions. HEALTH POLICY AND TECHNOLOGY 2022. [DOI: 10.1016/j.hlpt.2022.100686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
86
|
Costescu C, Podina IR, Voinescu A. Editorial: Digital mental health: Interventions and assessment. Front Psychol 2022; 13:1014527. [PMID: 36506981 PMCID: PMC9731277 DOI: 10.3389/fpsyg.2022.1014527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Cristina Costescu
- Department of Special Education, Babeş-Bolyai University, Cluj-Napoca, Romania,*Correspondence: Cristina Costescu
| | - Ioana R. Podina
- Laboratory of Cognitive Clinical Sciences, University of Bucharest, Bucharest, Romania,Department of Applied Psychology and Psychotherapy, University of Bucharest, Bucharest, Romania
| | | |
Collapse
|
87
|
Scherer J, Youssef Y, Dittrich F, Albrecht UV, Tsitsilonis S, Jung J, Pförringer D, Landgraeber S, Beck S, Back DA. Proposal of a New Rating Concept for Digital Health Applications in Orthopedics and Traumatology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14952. [PMID: 36429670 PMCID: PMC9690508 DOI: 10.3390/ijerph192214952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/29/2022] [Accepted: 11/11/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Health-related mobile applications (apps) are rapidly increasing in number. There is an urgent need for assessment tools and algorithms that allow the usability and content criteria of these applications to be objectively assessed. The aim of this work was to establish and validate a concept for orthopedic societies to rate health apps to set a quality standard for their safe use. METHODS An objective rating concept was created, consisting of nine quality criteria. A self-declaration sheet for app manufacturers was designed. Manufacturers completed the self-declaration, and the app was examined by independent internal reviewers. The pilot validation and analysis were performed on two independent health applications. An algorithm for orthopedic societies was created based on the experiences in this study flow. RESULTS "Sprunggelenks-App" was approved by the reviewers with 45 (98%) fulfilled criteria and one (2%) unfulfilled criterion. "Therapie-App" was approved, with 28 (61%) met criteria, 6 (13%) unfulfilled criteria and 12 (26%) criteria that could not be assessed. The self-declaration completed by the app manufacturer is recommended, followed by a legal and technical rating performed by an external institution. When rated positive, the societies' internal review using independent raters can be performed. In case of a positive rating, a visual certification can be granted to the manufacturer for a certain time frame. CONCLUSION An objective rating algorithm is proposed for the assessment of digital health applications. This can help societies to improve the quality assessment, quality assurance and patient safety of those apps. The proposed concept must be further validated for inter-rater consistency and reliability.
Collapse
Affiliation(s)
- Julian Scherer
- Department of Traumatology, University Hospital Zurich, Raemistr. 100, 8091 Zürich, Switzerland
| | - Yasmin Youssef
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Florian Dittrich
- Joint Centre Bergisch Land, Department for Orthopaedics, Sana Fabricius Clinic Remscheid, Brüderstraße 65, 42853 Remscheid, Germany
- Department of Orthopedics and Orthopedic Surgery, Universität des Saarlandes-Campus Homburg, Kirrberger Straße, 66421 Homburg, Germany
| | - Urs-Vito Albrecht
- Medizinische Fakultät OWL, AG 4-Digitale Medizin, Universität Bielefeld, 33501 Bielefeld, Germany
| | - Serafeim Tsitsilonis
- Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Augustenburger Pl. 1, 13353 Berlin, Germany
| | - Jochen Jung
- ATOS Klinik Heidelberg, Department of Orthopaedic Surgery, Bismarckstr. 9-15, 69115 Heidelberg, Germany
| | - Dominik Pförringer
- Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Clinic and Policlinic for Trauma Surgery, Ismaninger Str. 22, 81675 Munich, Germany
| | - Stefan Landgraeber
- Department of Orthopedics and Orthopedic Surgery, Universität des Saarlandes-Campus Homburg, Kirrberger Straße, 66421 Homburg, Germany
| | - Sascha Beck
- Clinic for Orthopaedics and Trauma Surgery, Sportsclinic Hellersen, Paulmannshöher Str. 17, 58515 Lüdenscheid, Germany
| | - David A. Back
- Bundeswehr Hospital Berlin, Department for Traumatology and Orthopedics, Scharnhorststr. 13, 10115 Berlin, Germany
| |
Collapse
|
88
|
Webb CA, Hirshberg MJ, Davidson RJ, Goldberg SB. Personalized Prediction of Response to Smartphone-Delivered Meditation Training: Randomized Controlled Trial. J Med Internet Res 2022; 24:e41566. [PMID: 36346668 PMCID: PMC9682449 DOI: 10.2196/41566] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/03/2022] [Accepted: 09/26/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Meditation apps have surged in popularity in recent years, with an increasing number of individuals turning to these apps to cope with stress, including during the COVID-19 pandemic. Meditation apps are the most commonly used mental health apps for depression and anxiety. However, little is known about who is well suited to these apps. OBJECTIVE This study aimed to develop and test a data-driven algorithm to predict which individuals are most likely to benefit from app-based meditation training. METHODS Using randomized controlled trial data comparing a 4-week meditation app (Healthy Minds Program [HMP]) with an assessment-only control condition in school system employees (n=662), we developed an algorithm to predict who is most likely to benefit from HMP. Baseline clinical and demographic characteristics were submitted to a machine learning model to develop a "Personalized Advantage Index" (PAI) reflecting an individual's expected reduction in distress (primary outcome) from HMP versus control. RESULTS A significant group × PAI interaction emerged (t658=3.30; P=.001), indicating that PAI scores moderated group differences in outcomes. A regression model that included repetitive negative thinking as the sole baseline predictor performed comparably well. Finally, we demonstrate the translation of a predictive model into personalized recommendations of expected benefit. CONCLUSIONS Overall, the results revealed the potential of a data-driven algorithm to inform which individuals are most likely to benefit from a meditation app. Such an algorithm could be used to objectively communicate expected benefits to individuals, allowing them to make more informed decisions about whether a meditation app is appropriate for them. TRIAL REGISTRATION ClinicalTrials.gov NCT04426318; https://clinicaltrials.gov/ct2/show/NCT04426318.
Collapse
Affiliation(s)
- Christian A Webb
- Harvard Medical School, Boston, MA, United States
- McLean Hospital, Belmont, MA, United States
| | - Matthew J Hirshberg
- Center for Healthy Minds, University of Wisconsin - Madison, Madison, WI, United States
| | - Richard J Davidson
- Center for Healthy Minds, University of Wisconsin - Madison, Madison, WI, United States
- Department of Psychology, University of Wisconsin - Madison, Madison, WI, United States
- Department of Psychiatry, University of Wisconsin - Madison, Madison, WI, United States
| | - Simon B Goldberg
- Center for Healthy Minds, University of Wisconsin - Madison, Madison, WI, United States
- Department of Counseling Psychology, University of Wisconsin - Madison, Madison, WI, United States
| |
Collapse
|
89
|
McLean C, Davis CA, Miller M, Ruzek J, Neri E. The Effects of an Exposure-Based Mobile App on Symptoms of Posttraumatic Stress Disorder in Veterans: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2022; 10:e38951. [PMID: 36331540 PMCID: PMC9675013 DOI: 10.2196/38951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/09/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Barriers to accessing in-person care can prevent veterans with posttraumatic stress disorder (PTSD) from receiving trauma-focused treatments such as exposure therapy. Mobile apps may help to address unmet need for services by offering tools for users to self-manage PTSD symptoms. Renew is a mobile mental health app that focuses on exposure therapy and incorporates a social support function designed to promote user engagement. OBJECTIVE We examined the preliminary efficacy of Renew with and without support from a research staff member compared with waitlist among 93 veterans with clinically significant PTSD symptoms. We also examined the impact of study staff support on participant engagement with the app. METHODS In a pilot randomized controlled trial, we compared Renew with and without support from a research staff member (active use condition) with waitlist (delayed use condition) over 6 weeks. Participants were recruited through online advertisements. The Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) was used to measure PTSD symptoms at pre, post, and 6-week follow-up. Usage data were collected to assess engagement with Renew. RESULTS Results indicated a small effect size (d=-0.39) favoring those in the active use conditions relative to the delayed use condition, but the between-group difference was not significant (P=.29). There were no differences on indices of app engagement between the 2 active use conditions. Exploratory analyses found that the number of support persons users added to the app, but not the number of support messages received, was positively correlated with app engagement. CONCLUSIONS Findings suggest Renew may hold promise as a self-management tool to reduce PTSD symptoms in veterans. Involving friends and family in mobile mental health apps may help bolster engagement with no additional cost to public health systems. TRIAL REGISTRATION ClinicalTrials.gov NCT04155736; https://clinicaltrials.gov/ct2/show/NCT04155736.
Collapse
Affiliation(s)
- Carmen McLean
- National Center for Posttraumatic Stress Disorder, Dissemination and Training Division, Department of Veterans Affairs, Menlo Park, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
| | - C Adrian Davis
- National Center for Posttraumatic Stress Disorder, Dissemination and Training Division, Department of Veterans Affairs, Menlo Park, CA, United States
| | - Madeleine Miller
- National Center for Posttraumatic Stress Disorder, Dissemination and Training Division, Department of Veterans Affairs, Menlo Park, CA, United States
| | - Josef Ruzek
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
- Department of Psychology, University of Colorado, Colorado Springs, CO, United States
| | - Eric Neri
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
| |
Collapse
|
90
|
Linardon J, Westrupp EM, Macdonald JA, Mikocka-Walus A, Stokes MA, Greenwood CJ, Youssef GJ, Teague S, Hutchinson D, Sciberras E, Fuller-Tyszkiewicz M. Monitoring Australian parents' shifting receptiveness to digital mental health interventions during the COVID-19 pandemic. Aust N Z J Psychiatry 2022; 56:1503-1514. [PMID: 34963330 DOI: 10.1177/00048674211065985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Nascent evidence indicates that the mental health of parents and children has markedly declined during the COVID-19 pandemic. Considering disruptions to traditional face-to-face mental health services resultant from stay-at-home orders, the potential value of digital mental health interventions has become extremely apparent. Despite this, uptake of digital interventions remains poor, indicating that a better understanding is needed of factors that determine a willingness to use digital platforms. METHOD The present multi-wave, longitudinal study of 2365 Australian parents explored between-person and within-person predictors of intentions to use digital interventions during the pandemic. RESULTS More than one-third of parents reported likely use of a self-guided and therapist-guided digital intervention, with the most endorsed reason for use being to support their child's mental health. Between-person baseline predictors of higher intention ratings were parent's prior mental illness, not living with a partner and recent environmental stressors. Within-person predictors of higher intention ratings were endorsement of mindful parenting strategies, child access to the Internet, better perceived management of child's education, lower social support and financial hardship. CONCLUSION Findings demonstrate that willingness to engage in digital interventions fluctuates in response to changing circumstances. Identifying novel ways to increase acceptance and uptake of digital interventions based on modifiable predictors established here is needed to realize the full potential of these modes of care in times of need.
Collapse
Affiliation(s)
- Jake Linardon
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Elizabeth M Westrupp
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia
| | - Jacqui A Macdonald
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne Royal Children's Hospital, Melbourne, VIC, Australia
| | - Antonina Mikocka-Walus
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Mark A Stokes
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Christopher J Greenwood
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
| | - George J Youssef
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Samantha Teague
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Delyse Hutchinson
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne Royal Children's Hospital, Melbourne, VIC, Australia
- The National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Emma Sciberras
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne Royal Children's Hospital, Melbourne, VIC, Australia
| | - Matthew Fuller-Tyszkiewicz
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
| |
Collapse
|
91
|
Beard C, Beckham E, Solomon A, Fenley AR, Pincus DB. A Pilot Feasibility Open Trial of an Interpretation Bias Intervention for Parents of Anxious Children. COGNITIVE AND BEHAVIORAL PRACTICE 2022; 29:860-873. [PMID: 36506843 PMCID: PMC9731147 DOI: 10.1016/j.cbpra.2021.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Interpretation bias is a transdiagnostic mechanism underlying anxiety. Theoretical models highlight the role of parental interpretation bias in predicting and maintaining child anxiety. However, very few studies have examined parent interpretation bias as a treatment target. The current pilot study tested the feasibility and acceptability of an interpretation bias intervention delivered by a smartphone app, called HabitWorks, in parents of anxious children who self-reported at least mild symptoms of anxiety and negative interpretation bias. Parents of anxious youth (ages 8 to 16) were recruited from the waitlists of three child anxiety clinics. They were asked to complete interpretation modification exercises via the HabitWorks app 3 times per week for 1 month. Participants completed assessments at pre- and post-intervention and 1-month follow-up to assess changes in interpretation bias, anxiety symptoms, and overall perceptions of HabitWorks. Participants (N=14) (Mage=44.36; 14.29% men, 85.71% women) completed an average of 13.29 exercises out of the 12 prescribed. Acceptability ratings were high. Interpretation bias, as measured by an assessment version of the intervention exercise, significantly improved from pre- to posttreatment, and these improvements were maintained at the 1-month follow-up. Anxiety symptoms significantly improved from the "mild" severity range to the "none to minimal" range. In this pilot feasibility study in parents of anxious youth, HabitWorks was a feasible and acceptable low-intensity intervention. These preliminary results support a future controlled trial of HabitWorks for parents. Future studies are also needed to test whether targeting interpretation bias in parents has downstream effects on maladaptive parent behaviors and ultimately, child interpretation bias and anxiety.
Collapse
Affiliation(s)
| | | | | | - Alicia R Fenley
- Center for Anxiety and Related Disorders at Boston University
| | - Donna B Pincus
- Center for Anxiety and Related Disorders at Boston University
| |
Collapse
|
92
|
Jarman HK, McLean SA, Rodgers R, Fuller-Tyszkiewicz M, Paxton S, O'Gorman B, Harris E, Shatte A, Bishop K, Baumann T, Mahoney D, Daugelat MC, Yager Z. Informing mHealth and Web-Based Eating Disorder Interventions: Combining Lived Experience Perspectives With Design Thinking Approaches. JMIR Form Res 2022; 6:e38387. [PMID: 36315225 PMCID: PMC9664336 DOI: 10.2196/38387] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/05/2022] [Accepted: 08/19/2022] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND App-based interventions designed to prevent and treat eating disorders have considerable potential to overcome known barriers to treatment seeking. Existing apps have shown efficacy in terms of symptom reduction; however, uptake and retention issues are common. To ensure that apps meet the needs and preferences of those for whom they were designed, it is critical to understand the lived experience of potential users and involve them in the process of design, development, and delivery. However, few app-based interventions are pretested on and co-designed with end users before randomized controlled trials. OBJECTIVE To address the issue, this study used a highly novel design thinking approach to provide the context and a lived experience perspective of the end user, thus allowing for a deeper level of understanding. METHODS In total, 7 young women (mean age 25.83, SD 5.34, range 21-33 years) who self-identified as having a history of body image issues or eating disorders were recruited. Participants were interviewed about their lived experience of body image and eating disorders and reported their needs and preferences for app-based eating disorder interventions. Traditional (thematic analysis) and novel (empathy mapping; visually depicting and empathizing with the user's personal experience) analyses were performed, providing a lived experience perspective of eating disorders and identifying the needs and preferences of this population in relation to app-based interventions for eating disorders. Key challenges and opportunities for app-based eating disorder interventions were also identified. RESULTS Findings highlighted the importance of understanding and identifying problematic eating disorder symptoms for the user, helpful practices for recovery that identify personal values and goals, the role of social support in facilitating hope, and aspects of usability to promote continued engagement and recovery. CONCLUSIONS Practical guidance and recommendations are described for those developing app-based eating disorder interventions. These findings have the potential to inform practices to enhance participant uptake and retention in the context of app-based interventions for this population.
Collapse
Affiliation(s)
- Hannah K Jarman
- School of Psychology, Deakin University, Geelong, Australia
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Melbourne, Australia
| | - Siân A McLean
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Rachel Rodgers
- Applied Psychology Program for Eating and Appearance Research, Department of Applied Psychology, Northeastern University, Boston, MA, United States
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, Centre Hospitalier Regional Universitaire Montpellier, Montpellier, France
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Geelong, Australia
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Melbourne, Australia
| | - Susan Paxton
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Beth O'Gorman
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Emily Harris
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Adrian Shatte
- Department of Planning, Performance & Analytics, James Cook University, Townsville, Australia
| | - Katie Bishop
- School of Psychology, Deakin University, Geelong, Australia
| | - Tahlia Baumann
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Danielle Mahoney
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Melissa-Claire Daugelat
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
- Centre of Excellence for Eating Disorders, University of Tübingen, Tübingen, Germany
| | - Zali Yager
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| |
Collapse
|
93
|
McCue M, Blair C, Fehnert B, King J, Cormack F, Sarkey S, Eramo A, Kabir C, Khatib R, Kemp D. Mobile App to Enhance Patient Activation and Patient-Provider Communication in Major Depressive Disorder Management: Collaborative, Randomized Controlled Pilot Study. JMIR Form Res 2022; 6:e34923. [PMID: 36301599 PMCID: PMC9650572 DOI: 10.2196/34923] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Enhanced patient-provider engagement can improve patient health outcomes in chronic conditions, including major depressive disorder (MDD). OBJECTIVE We evaluated the impact of a digitally enabled care mobile app, Pathway, designed to improve MDD patient-provider engagement. Patients used a mobile interface to assess treatment progress and share this information with primary care providers (PCPs). METHODS In this 52-week, real-world effectiveness and feasibility study conducted in primary care clinics, 40 patients with MDD who were recently prescribed antidepressant monotherapy were randomized to use a mobile app with usual care (20/40, 50%) or usual care alone (20/40, 50%). Patients in the app arm engaged with the app daily for 18 weeks; a report was generated at 6-week intervals and shared with the PCPs to facilitate shared treatment decision-making discussions. The patients discontinued the app at week 18 and were followed through year 1. Coprimary outcome measures, assessed via research visits, included change from baseline in the 13-item Patient Activation Measure (PAM-13) and 7-item Patient-Provider Engagement Scale scores at week 18. Additional outcome measures included depression severity (9-item Patient Health Questionnaire [PHQ-9]) and cognitive symptoms (5-item Perceived Deficits Questionnaire-Depression). RESULTS All 37 patients (app arm: n=18, 49%; usual care arm: n=19, 51%) who completed the 18-week follow-up period (n=31, 84% female, mean age 36, SD 11.3 years) had moderate to moderately severe depression. Improvements in PAM-13 and PHQ-9 scores were observed in both arms. Increases in PAM-13 scores from baseline to 18 weeks were numerically greater in the app arm than in the usual care arm (mean 10.5, SD 13.2 vs mean 8.8, SD 9.4; P=.65). At 52 weeks, differences in PAM-13 scores from baseline demonstrated significantly greater improvements in the app arm than in the usual care arm (mean 20.2, SD 17.7 vs mean 1.6, SD 14.2; P=.04). Compared with baseline, PHQ-9 scores decreased in both the app arm and the usual care arm at 18 weeks (mean 7.8, SD 7.2 vs mean 7.0, SD 6.5; P=.73) and 52 weeks (mean 9.5, SD 4.0 vs mean 4.7, SD 6.0; P=.07). Improvements in 7-item Patient-Provider Engagement Scale and WHO-5 scores were observed in both arms at 18 weeks and were sustained through 52 weeks in the app arm. Improvements in WHO-5 scores at 52 weeks were significantly greater in the app arm than in the usual care arm (41.5 vs 20.0; P=.02). CONCLUSIONS Patients with MDD will engage with a mobile app designed to track treatment and disease progression. PCPs will use the data generated as part of their assessment to inform clinical care. The study results suggest that an app-enabled clinical care pathway may enhance patient activation and benefit MDD management. TRIAL REGISTRATION ClinicalTrials.gov NCT03242213; https://clinicaltrials.gov/ct2/show/NCT03242213.
Collapse
Affiliation(s)
- Maggie McCue
- Takeda Pharmaceuticals USA, Inc, Lexington, MA, United States
| | | | - Ben Fehnert
- Cognition Kit, Cambridge, United Kingdom
- Ctrl Group, London, United Kingdom
| | - James King
- Cognition Kit, Cambridge, United Kingdom
- Ctrl Group, London, United Kingdom
| | - Francesca Cormack
- Cognition Kit, Cambridge, United Kingdom
- Cambridge Cognition, Cambridge, United Kingdom
| | - Sara Sarkey
- Takeda Pharmaceuticals USA, Inc, Lexington, MA, United States
| | - Anna Eramo
- Lundbeck LLC, Deerfield, IL, United States
| | - Christopher Kabir
- Advocate Research Institute, Advocate Health Care, Downers Grove, IL, United States
| | - Rasha Khatib
- Advocate Research Institute, Advocate Health Care, Downers Grove, IL, United States
| | - David Kemp
- Advocate Aurora Health, Downers Grove, IL, United States
| |
Collapse
|
94
|
Digital Health Interventions in Depression Care-A Survey on Acceptance from the Perspective of Patients, Their Relatives and Health Professionals. Healthcare (Basel) 2022; 10:healthcare10102019. [PMID: 36292466 PMCID: PMC9602748 DOI: 10.3390/healthcare10102019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/27/2022] [Accepted: 10/11/2022] [Indexed: 11/04/2022] Open
Abstract
Digital health interventions may contribute to closing the treatment gap for depression by reaching large populations at relatively low costs. This article presents the results of a broad, multisided German survey in 2020 on the acceptance and use of digital health interventions in depression care from the perspective of patients, their relatives, and health professionals. A total of 97 patients and relatives and 229 health professionals participated. Survey participants reported openness towards the use of digital health interventions in depression care but little knowledge and experience in the field. Digital health interventions appear to be a promising opportunity for reducing depressive symptoms and shortening waiting time for depression treatment, especially in rural areas. Providing information and technical competencies may increase awareness and knowledge about digital health interventions and the benefits of depression care.
Collapse
|
95
|
Lo B, Pham Q, Sockalingam S, Wiljer D, Strudwick G. Identifying essential factors that influence user engagement with digital mental health tools in clinical care settings: Protocol for a Delphi study. Digit Health 2022; 8:20552076221129059. [PMID: 36249478 PMCID: PMC9558854 DOI: 10.1177/20552076221129059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/09/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Improving effective user engagement with digital mental health tools has
become a priority in enabling the value of digital health. With increased
interest from the mental health community in embedding digital health tools
as part of care delivery, there is a need to examine and identify the
essential factors in influencing user engagement with digital mental health
tools in clinical care. The current study will use a Delphi approach to gain
consensus from individuals with relevant experience and expertise (e.g.
patients, clinicians and healthcare administrators) on factors that
influence user engagement (i.e. an essential factor). Methods Participants will be invited to complete up to four rounds of online surveys.
The first round of the Delphi study comprises of reviewing existing factors
identified in literature and commenting on whether any factors they believe
are important are missing from the list. Subsequent rounds will involve
asking participants to rate the perceived impact of each factor in
influencing user engagement with digital mental health tools in clinical
care contexts. This work is expected to consolidate the perspectives from
relevant stakeholders and the academic literature to identify a core set of
factors considered essential in influencing user engagement with digital
mental health tools in clinical care contexts.
Collapse
Affiliation(s)
- Brian Lo
- Institute of Health Policy, Management and Evaluation,
University of
Toronto, Toronto, Ontario, Canada,Campbell Family Mental Health Research Institute,
Centre for
Addiction and Mental Health, Toronto,
Ontario, Canada,Office of Education, Centre for Addiction and Mental
Health, Toronto, Ontario, Canada,Information Management Group, Centre for Addiction and Mental
Health, Toronto, Ontario, Canada,UHN Digital, University Health
Network, Toronto, Ontario, Canada,Brian Lo, Institute of Health Policy,
Management and Evaluation, 155 College Street, 4th Floor, Toronto, ON M5T 1P8,
Canada.
| | - Quynh Pham
- Institute of Health Policy, Management and Evaluation,
University of
Toronto, Toronto, Ontario, Canada,Centre for Digital Therapeutics, University Health
Network, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- Office of Education, Centre for Addiction and Mental
Health, Toronto, Ontario, Canada,Department of Psychiatry, Temerty Faculty of Medicine,
University of
Toronto, Toronto, Ontario, Canada
| | - David Wiljer
- Institute of Health Policy, Management and Evaluation,
University of
Toronto, Toronto, Ontario, Canada,Office of Education, Centre for Addiction and Mental
Health, Toronto, Ontario, Canada,UHN Digital, University Health
Network, Toronto, Ontario, Canada,Department of Psychiatry, Temerty Faculty of Medicine,
University of
Toronto, Toronto, Ontario, Canada
| | - Gillian Strudwick
- Institute of Health Policy, Management and Evaluation,
University of
Toronto, Toronto, Ontario, Canada,Campbell Family Mental Health Research Institute,
Centre for
Addiction and Mental Health, Toronto,
Ontario, Canada,Information Management Group, Centre for Addiction and Mental
Health, Toronto, Ontario, Canada
| |
Collapse
|
96
|
Stein DJ, Shoptaw SJ, Vigo DV, Lund C, Cuijpers P, Bantjes J, Sartorius N, Maj M. Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration. World Psychiatry 2022; 21:393-414. [PMID: 36073709 PMCID: PMC9453916 DOI: 10.1002/wps.20998] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Psychiatry has always been characterized by a range of different models of and approaches to mental disorder, which have sometimes brought progress in clinical practice, but have often also been accompanied by critique from within and without the field. Psychiatric nosology has been a particular focus of debate in recent decades; successive editions of the DSM and ICD have strongly influenced both psychiatric practice and research, but have also led to assertions that psychiatry is in crisis, and to advocacy for entirely new paradigms for diagnosis and assessment. When thinking about etiology, many researchers currently refer to a biopsychosocial model, but this approach has received significant critique, being considered by some observers overly eclectic and vague. Despite the development of a range of evidence-based pharmacotherapies and psychotherapies, current evidence points to both a treatment gap and a research-practice gap in mental health. In this paper, after considering current clinical practice, we discuss some proposed novel perspectives that have recently achieved particular prominence and may significantly impact psychiatric practice and research in the future: clinical neuroscience and personalized pharmacotherapy; novel statistical approaches to psychiatric nosology, assessment and research; deinstitutionalization and community mental health care; the scale-up of evidence-based psychotherapy; digital phenotyping and digital therapies; and global mental health and task-sharing approaches. We consider the extent to which proposed transitions from current practices to novel approaches reflect hype or hope. Our review indicates that each of the novel perspectives contributes important insights that allow hope for the future, but also that each provides only a partial view, and that any promise of a paradigm shift for the field is not well grounded. We conclude that there have been crucial advances in psychiatric diagnosis and treatment in recent decades; that, despite this important progress, there is considerable need for further improvements in assessment and intervention; and that such improvements will likely not be achieved by any specific paradigm shifts in psychiatric practice and research, but rather by incremental progress and iterative integration.
Collapse
Affiliation(s)
- Dan J. Stein
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape TownCape TownSouth Africa
| | - Steven J. Shoptaw
- Division of Family MedicineDavid Geffen School of Medicine, University of California Los AngelesLos AngelesCAUSA
| | - Daniel V. Vigo
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Crick Lund
- Centre for Global Mental Health, Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental PsychologyAmsterdam Public Health Research Institute, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Jason Bantjes
- Alcohol, Tobacco and Other Drug Research UnitSouth African Medical Research CouncilCape TownSouth Africa
| | - Norman Sartorius
- Association for the Improvement of Mental Health ProgrammesGenevaSwitzerland
| | - Mario Maj
- Department of PsychiatryUniversity of Campania “L. Vanvitelli”NaplesItaly
| |
Collapse
|
97
|
Osma J, Martínez-García L, Prado-Abril J, Peris-Baquero Ó, González-Pérez A. Developing a smartphone App based on the Unified Protocol for the transdiagnostic treatment of emotional disorders: A qualitative analysis of users and professionals' perspectives. Internet Interv 2022; 30:100577. [PMID: 36213084 PMCID: PMC9535424 DOI: 10.1016/j.invent.2022.100577] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 09/05/2022] [Accepted: 09/27/2022] [Indexed: 12/01/2022] Open
Abstract
Emotional Disorders have become the most prevalent mental disorders in the world. In relation to their high prevalence, mental health care from public health services faces major challenges. Consequently, finding solutions to deliver cost-effective evidence-based treatments has become a main goal of today's clinical psychology. Smartphone apps for mental health have emerged as a potential tool to deal with it. However, despite their effectiveness and advantages, several studies suggest the need to involve patients and professionals in the design of these apps from the first stage of the development process. Thus, this study aimed to identify, from both a group of users and professionals, the needs, opinions, expectations and design aspects of a future smartphone app based in the Unified Protocol (UP), that will allow to develop the subsequent technical work of the app engineers. Two focus groups were conducted, one with 7 professionals and the other with 9 users, both groups familiar with the UP. A thematic content analysis based in grounded theory was performed in order to define emergent categories of analysis derived from the interview data. The results revealed 8 common topics in both focus groups and 5 specific key topics were identified in the professionals' focus group. Of the total proposals, 93 % of the professionals' and 78 % of the users' are implemented in the preliminary version of the app.
Collapse
Affiliation(s)
- Jorge Osma
- University of Zaragoza, Department of Psicology and Sociology, Faculty of Social and Human Sciences, C/Atarazanas, 4, 44003 Teruel, Spain
- Health Research Institute of Aragon, Biomedic Research Center of Aragon (CIBA), Av. San Juan Bosco, 13, 50009 Zaragoza, Spain
- Corresponding author at: Universidad de Zaragoza, Departamento de Psicología y Sociología, Facultad de Ciencias Sociales y Humanas, C/Atarazanas, 4, 44003 Teruel, Spain.
| | - Laura Martínez-García
- University of Zaragoza, Department of Psicology and Sociology, Faculty of Social and Human Sciences, C/Atarazanas, 4, 44003 Teruel, Spain
- Health Research Institute of Aragon, Biomedic Research Center of Aragon (CIBA), Av. San Juan Bosco, 13, 50009 Zaragoza, Spain
| | - Javier Prado-Abril
- Health Research Institute of Aragon, Biomedic Research Center of Aragon (CIBA), Av. San Juan Bosco, 13, 50009 Zaragoza, Spain
- Miguel Servet University Hospital, Zaragoza, Spain
| | - Óscar Peris-Baquero
- University of Zaragoza, Department of Psicology and Sociology, Faculty of Social and Human Sciences, C/Atarazanas, 4, 44003 Teruel, Spain
- Health Research Institute of Aragon, Biomedic Research Center of Aragon (CIBA), Av. San Juan Bosco, 13, 50009 Zaragoza, Spain
| | - Alberto González-Pérez
- Institute of New Imaging Technologies, Universitat Jaume I, Av. Vicente Sos Baynat s/n, 12071 Castellón, Spain
| |
Collapse
|
98
|
Toyama M, Cavero V, Araya R, Menezes PR, Mohr DC, Miranda JJ, Diez-Canseco F. Participants’ and Nurses’ Experiences With a Digital Intervention for Patients With Depressive Symptoms and Comorbid Hypertension or Diabetes in Peru: Qualitative Post–Randomized Controlled Trial Study. JMIR Hum Factors 2022; 9:e35486. [PMID: 36107482 PMCID: PMC9523528 DOI: 10.2196/35486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 07/08/2022] [Accepted: 07/18/2022] [Indexed: 11/24/2022] Open
Abstract
Background Depression is one of the most prevalent mental disorders and a leading cause of disability, disproportionately affecting specific groups, such as patients with noncommunicable diseases. Over the past decade, digital interventions have been developed to provide treatment for these patients. CONEMO (Emotional Control in Spanish) is an 18-session psychoeducational digital intervention delivered through a smartphone app and minimally supported by a nurse. CONEMO demonstrated effectiveness in reducing depressive symptoms through a randomized controlled trial (RCT) among patients with diabetes, hypertension, or both, in Lima, Peru. However, in addition to clinical outcomes, it is important to explore users’ experiences, satisfaction, and perceptions of usability and acceptability, which can affect their engagement with the intervention. Objective This study aimed to explore the RCT participants’ experiences with CONEMO in Peru, complemented with information provided by the nurses who monitored them. Methods In 2018, semistructured interviews were conducted with a sample of 29 (13.4%) patients from the 217 patients who participated in the CONEMO intervention in Peru and the 3 hired nurses who supported its delivery. Interviewees were selected at random based on their adherence to the digital intervention (0-5, 10-14, and 15-18 sessions completed), to include different points of view. Content analysis was conducted to analyze the interviews. Results Participants’ mean age was 64.4 (SD 8.5) years, and 79% (23/29) of them were women. Most of the interviewed participants (21/29, 72%) stated that CONEMO fulfilled their expectations and identified positive changes in their physical and mental health after using it. Some of these improvements were related to their thoughts and feelings (eg, think differently, be more optimistic, and feel calmer), whereas others were related to their routines (eg, go out more and improve health-related habits). Most participants (19/29, 66%) reported not having previous experience with using smartphones, and despite experiencing some initial difficulties, they managed to use CONEMO. The most valued features of the app were the videos and activities proposed for the participant to perform. Most participants (27/29, 93%) had a good opinion about the study nurses and reported feeling supported by them. A few participants provided suggestions to improve the intervention, which included adding more videos, making the sessions’ text simple, extending the length of the intervention, and improving the training session with long explanations. Conclusions The findings of this qualitative study provide further support and contextualize the positive results found in the CONEMO RCT, including insights into the key features that made the intervention effective and engaging. The participants’ experience with the smartphone and CONEMO app reveal that it is feasible to be used by people with little knowledge of technology. In addition, the study identified suggestions to improve the CONEMO intervention for its future scale-up. Trial Registration ClinicalTrials.gov NCT03026426; https://clinicaltrials.gov/ct2/show/NCT03026426
Collapse
Affiliation(s)
- Mauricio Toyama
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Victoria Cavero
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ricardo Araya
- Centre for Global Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Paulo Rossi Menezes
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
- Department of Preventive Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| |
Collapse
|
99
|
A systematic review of digital and face-to-face cognitive behavioral therapy for depression. NPJ Digit Med 2022; 5:144. [PMID: 36109583 PMCID: PMC9476400 DOI: 10.1038/s41746-022-00677-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/12/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractCognitive behavioral therapy (CBT) represents one of the major treatment options for depressive disorders besides pharmacological interventions. While newly developed digital CBT approaches hold important advantages due to higher accessibility, their relative effectiveness compared to traditional CBT remains unclear. We conducted a systematic literature search to identify all studies that conducted a CBT-based intervention (face-to-face or digital) in patients with major depression. Random-effects meta-analytic models of the standardized mean change using raw score standardization (SMCR) were computed. In 106 studies including n = 11854 patients face-to-face CBT shows superior clinical effectiveness compared to digital CBT when investigating depressive symptoms (p < 0.001, face-to-face CBT: SMCR = 1.97, 95%-CI: 1.74–2.13, digital CBT: SMCR = 1.20, 95%-CI: 1.08–1.32) and adherence (p = 0.014, face-to-face CBT: 82.4%, digital CBT: 72.9%). However, after accounting for differences between face-to-face and digital CBT studies, both approaches indicate similar effectiveness. Important variables with significant moderation effects include duration of the intervention, baseline severity, adherence and the level of human guidance in digital CBT interventions. After accounting for potential confounders our analysis indicates comparable effectiveness of face-to-face and digital CBT approaches. These findings underline the importance of moderators of clinical effects and provide a basis for the future personalization of CBT treatment in depression.
Collapse
|
100
|
Garbett KM, Haywood S, Craddock N, Gentili C, Nasution K, Saraswati LA, Medise BE, White P, Diedrichs PC, Williamson H. Evaluating the Efficacy of a Social Media-Based Intervention (Warna-Warni Waktu) to Improve Body Image Among Young Indonesian Women: Parallel Randomized Controlled Trial (Preprint). J Med Internet Res 2022; 25:e42499. [PMID: 37010911 PMCID: PMC10131926 DOI: 10.2196/42499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/09/2022] [Accepted: 01/12/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Body dissatisfaction is a global issue, particularly among adolescent girls and young women. Effective body image interventions exist but face barriers to scaling up, particularly in lower- and middle-income countries, such as Indonesia, where a need exists. OBJECTIVE We aimed to evaluate the acceptability and efficacy of Warna-Warni Waktu, a social media-based, fictional 6-episode video series with self-guided web-based activities for improving body image among young Indonesian adolescent girls and young women. We hypothesized that Warna-Warni Waktu would increase trait body satisfaction and mood and decrease internalization of appearance ideals and skin shade dissatisfaction relative to the waitlist control condition. We also anticipated improvements in state body satisfaction and mood immediately following each video. METHODS We conducted a web-based, 2-arm randomized controlled trial among 2000 adolescent girls and young women, aged 15 to 19 years, recruited via telephone by an Indonesian research agency. Block randomization (1:1 allocation) was performed. Participants and researchers were not concealed from the randomized arm. Participants completed self-report assessments of trait body satisfaction (primary outcome) and the internalization of appearance ideals, mood, and skin shade dissatisfaction at baseline (before randomization), time 2 (1 day after the intervention [T2]), and time 3 (1 month after the intervention [T3]). Participants also completed state body satisfaction and mood measures immediately before and after each video. Data were evaluated using linear mixed models with an intent-to-treat analysis. Intervention adherence was tracked. Acceptability data were collected. RESULTS There were 1847 participants. Relative to the control condition (n=923), the intervention group (n=924) showed reduced internalization of appearance ideals at T2 (F1,1758=40.56, P<.001, partial η2=0.022) and T3 (F1,1782=54.03, P<.001, partial η2=0.03) and reduced skin shade dissatisfaction at T2 (F1,1744=8.05, P=.005, partial η2=0.005). Trait body satisfaction improvements occurred in the intervention group at T3 (F1, 1781=9.02, P=.005, partial η2=0.005), which was completely mediated by the internalization change scores between baseline and T2 (indirect effect: β=.03, 95% CI 0.017-0.041; direct effect: β=.03, P=.13), consistent with the Tripartite Influence Model of body dissatisfaction. Trait mood showed no significant effects. Dependent sample t tests (2-tailed) found each video improved state body satisfaction and mood. Cumulative analyses found significant and progressive improvements in pre- and poststate body satisfaction and mood. Intervention adherence was good; participants watched an average of 5.2 (SD 1.66) videos. Acceptability scores were high for understandability, enjoyment, age appropriateness, usefulness, and likelihood to recommend. CONCLUSIONS Warna-Warni Waktu is an effective eHealth intervention to reduce body dissatisfaction among Indonesian adolescent girls and young women. Although the effects were small, Warna-Warni Waktu is a scalable, cost-effective alternative to more intense interventions. Initially, dissemination through paid social media advertising will reach thousands of young Indonesian women. TRIAL REGISTRATION ClinicalTrials.gov NCT05383807, https://clinicaltrials.gov/ct2/show/NCT05383807 ; ISRCTN Registry ISRCTN35483207, https://www.isrctn.com/ISRCTN35483207. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/33596.
Collapse
Affiliation(s)
- Kirsty M Garbett
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Sharon Haywood
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Nadia Craddock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Caterina Gentili
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | | | - L Ayu Saraswati
- Department of Women, Gender, and Sexuality Studies, University of Hawai'i at Mānoa, Honolulu, HI, United States
| | | | - Paul White
- Faculty of Environment and Technology, University of the West of England, Bristol, United Kingdom
| | - Phillippa C Diedrichs
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Heidi Williamson
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| |
Collapse
|