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Lustgarten SD, Garrison YL, Sinnard MT, Flynn AW. Digital privacy in mental healthcare: current issues and recommendations for technology use. Curr Opin Psychol 2020; 36:25-31. [PMID: 32361651 PMCID: PMC7195295 DOI: 10.1016/j.copsyc.2020.03.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 11/26/2022]
Abstract
Mental healthcare providers increasingly use technology for psychotherapy services. This progress enables professionals to communicate, store information, and rely on digital software and hardware. Emails, text messaging, telepsychology/telemental health therapy, electronic medical records, cloud-based storage, apps/applications, and assessments are now available within the provision of services. Of those mentioned, some are directly utilized for psychotherapy while others indirectly aid providers. Whereas professionals previously wrote notes locally, technology has empowered providers to work more efficiently with third-party services and solutions. However, the implementation of these advancements in mental healthcare involves consequences to digital privacy and might increase clients' risk of unintended breaches of confidentiality. This manuscript reviews common technologies, considers the vulnerabilities therein, and proposes suggestions to strengthen privacy.
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Affiliation(s)
- Samuel D Lustgarten
- Department of Counseling Psychology, University of Wisconsin-Madison, United States.
| | - Yunkyoung L Garrison
- Department of Psychological and Quantitative Foundations, University of Iowa, Iowa City, United States; Colorado State University Health Network, Fort Collins, United States
| | - Morgan T Sinnard
- Department of Counseling Psychology, University of Wisconsin-Madison, United States
| | - Anthony Wp Flynn
- Department of Counseling Psychology, University of Wisconsin-Madison, United States
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252
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Böhm AK, Jensen ML, Sørensen MR, Stargardt T. Real-World Evidence of User Engagement With Mobile Health for Diabetes Management: Longitudinal Observational Study. JMIR Mhealth Uhealth 2020; 8:e22212. [PMID: 32975198 PMCID: PMC7679206 DOI: 10.2196/22212] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 12/22/2022] Open
Abstract
Background Patient support apps have risen in popularity and provide novel opportunities for self-management of diabetes. Such apps offer patients to play an active role in monitoring their condition, thereby increasing their own treatment responsibility. Although many health apps require active user engagement to be effective, there is little evidence exploring engagement with mobile health (mHealth). Objective This study aims to analyze the extent to which users engage with mHealth for diabetes and identify patient characteristics that are associated with engagement. Methods The analysis is based on real-world data obtained by Novo Nordisk’s Cornerstones4Care Powered by Glooko diabetes support app. User engagement was assessed as the number of active days and using measures expressing the persistence, longevity, and regularity of interaction within the first 180 days of use. Beta regressions were estimated to assess the associations between user characteristics and engagement outcomes for each module of the app. Results A total of 9051 individuals initiated use after registration and could be observed for 180 days. Among these, 55.39% (5013/9051) used the app for one specific purpose. The average user activity ratio varied from 0.05 (medication and food) to 0.55 (continuous glucose monitoring), depending on the module of the app. Average user engagement was lower if modules required manual data entries, although the initial uptake was higher for these modules. Regression analyses further revealed that although more women used the app (2075/3649, 56.86%), they engaged significantly less with it. Older people and users who were recently diagnosed tended to use the app more actively. Conclusions Strategies to increase or sustain the use of apps and availability of health data may target the mode of data collection and content design and should take into account privacy concerns of the users at the same time. Users’ engagement was determined by various user characteristics, indicating that particular patient groups should be targeted or assisted when integrating apps into the self-management of their disease.
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Affiliation(s)
- Anna-Katharina Böhm
- Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany
| | | | | | - Tom Stargardt
- Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany
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253
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Powell A, Torous J. A Patient-Centered Framework for Measuring the Economic Value of the Clinical Benefits of Digital Health Apps: Theoretical Modeling. JMIR Ment Health 2020; 7:e18812. [PMID: 33124995 PMCID: PMC7665948 DOI: 10.2196/18812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND As digital health tools such as smartphone apps evolve and enter clinical use, questions regarding their value must be addressed. Although there are scarce generalizable data on the value of health apps given their nascency and diverse use cases, it is possible to estimate the economic value of the clinical improvement they bring to patients using a quality-adjusted life-year (QALY)-based approach and generalized values from existing literature. OBJECTIVE This paper aims to provide a patient-centered framework for assessing the economic value of the clinical benefits delivered by digital health apps. METHODS We proposed a model based upon 5 levers: country-specific monetary value of a QALY, QALYs lost due to the condition, engagement rate of app users, average effect size of the app's health impact, and duration of the app's impact before remission. RESULTS Using 2 digital health apps from the United States and United Kingdom as examples, we explored how this model could generate country-specific estimates of the economic value of the clinical benefits of health apps. CONCLUSIONS This new framework can help drive research priorities for digital health by elucidating the factors that influence the economic value.
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Affiliation(s)
- Adam Powell
- Payer+Provider Syndicate, Boston, MA, United States
| | - John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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254
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Abstract
E-health offers great potential in the field of traumatic stress to deliver training, assessment, prevention, and treatment of adverse outcomes after trauma worldwide. In order to encourage research on E-health applications in the field of traumatic stress, this current special issue of the European Journal of Psychotraumatology presents a series of papers divided into three emergent topics: I) development of digital interventions, II) the use of digital interventions to foster self-management and deliver therapy, and III) digital methods to improve prediction, assessment, and monitoring of post-trauma outcomes. These studies show acceptance of the tools by various end-user groups and improvements of current research and clinical practices, but also areas for improvement regarding the development process and making even better use of technological capabilities of E-Health. We propose three general themes to accelerate the quality of e-Health interventions and studies in this area in the coming years: optimizing user engagement and adherence, conducting more (innovative) research, and increasing implementation and dissemination activities. This issue appears in the midst of the COVID-19 pandemic. It is exactly at times like these that we need effective online interventions and we see an enormous increase in the use of e-Health. We hope this issue will contribute to help those affected and to serve the community worldwide.
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Affiliation(s)
- Anne Bakker
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Heleen Riper
- Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam (VU), Amsterdam, the Netherlands
| | - Miranda Olff
- Department of Psychiatry, Amsterdam Neuroscience Research Institute & Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,ARQ National Psychotrauma Centre, Diemen, the Netherlands
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255
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Stenzel L, Röcken M, Thrien H, Stoll O. Blended Learning zur Betreuung der deutschen männlichen U19 Handballnationalmannschaft bei der WM 2019. ZEITSCHRIFT FUR SPORTPSYCHOLOGIE 2020. [DOI: 10.1026/1612-5010/a000315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Zusammenfassung. Die vorliegende Fallstudie beschreibt detailliert und ganzheitlich das App-basierte mentale Training (MT) der deutschen männlichen U19 Handballnationalmannschaft vor und während der Weltmeisterschaft 2019 in Mazedonien. Die Betreuung folgte einem Blended Learning Ansatz und bestand aus einem dreistündigen psychoedukativen Präsenzworkshop, einer App und einer begleitenden E-Mail-Kampagne. Die Eingangsdiagnostik, das Grundlagen- und Fertigkeitstraining sowie die Krisenintervention fanden über die auf das MT zugeschnittene App statt. Die Fallstudie enthält eine Outcome- und Prozess-Evaluation. Das Team gewann in Mazedonien die Silbermedaille. In anderen Outcome-Variablen zeigten sich keine signifikanten Veränderungen. Die Prozess-Evaluation zeigt, dass die Nutzungszeit mit der App gering war. In der Praxis arbeitende Sportpsychologinnen und Sportpsychologen sollten daher die Nutzung von Apps mit ausreichend persönlichem Kontakt mit Athletinnen und Athleten verbinden, um diese systematisch zu betreuen.
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Affiliation(s)
- Lukas Stenzel
- Martin-Luther-Universität Halle-Wittenberg, Deutschland
| | | | | | - Oliver Stoll
- Martin-Luther-Universität Halle-Wittenberg, Deutschland
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256
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Leveraging Implementation Science to Understand Factors Influencing Sustained Use of Mental Health Apps: a Narrative Review. ACTA ACUST UNITED AC 2020; 6:184-196. [PMID: 32923580 PMCID: PMC7476675 DOI: 10.1007/s41347-020-00165-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/10/2020] [Accepted: 08/31/2020] [Indexed: 12/11/2022]
Abstract
Mental health (MH) smartphone applications (apps), which can aid in self-management of conditions such as depression and anxiety, have demonstrated dramatic growth over the past decade. However, their effectiveness and potential for sustained use remain uncertain. This narrative review leverages implementation science theory to explore factors influencing MH app uptake. The review is guided by the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and discusses the role of the innovation, its recipients, context, and facilitation in influencing successful implementation of MH apps. The review highlights critical literature published between 2015 and 2020 with a focus on depression and anxiety apps. Sources were identified via PubMed, Google Scholar, and Twitter using a range of keywords pertaining to MH apps. Findings suggest that for apps to be successful, they must be advantageous over alternative tools, relatively easy to navigate, and aligned with users’ needs, skills, and resources. Significantly more attention must be paid to the complex contexts in which MH app implementation is occurring in order to refine facilitation strategies. The evidence base is still uncertain regarding the effectiveness and usability of MH apps, and much can be learned from the apps we use daily; namely, simpler is better and plans to integrate full behavioral treatments into smartphone form may be misguided. Non-traditional funding mechanisms that are nimble, responsive, and encouraging of industry partnerships will be necessary to move the course of MH app development in the right direction.
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257
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Deady M, Glozier N, Collins D, Einboden R, Lavender I, Wray A, Gayed A, Calvo RA, Christensen H, Harvey SB, Choi I. The Utility of a Mental Health App in Apprentice Workers: A Pilot Study. Front Public Health 2020; 8:389. [PMID: 33014953 PMCID: PMC7498639 DOI: 10.3389/fpubh.2020.00389] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/02/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Young people are at heightened risk for mental health problems. Apprenticeships are common pathways into the workforce at a critical developmental period. However, in some cases the working conditions for apprentices present significant challenges to mental wellness. As apprentices are unlikely to utilize traditional services, eHealth and mHealth interventions are a useful means of delivering interventions to this group. The aim of the current paper is to: (1) qualitatively explore the utility of an existing mental health app within an apprentice population; and (2) evaluate the usability, acceptability, feasibility and preliminary efficacy of a modified version of the app (HeadGear Apprentice), designed to reduce depressive symptoms in an apprentice working population. Methods: Study One: Twenty-six apprentices (aged 18–30) took part in one of eight (90-min) focus groups. Participants explored the HeadGear app, took part in group discussions, and completed uMARS questionnaires. Modifications were made to the app based on feedback. Study Two: In the follow-up pilot testing, 47 apprentices downloaded and used the modified app over 30 days. Assessment occurred online at baseline, 5-weeks, and 3-months post-baseline. Feasibility was evaluated using consent rates, adherence and attrition. Acceptability was assessed using questionnaires and a post-study interview. Depression, anxiety, well-being, and work performance scores were used to assess preliminary efficacy. Results: Overall, the app was well-received in both studies, with high self-reported scores for acceptability and utility. However, engagement—both in terms of self-report and adherence—was an issue in both studies. In Study Two, users completed approximately one-third of the app's therapeutic content, with increased usage associated with improved outcomes. This had implications for the preliminary effectiveness of the app [depression as measured by the PHQ-9 Cohen's d = 0.27 (95%CI:-0.16–0.69)]. At follow-up users reported improvements in all outcomes, but overall only change in well-being reached statistical significance [Cohen's d = −0.29 (95%CI:-0.72–0.14)]. Conclusion: Overall, findings from the two studies suggest that an eHealth tool, HeadGear Apprentice, was an acceptable and well-received intervention when adapted to young apprentices. However, questions remain regarding how to improve engagement and adherence to the program. These questions appear critical to effectiveness. The two studies also have implications for awareness raising in this population. Whilst preliminary results were encouraging, these improvements, along with a full-scale efficacy trial, are needed to better understand the utility of smartphone applications for mental health in this population. Trial registration: ACTRN12618001475235 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375875&isReview=true.
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Affiliation(s)
- Mark Deady
- Faculty of Medicine, Black Dog Institute, UNSW, Sydney, NSW, Australia
| | - Nicholas Glozier
- Faculty of Medicine and Health, Brain and Mind Centre, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Daniel Collins
- Faculty of Medicine, Black Dog Institute, UNSW, Sydney, NSW, Australia
| | - Rochelle Einboden
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
| | - Isobel Lavender
- Faculty of Medicine, Black Dog Institute, UNSW, Sydney, NSW, Australia
| | - Alexis Wray
- SafeWork NSW, Sydney, NSW, Australia.,WorkSafe ACT, Canberra, ACT, Australia
| | - Aimee Gayed
- Faculty of Medicine, Black Dog Institute, UNSW, Sydney, NSW, Australia
| | - Rafael A Calvo
- Dyson School of Design Engineering, Imperial College London, London, United Kingdom
| | - Helen Christensen
- Faculty of Medicine, Black Dog Institute, UNSW, Sydney, NSW, Australia
| | - Samuel B Harvey
- Faculty of Medicine, Black Dog Institute, UNSW, Sydney, NSW, Australia
| | - Isabella Choi
- Faculty of Medicine and Health, Brain and Mind Centre, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
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258
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Gamification as an approach to improve resilience and reduce attrition in mobile mental health interventions: A randomized controlled trial. PLoS One 2020; 15:e0237220. [PMID: 32877425 PMCID: PMC7467300 DOI: 10.1371/journal.pone.0237220] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 07/20/2020] [Indexed: 01/17/2023] Open
Abstract
Forty percent of all general-practitioner appointments are related to mental illness, although less than 35% of individuals have access to therapy and psychological care, indicating a pressing need for accessible and affordable therapy tools. The ubiquity of smartphones offers a delivery platform for such tools. Previous research suggests that gamification-turning intervention content into a game format-could increase engagement with prevention and early-stage mobile interventions. This study aimed to explore the effects of a gamified mobile mental health intervention on improvements in resilience, in comparison with active and inactive control conditions. Differences between conditions on changes in personal growth, anxiety and psychological wellbeing, as well as differences in attrition rates, were also assessed. The eQuoo app was developed and published on all leading mobile platforms. The app educates users about psychological concepts including emotional bids, generalization, and reciprocity through psychoeducation, storytelling, and gamification. In total, 358 participants completed in a 5-week, 3-armed (eQuoo, "treatment as usual" cognitive behavioral therapy journal app, no-intervention waitlist) randomized controlled trial. Relevant scales were administered to all participants on days 1, 17, and 35. Repeated-measures ANOVA revealed statistically significant increases in resilience in the test group compared with both control groups over 5 weeks. The app also significantly increased personal growth, positive relations with others, and anxiety. With 90% adherence, eQuoo retained 21% more participants than the control or waitlist groups. Intervention delivered via eQuoo significantly raised mental well-being and decreased self-reported anxiety while enhancing adherence in comparison with the control conditions. Mobile apps using gamification can be a valuable and effective platform for well-being and mental health interventions and may enhance motivation and reduce attrition. Future research should measure eQuoo's effect on anxiety with a more sensitive tool and examine the impact of eQuoo on a clinical population.
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259
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Bell L, Garnett C, Qian T, Perski O, Potts HWW, Williamson E. Notifications to Improve Engagement With an Alcohol Reduction App: Protocol for a Micro-Randomized Trial. JMIR Res Protoc 2020; 9:e18690. [PMID: 32763878 PMCID: PMC7442945 DOI: 10.2196/18690] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/13/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Drink Less is a behavior change app that aims to help users in the general adult population reduce hazardous and harmful alcohol consumption. The app includes a daily push notification, delivered at 11 am, asking users to "Please complete your mood and drinking diaries." Previous analysis of Drink Less engagement data suggests the current notification strongly influences how users engage with the app in the subsequent hour. To exploit a potential increase of vulnerability of excess drinking and opportunity to engage with the app in the evenings, we changed the delivery time from 11 am to 8 pm. We now aim to further optimise the content and sequence of notifications, testing 30 new evidence-informed notifications targeting the user's perceived usefulness of the app. OBJECTIVE The primary objective is to assess whether sending a notification at 8 pm increases behavioral engagement (opening the app) in the subsequent hour. Secondary objectives include comparing the effect of the new bank of messages with the standard message and effect moderation over time. We also aim to more generally understand the role notifications have on the overall duration, depth, and frequency of engagement with Drink Less over the first 30 days after download. METHODS This is a protocol for a micro-randomized trial with two additional parallel arms. Inclusion criteria are Drink Less users who (1) consent to participate in the trial; (2) self-report a baseline Alcohol Use Disorders Identification Test score of 8 or above; (3) reside in the United Kingdom; (4) age ≥18 years and; (5) report interest in drinking less alcohol. In the micro-randomized trial, participants will be randomized daily at 8 pm to receive no notification, a notification with text from the new message bank, or the standard message. The primary outcome is the time-varying, binary outcome of "Did the user open the app in the hour from 8 pm to 9 pm?". The primary analysis will estimate the marginal relative risk for the notifications using an estimator developed for micro-randomized trials with binary outcomes. Participants randomized to the parallel arms will receive no notifications (Secondary Arm A), or the standard notification delivered daily at 11 am (Secondary Arm B) over 30 days, allowing the comparison of overall engagement between different notification delivery strategies. RESULTS Approval was granted by the University College of London's Departmental Research Ethics Committee (CEHP/2016/556) on October 11, 2019, and The London School of Hygiene and Tropical Medicine Interventions Research Ethics Committee (17929) on November 27, 2019. Recruitment began on January 2, 2020, and is ongoing. CONCLUSIONS Understanding how push notifications may impact engagement with a behavior change app can lead to further improvements in engagement, and ultimately help users reduce their alcohol consumption. This understanding may also be generalizable to other apps that target a variety of behavior changes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/18690.
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Affiliation(s)
- Lauren Bell
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Claire Garnett
- Research Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Tianchen Qian
- Department of Statistics, Harvard University, Cambridge, MA, United States
| | - Olga Perski
- Research Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Henry W W Potts
- Institute of Health Informatics, University College London, London, United Kingdom
- Health Data Research UK, London, United Kingdom
| | - Elizabeth Williamson
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Health Data Research UK, London, United Kingdom
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260
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Abstract
OBJECTIVES To survey international regulatory frameworks that serve to protect privacy of personal data as a human right as well as to review the literature regarding privacy protections and data ownership in mobile health (mHealth) technologies between January 1, 2016 and June 1, 2019 in order to identify common themes. METHODS We performed a review of relevant literature available in English published between January 1, 2016 and June 1, 2019 from databases including PubMed, Google Scholar, and Web of Science, as well as relevant legislative background material. Articles out of scope (as detailed below) were eliminated. We categorized the remaining pool of articles and discrete themes were identified, specifically: concerns around data transmission and storage, including data ownership and the ability to re-identify previously de-identified data; issues with user consent (including the availability of appropriate privacy policies) and access control; and the changing culture and variable global attitudes toward privacy of health data. RESULTS Recent literature demonstrates that the security of mHealth data storage and transmission remains of wide concern, and aggregated data that were previously considered "de-identified" have now been demonstrated to be re-identifiable. Consumer-informed consent may be lacking with regard to mHealth applications due to the absence of a privacy policy and/or to text that is too complex and lengthy for most users to comprehend. The literature surveyed emphasizes improved access control strategies. This survey also illustrates a wide variety of global user perceptions regarding health data privacy. CONCLUSION The international regulatory framework that serves to protect privacy of personal data as a human right is diverse. Given the challenges legislators face to keep up with rapidly advancing technology, we introduce the concept of a "healthcare fiduciary" to serve the best interest of data subjects in the current environment.
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Affiliation(s)
- Hannah K. Galvin
- Cambridge Health Alliance, Cambridge, MA, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - Paul R. DeMuro
- Chief Legal Officer Health and Wellness, Royal Palm Companies, Miami, Florida
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261
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Weerdmeester J, van Rooij MM, Engels RC, Granic I. An Integrative Model for the Effectiveness of Biofeedback Interventions for Anxiety Regulation: Viewpoint. J Med Internet Res 2020; 22:e14958. [PMID: 32706654 PMCID: PMC7413290 DOI: 10.2196/14958] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 01/03/2020] [Accepted: 01/22/2020] [Indexed: 12/22/2022] Open
Abstract
Biofeedback has shown to be a promising tool for the treatment of anxiety; however, several theoretical as well as practical limitations have prevented widespread adaptation until now. With current technological advances and the increasing interest in the use of self-monitoring technology to improve mental health, we argue that this is an ideal time to launch a new wave of biofeedback training. In this viewpoint paper, we reflect on the current state of biofeedback training, including the more traditional techniques and mechanisms that have been thought to explain the effectiveness of biofeedback such as the integration of operant learning and meditation techniques, and the changes in interoceptive awareness and physiology. Subsequently, we propose an integrative model that includes a set of cognitive appraisals as potential determinants of adaptive trajectories within biofeedback training such as growth mindset, self-efficacy, locus of control, and threat-challenge appraisals. Finally, we present a set of detailed guidelines based on the integration of our model with the mechanics and mechanisms offered by emerging interactive technology to encourage a new phase of research and implementation using biofeedback. There is a great deal of promise for future biofeedback interventions that harness the power of wearables and video games, and that adopt a user-centered approach to help people regulate their anxiety in a way that feels engaging, personal, and meaningful.
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Affiliation(s)
| | | | | | - Isabela Granic
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
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262
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Bubolz S, Mayer G, Gronewold N, Hilbel T, Schultz JH. Adherence to Established Treatment Guidelines Among Unguided Digital Interventions for Depression: Quality Evaluation of 28 Web-Based Programs and Mobile Apps. J Med Internet Res 2020; 22:e16136. [PMID: 32673221 PMCID: PMC7385636 DOI: 10.2196/16136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 04/01/2020] [Accepted: 04/19/2020] [Indexed: 01/04/2023] Open
Abstract
Background Web-based interventions for depression have been widely tested for usability and functioning. However, the few studies that have addressed the therapeutic quality of these interventions have mainly focused on general aspects without consideration of specific quality factors related to particular treatment components. Clinicians and scientists are calling for standardized assessment criteria for web-based interventions to enable effective and trustworthy patient care. Therefore, an extensive evaluation of web-based interventions at the level of individual treatment components based on therapeutic guidelines and manuals is needed. Objective The objective of this study was to evaluate the quality of unguided web-based interventions for depression at the level of individual treatment components based on their adherence to current gold-standard treatment guidelines and manuals. Methods A comprehensive online search of popular app stores and search engines in January 2018 revealed 11 desktop programs and 17 smartphone apps that met the inclusion criteria. Programs and apps were included if they were available for German users, interactive, unguided, and targeted toward depression. All programs and apps were tested by three independent researchers following a standardized procedure with a predefined symptom trajectory. During the testing, all web-based interventions were rated with a standardized list of criteria based on treatment guidelines and manuals for depression. Results Overall interrater reliability for all raters was substantial with an intraclass correlation coefficient of 0.73 and Gwet AC1 value of 0.80. The main features of web-based interventions included mood tracking (24/28, 86%), psychoeducation (21/28, 75%), cognitive restructuring (21/28, 75%), crisis management (20/28, 71%), behavioral activation (19/29, 68%), and relaxation training (18/28, 64%). Overall, therapeutic meaningfulness was rated higher for desktop programs (mean 4.13, SD 1.17) than for smartphone apps (mean 2.92, SD 1.46). Conclusions Although many exercises from manuals are included in web-based interventions, the necessary therapeutic depth of the interventions is often not reached, and risk management is frequently lacking. There is a need for further research targeting general principles for the development and evaluation of therapeutically sound web-based interventions for depression.
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Affiliation(s)
- Stefan Bubolz
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Gwendolyn Mayer
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Nadine Gronewold
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Hilbel
- Westphalian University of Applied Sciences, Gelsenkirchen, Germany
| | - Jobst-Hendrik Schultz
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
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263
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A pilot digital intervention targeting loneliness in young people with psychosis. Soc Psychiatry Psychiatr Epidemiol 2020; 55:877-889. [PMID: 30874828 DOI: 10.1007/s00127-019-01681-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/25/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Loneliness has been identified as a significant challenge for people with psychosis. Interventions targeting loneliness are lacking but adopting a positive psychology approach may reduce loneliness, promote well-being, and support meaningful social interactions. Together with youth mental health consumers, we developed a digital smartphone application (app) called +Connect, which delivers positive psychology content daily for 6 weeks. MATERIALS AND METHODS Twelve participants diagnosed with a psychotic disorder were recruited from early psychosis services. Loneliness was assessed pre-intervention, post-intervention, and 3-month post-intervention. Acceptability, feasibility, and usability were measured post-intervention, including a semi-structured interview on the user's experience of +Connect. RESULTS We found evidence for the feasibility of +Connect. All but two participants completed the +Connect program, completing 95% (40.10 out of 42 days) of the program. Furthermore, 66.67% (8 out of the 12 participants) remained engaged with the program 3-months post-intervention. Our data indicates preliminary evidence that +Connect may reduce loneliness, with scores from pre-intervention (M = 50.00, SD = 8.47) to post-intervention (M = 48.10, SD = 10.38) and 3-months post-intervention (M = 42.89, SD = 7.04). We found that positive reinforcement of in-game rewards and evidence of positive mood changes added to the feasibility of the app. Regarding acceptability, while 10% (1/10 participants) reported not finding +Connect useful or enjoyable, 90% of participants agreed that +Connect helped them to increase their social confidence, enjoy life, look forward to being with other people, and feel more connected with others. Participant interviews supported these results, with participants highlighting the app's strengths in providing useful information, stimulating self-reflection, fostering positive affect, and encouraging transfer of skills into their social interactions. DISCUSSION While preliminary findings indicated that +Connect yielded high levels of acceptability and feasibility, it is important to consider that we recruited a small and selected sample of lonely young people. Further iterations of this proof of concept app, which can incorporate participant feedback such preferences for increased personalisation, in-app feedback, and gamification, may allow an opportunity to test an improved version in the future.
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264
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Scherr S, Goering M. Is a Self-Monitoring App for Depression a Good Place for Additional Mental Health Information? Ecological Momentary Assessment of Mental Help Information Seeking among Smartphone Users. HEALTH COMMUNICATION 2020; 35:1004-1012. [PMID: 31025888 DOI: 10.1080/10410236.2019.1606135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Mobile devices and apps offer promising opportunities for both patients and healthcare professionals, for example, to monitor and assess health status, and also to provide relevant health information. However, health information seeking within a mood-tracking app has not yet been addressed by research. To bridge this gap, the depression-related health information seeking of 6,675 users of a mood-tracking smartphone app was unobtrusively monitored. The study shows that self-monitored depressive symptoms are associated with higher depression-related information seeking within the app. Health information seeking was low in general, with differences across 12 depression-related topics (e.g., depressive thoughts, a depression diagnosis, or depression facts), but the findings are also promising as the smartphone app was shown to be a place where users can inform themselves about health topics related to the main purpose of the app. Smartphone apps would therefore seem to be a vehicle through which to provide additional health information about, for example, comorbidities, or pre- or post-interventions, even going beyond the original purposes of such mobile health (mHealth) monitoring apps.
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265
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Valentine L, McEnery C, O'Sullivan S, Gleeson J, Bendall S, Alvarez-Jimenez M. Young People's Experience of a Long-Term Social Media-Based Intervention for First-Episode Psychosis: Qualitative Analysis. J Med Internet Res 2020; 22:e17570. [PMID: 32384056 PMCID: PMC7381038 DOI: 10.2196/17570] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/17/2020] [Accepted: 02/21/2020] [Indexed: 01/19/2023] Open
Abstract
Background Digital mental health interventions present a unique opportunity to address the lack of social connection and loneliness experienced by young people with first-episode psychosis (FEP). The first generation of digital interventions, however, is associated with high attrition rates. Social media presents an opportunity to target this issue. A new generation of digital intervention has harnessed the popularity of social media to both promote engagement and foster social connectedness in youth mental health interventions. Despite their potential, little is known about how young people engage with, and experience, social media–based interventions as well as the optimal design, implementation, and management needed to ensure young people with psychosis receive benefit. Objective This study aimed to explore how young people engage with, and experience, a long-term social media–based mental health intervention designed to address social functioning in individuals with FEP. Methods This qualitative study was based on 12 interviews with young people who used Horyzons, a long-term social media–based mental health intervention, as part of a previous randomized controlled trial. A semistructured phenomenological interview guide with open-ended questions was used to explore young people’s subjective experience of the intervention. All interviews were recorded and transcribed verbatim. Data were analyzed using interpretative phenomenological analysis. Results A total of 4 superordinate themes emerged during the analysis including (1) shared experience as the catalyst for a cocreated social space, (2) the power of peer support, (3) an upbeat environment, and (4) experiences that interrupt being in Horyzons. Conclusions We found that Horyzon’s therapeutic social network fostered a connection and an understanding among young people. It also aided in the creation of an embodied experience that afforded young people with FEP a sense of self-recognition and belonging over the long term. However, although we found that most young people had strong positive experiences of a social connection on Horyzons, we also found that they experienced significant barriers that could substantively interrupt their ability to use the platform. We found that social anxiety, paranoia, internalized stigma, lack of autonomy, and social protocol confusion interfered with young people’s usage of the platform. From a design perspective, digital interventions are flexible and thus equipped to begin addressing these implications by providing customizable and personalized treatment options that account for varying levels of social connection and psychological need that could otherwise interrupt young people’s usage of social media–based interventions.
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Affiliation(s)
- Lee Valentine
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Carla McEnery
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.,Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
| | - Shaunagh O'Sullivan
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - John Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Sarah Bendall
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
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266
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Lo B, Shi J, Hollenberg E, Abi-Jaoudé A, Johnson A, Wiljer D. Surveying the Role of Analytics in Evaluating Digital Mental Health Interventions for Transition-Aged Youth: Scoping Review. JMIR Ment Health 2020; 7:e15942. [PMID: 32348261 PMCID: PMC7381002 DOI: 10.2196/15942] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/20/2019] [Accepted: 02/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Consumer-facing digital health interventions provide a promising avenue to bridge gaps in mental health care delivery. To evaluate these interventions, understanding how the target population uses a solution is critical to the overall validity and reliability of the evaluation. As a result, usage data (analytics) can provide a proxy for evaluating the engagement of a solution. However, there is paucity of guidance on how usage data or analytics should be used to assess and evaluate digital mental health interventions. OBJECTIVE This review aimed to examine how usage data are collected and analyzed in evaluations of mental health mobile apps for transition-aged youth (15-29 years). METHODS A scoping review was conducted using the Arksey and O'Malley framework. A systematic search was conducted on 5 journal databases using keywords related to usage and engagement, mental health apps, and evaluation. A total of 1784 papers from 2008 to 2019 were identified and screened to ensure that they included analytics and evaluated a mental health app for transition-aged youth. After full-text screening, 49 papers were included in the analysis. RESULTS Of the 49 papers included in the analysis, 40 unique digital mental health innovations were evaluated, and about 80% (39/49) of the papers were published over the past 6 years. About 80% involved a randomized controlled trial and evaluated apps with information delivery features. There were heterogeneous findings in the concept that analytics was ascribed to, with the top 3 being engagement, adherence, and acceptability. There was also a significant spread in the number of metrics collected by each study, with 35% (17/49) of the papers collecting only 1 metric and 29% (14/49) collecting 4 or more analytic metrics. The number of modules completed, the session duration, and the number of log ins were the most common usage metrics collected. CONCLUSIONS This review of current literature identified significant variability and heterogeneity in using analytics to evaluate digital mental health interventions for transition-aged youth. The large proportion of publications from the last 6 years suggests that user analytics is increasingly being integrated into the evaluation of these apps. Numerous gaps related to selecting appropriate and relevant metrics and defining successful or high levels of engagement have been identified for future exploration. Although long-term use or adoption is an important precursor to realizing the expected benefits of an app, few studies have examined this issue. Researchers would benefit from clarification and guidance on how to measure and analyze app usage in terms of evaluating digital mental health interventions for transition-aged youth. Given the established role of adoption in the success of health information technologies, understanding how to abstract and analyze user adoption for consumer digital mental health apps is also an emerging priority.
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Affiliation(s)
- Brian Lo
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jenny Shi
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Elisa Hollenberg
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alexxa Abi-Jaoudé
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Andrew Johnson
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - David Wiljer
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Education, Technology and Innovation, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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267
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Weingarden H, Matic A, Calleja RG, Greenberg JL, Harrison O, Wilhelm S. Optimizing Smartphone-Delivered Cognitive Behavioral Therapy for Body Dysmorphic Disorder Using Passive Smartphone Data: Initial Insights From an Open Pilot Trial. JMIR Mhealth Uhealth 2020; 8:e16350. [PMID: 32554382 PMCID: PMC7333068 DOI: 10.2196/16350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 03/09/2020] [Accepted: 04/03/2020] [Indexed: 11/26/2022] Open
Abstract
Background Smartphone-delivered cognitive behavioral therapy (CBT) is becoming more common, but research on the topic remains in its infancy. Little is known about how people typically engage with smartphone CBT or which engagement and mobility patterns may optimize treatment. Passive smartphone data offer a unique opportunity to gain insight into these knowledge gaps. Objective This study aimed to examine passive smartphone data across a pilot course of smartphone CBT for body dysmorphic disorder (BDD), a psychiatric illness characterized by a preoccupation with a perceived defect in physical appearance, to inform hypothesis generation and the design of subsequent, larger trials. Methods A total of 10 adults with primary diagnoses of BDD were recruited nationally and completed telehealth clinician assessments with a reliable evaluator. In a 12-week open pilot trial of smartphone CBT, we initially characterized natural patterns of engagement with the treatment and tested how engagement and mobility patterns across treatment corresponded with treatment response. Results Most participants interacted briefly and frequently with smartphone-delivered treatment. More frequent app usage (r=–0.57), as opposed to greater usage duration (r=–0.084), correlated strongly with response. GPS-detected time at home, a potential digital marker of avoidance, decreased across treatment and correlated moderately with BDD severity (r=0.49). Conclusions The sample was small in this pilot study; thus, results should be used to inform the hypotheses and design of subsequent trials. The results provide initial evidence that frequent (even if brief) practice of CBT skills may optimize response to smartphone CBT and that mobility patterns may serve as useful passive markers of symptom severity. This is one of the first studies to examine the value that passively collected sensor data may contribute to understanding and optimizing users’ response to smartphone CBT. With further validation, the results can inform how to enhance smartphone CBT design.
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Affiliation(s)
- Hilary Weingarden
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States
| | | | | | - Jennifer L Greenberg
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States
| | | | - Sabine Wilhelm
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States
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268
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Ilagan GS, Iliakis EA, Wilks CR, Vahia IV, Choi-Kain LW. Smartphone applications targeting borderline personality disorder symptoms: a systematic review and meta-analysis. Borderline Personal Disord Emot Dysregul 2020; 7:12. [PMID: 32549987 PMCID: PMC7296633 DOI: 10.1186/s40479-020-00127-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/19/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Smartphone applications could improve symptoms of borderline personality disorder (BPD) in a scalable and resource-efficient manner in the context limited access to specialized care. OBJECTIVE This systematic review and meta-analysis aims to evaluate the effectiveness of applications designed as treatment interventions for adults with symptoms such as anger, suicidality, or self-harm that commonly occur in BPD. DATA SOURCES Search terms for BPD symptoms, smartphone applications, and treatment interventions were combined on PubMed, MEDLINE, and PsycINFO from database inception to December 2019. STUDY SELECTION Controlled and uncontrolled studies of smartphone interventions for adult participants with symptoms such as anger, suicidality, or self-harm that commonly occur in BPD were included. STUDY APPRAISAL AND SYNTHESIS METHODS Comprehensive Meta-Analysis v3 was used to compute between-groups effect sizes in controlled designs. The primary outcome was BPD-related symptoms such as anger, suicidality, and impulsivity; and the secondary outcome was general psychopathology. An average dropout rate across interventions was computed. Study quality, target audiences, therapeutic approach and targets, effectiveness, intended use, usability metrics, availability on market, and downloads were assessed qualitatively from the papers and through internet search. RESULTS Twelve studies of 10 applications were included, reporting data from 408 participants. Between-groups meta-analyses of RCTs revealed no significant effect of smartphone applications above and beyond in-person treatments or a waitlist on BPD symptoms (Hedges' g = - 0.066, 95% CI [-.257, .125]), nor on general psychopathology (Hedges' g = 0.305, 95% CI [- 0.14, 0.75]). Across the 12 trials, dropout rates ranged from 0 to 56.7% (M = 22.5, 95% CI [0.15, 0.46]). A majority of interventions studied targeted emotion dysregulation and behavioral dyscontrol symptoms. Half of the applications are commercially available. CONCLUSIONS The effects of smartphone interventions on symptoms of BPD are unclear and there is currently a lack of evidence for their effectiveness. More research is needed to build on these preliminary findings in BPD to investigate both positive and adverse effects of smartphone applications and identify the role these technologies may provide in expanding mental healthcare resources.
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Affiliation(s)
| | | | | | - Ipsit V. Vahia
- McLean Hospital, 115 Mill St, Belmont, MA 02478 USA
- Harvard Medical School, Boston, USA
| | - Lois W. Choi-Kain
- McLean Hospital, 115 Mill St, Belmont, MA 02478 USA
- Harvard Medical School, Boston, USA
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269
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Austin SF, Jansen JE, Petersen CJ, Jensen R, Simonsen E. Mobile App Integration Into Dialectical Behavior Therapy for Persons With Borderline Personality Disorder: Qualitative and Quantitative Study. JMIR Ment Health 2020; 7:e14913. [PMID: 32525488 PMCID: PMC7317633 DOI: 10.2196/14913] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 10/18/2019] [Accepted: 03/19/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The advancement of and access to technology such as smartphones has implications for psychotherapeutic health care and how interventions for a range of mental health disorders are provided. OBJECTIVE The objective of this study was to describe the experiences of participants while using a mobile phone app that was designed to enhance and support dialectical behavior therapy for personality disorders. METHODS A combination of in-depth interviews and questionnaires were used to capture the experiences of participants who used the app while undergoing dialectical behavior therapy treatment. A mixed methods approach was used; qualitative data from the interviews were analyzed using thematic analysis and were combined with quantitative data from the questionnaires. RESULTS Participants (N=24) who were receiving dialectical behavior therapy used the trial app. Participants (n=20) completed an evaluation questionnaire and a subset of this group (n=8) participated in semistructured interviews. Major themes that were identified from the interviews were (1) an overall positive experience of using the app-participants perceived that the app facilitated access and implementation of dialectical behavior therapy strategies (to regulate mood and behavior in challenging situations)-and (2) that the app provided a common source of information for patient and therapist interactions-app-based interactions were perceived to facilitate therapeutic alliance. Qualitative themes from the interviews were largely congruent with the quantitative responses from the questionnaires. CONCLUSIONS Participants welcomed the integration of technology as a supplement to clinical treatment. The app was perceived to facilitate and support many of the therapeutic techniques associated with dialectical behavior therapy treatment. The incorporation of technology into psychotherapeutic interventions may facilitate the transfer of knowledge and strategies that are learned in therapy to use in real-world settings thereby promoting recovery from mental health problems.
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Affiliation(s)
- Stephen F Austin
- Department of Psychiatric Research, Region Zealand Psychiatry, Slagelse, Denmark
| | | | | | - Rasmus Jensen
- Psychiatry West, Region Zealand Psychiatry, Holbaek, Denmark
| | - Erik Simonsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Psychiatric Research, Region Zealand Psychiatry, Slagelse, Denmark
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270
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Rudd BN, Beidas RS. Digital Mental Health: The Answer to the Global Mental Health Crisis? JMIR Ment Health 2020; 7:e18472. [PMID: 32484445 PMCID: PMC7298632 DOI: 10.2196/18472] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/27/2020] [Accepted: 03/28/2020] [Indexed: 02/06/2023] Open
Abstract
Digital mental health interventions are often touted as the solution to the global mental health crisis. However, moving mental health care from the hands of professionals and into digital apps may further isolate individuals who need human connection the most. In this commentary, we argue that people, our society's greatest resource, are as ubiquitous as technology. Thus, we argue that research focused on using technology to support all people in delivering mental health prevention and intervention deserves greater attention in the coming decade.
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Affiliation(s)
- Brittany N Rudd
- Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States.,Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Penn Implementation Science Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
| | - Rinad S Beidas
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Penn Implementation Science Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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271
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Morris ME. Enhancing relationships through technology: directions in parenting, caregiving, romantic partnerships, and clinical practice
. DIALOGUES IN CLINICAL NEUROSCIENCE 2020; 22:151-160. [PMID: 32699515 PMCID: PMC7366940 DOI: 10.31887/dcns.2020.22.2/mmorris] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Media coverage of research on phones and social media over the last decade has prompted widespread concern and one-size-fits-all guidance to limit screen time. Recognizing the limitations of screen time as a metric, researchers are now studying technology use in terms of affordances, individual differences, and longitudinal patterns. The current review examines technology use by parents, caregivers, couples, and clinicians. Individuals in these roles navigate risks, such as privacy violations, with benefits such as improved communication, empathy, and progress toward shared goals. Successful approaches vary by relationship type but have commonalities such as engaging with the technologies used by the other person to open up sensitive conversations, negotiate conflict, and illuminate patterns that would otherwise be hard to detect. To enhance relationships, some individuals depart from the intended use of technologies, for example, adapting connected devices for emotional communication or drawing on games to cope with social anxiety. One promising way in which individuals adapt technology to improve communication involves sharing technologies that were designed for personal use. This review highlights the importance of context, motivation, and the nuances of use to understand how technologies can be optimally used in personal and clinical relationships.
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Affiliation(s)
- Margaret E Morris
- Affiliate faculty, University of Washington, Seattle, Washington, US
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272
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Czyz EK, Arango A, Healy N, King CA, Walton M. Augmenting Safety Planning With Text Messaging Support for Adolescents at Elevated Suicide Risk: Development and Acceptability Study. JMIR Ment Health 2020; 7:e17345. [PMID: 32160150 PMCID: PMC7281145 DOI: 10.2196/17345] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 03/08/2020] [Accepted: 03/09/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Suicide is the second leading cause of death among adolescents. A critical need exists for developing promising interventions for adolescents after psychiatric hospitalization who are at a high risk of experiencing repeated suicidal behaviors and related crises. The high-risk period following psychiatric hospitalization calls for cost-effective and scalable continuity of care approaches to support adolescents' transition from inpatient care. Text messages have been used to improve a wide range of behavioral and health outcomes and may hold promise as an accessible continuity of care strategy for youth at risk of suicide. OBJECTIVE In this study of 40 adolescents at elevated suicide risk, we report on the iterative development and acceptability of a text-based intervention designed to encourage adaptive coping and safety plan adherence in the high-risk period following psychiatric hospitalization. METHODS Adolescents (aged 13-17 years) who were hospitalized because of last-month suicide attempts or last-week suicidal ideation took part in either study phase 1 (n=25; 19/25, 76% female), wherein message content was developed and revised on the basis of feedback obtained during hospitalization, or study phase 2 (n=15; 11/15, 73% female), wherein text messages informed by phase 1 were further tested and refined based on feedback obtained daily over the course of a month after discharge (n=256 observations) and during an end-of-study phone interview. RESULTS Quantitative and qualitative feedback across the 2 study phases pointed to the acceptability of text-based support. Messages were seen as having the potential to be helpful with the transition after hospitalization, with adolescents indicating that texts may serve as reminders to use coping strategies, contribute to improvement in mood, and provide them with a sense of encouragement and hope. At the same time, some adolescents expressed concerns that messages may be insufficient for all teens or circumstances. In phase 2, the passage of time did not influence adolescents' perception of messages in the month after discharge (P=.74); however, there were notable daily level associations between the perception of messages and adolescents' affect. Specifically, higher within-person (relative to adolescents' own average) anger was negatively related to liking text messages (P=.005), whereas within-person positive affect was associated with the perception of messages as more helpful (P=.04). CONCLUSIONS Text-based support appears to be an acceptable continuity of care strategy to support adolescents' transition after hospitalization. The implications of study findings are discussed. Future work is needed to evaluate the impact of text-based interventions on suicide-related outcomes.
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Affiliation(s)
- Ewa K Czyz
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Alejandra Arango
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Nathaniel Healy
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Cheryl A King
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Maureen Walton
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States.,Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
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273
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274
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Huckvale K, Nicholas J, Torous J, Larsen ME. Smartphone apps for the treatment of mental health conditions: status and considerations. Curr Opin Psychol 2020; 36:65-70. [PMID: 32553848 DOI: 10.1016/j.copsyc.2020.04.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 12/23/2022]
Abstract
Clinical and research interest in the potential of mobile health apps for the management of mental health conditions has recently been given added impetus by growing evidence of consumer adoption. In parallel, there is now a developing evidence base that includes meta-analyses demonstrating reductions in symptoms of depression and anxiety, and reduction in suicidal ideation. While these findings are encouraging, recent research continues to identify a number of potential barriers to the widespread adoption of mental health apps. These challenges include poor data governance and data sharing practices; questions of clinical safety relating to the management of adverse events and potentially harmful content; low levels of user engagement and the possibility of 'digital placebo' effects; and workforce barriers to integration with clinical practice. Current efforts to address these include the development of new models of care, such as 'digital clinics' that integrate health apps. Other contemporary innovations in the field such as digital sensing and just-in-time adaptive interventions are showing early promise for providing accessible and personalised care.
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Affiliation(s)
| | - Jennifer Nicholas
- Orygen, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - John Torous
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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275
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Smith K, Ostinelli E, Cipriani A. Covid-19 and mental health: a transformational opportunity to apply an evidence-based approach to clinical practice and research. EVIDENCE-BASED MENTAL HEALTH 2020; 23:45-46. [PMID: 32317345 PMCID: PMC10231583 DOI: 10.1136/ebmental-2020-300155] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/10/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Katharine Smith
- Department of Psychiatry, University of Oxford Department of Psychiatry, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Edoardo Ostinelli
- Department of Psychiatry, University of Oxford Department of Psychiatry, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford Department of Psychiatry, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
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276
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Petrovic M, Gaggioli A. Digital Mental Health Tools for Caregivers of Older Adults-A Scoping Review. Front Public Health 2020; 8:128. [PMID: 32411643 PMCID: PMC7198719 DOI: 10.3389/fpubh.2020.00128] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 03/30/2020] [Indexed: 01/25/2023] Open
Abstract
Aim: Informal caregivers have an important role in bridging the gap between the assistance care recipients need and what can be provided by the health care systems across Europe. The burden of the caregiving role places a significant threat to caregiver health, and the vast majority of caregiver's report stress and emotional strain, depression, and increased rates of chronic diseases. In line with this, strengthening the caregiver's mental health is one of the main goals for optimal caregiving. Caregivers already struggle with the demand of their role while coping with health problems, social, family, and work obligations. The solution for the caregiver's mental health needs to be accessible, low cost, and time-effective. This scoping review investigates digital mental health tools available as a mean of supporting the mental health of caregivers. Method: Databases searched include Summon search box, the Cochrane Library, and PubMed. Three groups of keywords were combined: relating to digital mental health interventions for caregivers, digital mental health interventions and stress in elderly care, and digital mental health interventions and burden in elderly care. Results: Caregivers reported that digital mental health tools have an overall positive role in their health. Coping skills, emotion regulation, skill building, and education are found to be important aspects of digital mental health tools. There was a noted lack of digital mental health apps available specifically for the caregiver of older adults. Furthermore, the digital mental health tools, divided into three categories in this review, focused either on building skills or educating caregivers and assisting with the duties rather than the mental health of the caregiver itself. As repeatedly suggested in the reviewed studies, digital mental health interventions overall contribute to reducing the caregiver burden with a limitation of addressing one aspect of caregiver needs –i.e., specific coping skills or education regarding illnesses such as Alzheimer's disease and Dementia. The lack of all-encompassing, data and theory-driven digital mental health tools for addressing and supporting the caregiver's mental health is evident.
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Affiliation(s)
- Milica Petrovic
- Department of Psychology, Catholic University of Sacred Heart, Milan, Italy
| | - Andrea Gaggioli
- Department of Psychology, Catholic University of Sacred Heart, Milan, Italy.,Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano (IRCCS), Milan, Italy
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277
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Wright JH, Mishkind M. Computer-Assisted CBT and Mobile Apps for Depression: Assessment and Integration Into Clinical Care. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2020; 18:162-168. [PMID: 33162853 DOI: 10.1176/appi.focus.20190044] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A surge in the development of computer-assisted cognitive-behavioral therapy (CCBT) and mobile apps for depression has provided many tools with potential for enhancing treatment delivery. This article assesses progress in evaluation and implementation of CCBT and mobile apps for depression, with a focus on providing practical information on clinical applications. Advantage and disadvantages of these technologies are identified, outcome research is reviewed, and recommendations are made for clinical use. With increasing use of computer technology in everyday life, it is likely that clinicians and patients will pursue opportunities to employ computer tools in treatment for depression.
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Affiliation(s)
- Jesse H Wright
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky (Wright); Johnson Depression Center, Department of Family Medicine, University of Colorado School of Medicine, Aurora (Mishkind)
| | - Matthew Mishkind
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky (Wright); Johnson Depression Center, Department of Family Medicine, University of Colorado School of Medicine, Aurora (Mishkind)
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278
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Chow PI, Showalter SL, Gerber M, Kennedy EM, Brenin D, Mohr DC, Lattie EG, Gupta A, Ocker G, Cohn WF. Use of Mental Health Apps by Patients With Breast Cancer in the United States: Pilot Pre-Post Study. JMIR Cancer 2020; 6:e16476. [PMID: 32293570 PMCID: PMC7191345 DOI: 10.2196/16476] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/19/2019] [Accepted: 01/27/2020] [Indexed: 12/16/2022] Open
Abstract
Background Nearly half of the patients with breast cancer experience clinically significant mental distress within the first year of receiving their cancer diagnosis. There is an urgent need to identify scalable and cost-efficient ways of delivering empirically supported mental health interventions to patients with breast cancer. Objective The aim of this study was to evaluate the feasibility of in-clinic recruitment for a mobile phone app study and to evaluate the usability and preliminary impact of a suite of mental health apps (IntelliCare) with phone coaching on psychosocial distress symptoms in patients recently diagnosed with breast cancer. Methods This pilot study adopted a within-subject, 7-week pre-post study design. A total of 40 patients with breast cancer were recruited at a US National Cancer Institute–designated clinical cancer center. Self-reported distress (Patient Health Questionnaire-4) and mood symptoms (Patient-Reported Outcomes Measurement Information System depression and anxiety scales) were assessed at baseline and postintervention. App usability was assessed at postintervention. Results The minimum recruitment threshold was met. There was a significant decrease in general distress symptoms, as well as symptoms of depression and anxiety, from baseline to postintervention. Overall, participants reported high levels of ease of app use and learning. Scores for app usefulness and satisfaction were reinforced by some qualitative feedback suggesting that tailoring the apps more for patients with breast cancer could enhance engagement. Conclusions There is a dire need for scalable, supportive interventions in cancer. The results from this study inform how scalable mobile phone–delivered programs with additional phone support can be used to support patients with breast cancer. International Registered Report Identifier (IRRID) RR2-10.2196/11452
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Affiliation(s)
- Philip I Chow
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, United States
| | - Shayna L Showalter
- Department of Surgery, University of Virginia, Charlottesville, VA, United States
| | - Matthew Gerber
- Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA, United States
| | - Erin M Kennedy
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - David Brenin
- Department of Surgery, University of Virginia, Charlottesville, VA, United States
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, United States
| | - Emily G Lattie
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, United States
| | - Alisha Gupta
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Gabrielle Ocker
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Wendy F Cohn
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
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279
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Seeralan T, Härter M, Koschnitzke C, Scholl M, Kohlmann S, Lehmann M, Eisele M, Braunschneider LE, Marx G, Scherer M, Löwe B, Magaard JL, Brütt AL. Patient involvement in developing a patient-targeted feedback intervention after depression screening in primary care within the randomized controlled trial GET.FEEDBACK.GP. Health Expect 2020; 24 Suppl 1:95-112. [PMID: 32286005 PMCID: PMC8137500 DOI: 10.1111/hex.13039] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/31/2020] [Accepted: 02/05/2020] [Indexed: 11/28/2022] Open
Abstract
Background Patient and public involvement (PPI) is increasingly required in mental health services research. To empower patients to actively address depression, the GET.FEEDBACK.GP study evaluates a patient‐targeted feedback intervention after depression screening using the Patient Health Questionnaire (PHQ‐9). Objective To refine the patient‐targeted feedback from a previous study within a participatory research team (PRT) by conducting workshops to investigate patients' needs and preferences for feedback. To evaluate the process and outcome of PPI. Design Patient and public involvement was carried out on the levels of collaboration and consultation. A PRT of patient partners and researchers planned and conducted three workshops with patients. Patients' needs were investigated using a focus group. Participants prioritized needs, discussed feedback drafts and evaluated two drafts using cognitive debriefings. Researchers of the PRT communicated the results at project level. PPI was evaluated using the Public and Patient Engagement Evaluation Tools (PPEET). Setting and Participants A purposeful sampling of N = 12 patients with experiences of depression participated in at least one workshop. Results Relevant content‐related needs about feedback (eg no distinction between severe and moderate symptoms), recommendations for action and patient‐relevant information were considered. Needs for comprehensible, valuing, nonstigmatizing language and design elements (eg dimensional bar) were implemented. Workshops and PRT were positively evaluated. Discussion and Conclusions Patient and public involvement influenced the content, wording and design of the feedback. Strengths include two levels of PPI, methodical diversity and purposeful sampling. Limitations include the lack of inclusion of patients who are unaware of their depression. The evaluated PPI concept can be useful for future studies.
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Affiliation(s)
- Tharanya Seeralan
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Member of the Participatory Research Team, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Michael Scholl
- Member of the Participatory Research Team, Hamburg, Germany
| | - Sebastian Kohlmann
- Department of Psychosomatic Medicine and Psychotherapy, Center for Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marco Lehmann
- Department of Psychosomatic Medicine and Psychotherapy, Center for Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marion Eisele
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lea-Elena Braunschneider
- Department of Psychosomatic Medicine and Psychotherapy, Center for Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriella Marx
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, Center for Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Luise Magaard
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Member of the Participatory Research Team, Hamburg, Germany
| | - Anna Levke Brütt
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Member of the Participatory Research Team, Hamburg, Germany.,Department for Health Services Research, Faculty of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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280
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Wisiewski H, Torous J. Digital navigators to implement smartphone and digital tools in care. Acta Psychiatr Scand 2020; 141:350-355. [PMID: 31930477 PMCID: PMC7928068 DOI: 10.1111/acps.13149] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2020] [Indexed: 12/12/2022]
Abstract
While smartphone apps and other digital health tools have the clear potential to increase both quality of and access to care, actual successful implementation remains limited. Challenges often encountered in seeking to use apps in care include selecting safe/effective tools, spending clinical time troubleshooting technology instead of discussing health matters, and lack of time to check and review constant streams of data these digital tools can produce. In this 'From Research to Clinical Practice' piece, we focus on how a new care team member, the digital navigator, can help overcome these barriers through conducting evidence-based app evaluation to help in selecting the right apps, troubleshooting technology outside of visits to improve the therapeutic alliance during, and finally summarizing digital data to facilitate clinical care that focus on actionable data.
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Affiliation(s)
- Hannah Wisiewski
- Division of Digital Psychiatry. Department of Psychiatry. Beth Israel Deaconess Medical Center. Harvard Medical School. Boston, MA, 02446
| | - John Torous
- Division of Digital Psychiatry. Department of Psychiatry. Beth Israel Deaconess Medical Center. Harvard Medical School. Boston, MA, 02446
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281
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Gratzer D, Goldbloom D. Therapy and E-therapy-Preparing Future Psychiatrists in the Era of Apps and Chatbots. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:231-234. [PMID: 31898301 DOI: 10.1007/s40596-019-01170-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 12/11/2019] [Indexed: 06/10/2023]
Affiliation(s)
- David Gratzer
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - David Goldbloom
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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282
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Kornfield R, Zhang R, Nicholas J, Schueller SM, Cambo SA, Mohr DC, Reddy M. "Energy is a Finite Resource": Designing Technology to Support Individuals across Fluctuating Symptoms of Depression. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2020; 2020:10.1145/3313831.3376309. [PMID: 33585841 PMCID: PMC7877799 DOI: 10.1145/3313831.3376309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
While the HCI field increasingly examines how digital tools can support individuals in managing mental health conditions, it remains unclear how these tools can accommodate these conditions' temporal aspects. Based on weekly interviews with five individuals with depression, conducted over six weeks, this study identifies design opportunities and challenges related to extending technology-based support across fluctuating symptoms. Our findings suggest that participants perceive events and contexts in daily life to have marked impact on their symptoms. Results also illustrate that ebbs and flows in symptoms profoundly affect how individuals practice depression self-management. While digital tools often aim to reach individuals while they feel depressed, we suggest they should also engage individuals when they are less symptomatic, leveraging their energy and motivation to build habits, establish plans and goals, and generate and organize content to prepare for symptom onset.
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Affiliation(s)
| | | | - Jennifer Nicholas
- Northwestern University Chicago, IL, USA
- University of Melbourne Melbourne, Australia
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283
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Direct-to-consumer digital health. LANCET DIGITAL HEALTH 2020; 2:e163-e165. [PMID: 33328077 DOI: 10.1016/s2589-7500(20)30057-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/13/2020] [Accepted: 02/19/2020] [Indexed: 02/05/2023]
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284
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Abstract
The constant growth and widespread availability of mobile technologies (i.e. smartphones and wearables) over the last decades have been a subject of intense interest and research in the affective disorders (AD) field. The potential of mHealth for collecting a new kind of passive and active information while providing cost-effective and tailored interventions have raised many hopes. However, until now, despite some encouraging results, research in the field has not been translated to reach real-world clinical settings or to develop additional evidence-based mHealth tools for people suffering from AD. Meanwhile, commercial untested apps and wearables are already being increasingly used and adopted by patients for the self-management of their illnesses. Hence, there is a latent need and demand from service users to integrate mHealth in their care, which the field cannot yet fulfil. In this article, through a focused narrative review, we discuss the evidence available for the use, validity and efficacy of mHealth tools in AD. Challenges in the academic field hampering the advancement of these technologies and its implementation into clinical practice are discussed. Lastly, we propose a framework to overcome these issues, which may facilitate mHealth solutions reaching service users.
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285
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Torous J, Lipschitz J, Ng M, Firth J. Dropout rates in clinical trials of smartphone apps for depressive symptoms: A systematic review and meta-analysis. J Affect Disord 2020; 263:413-419. [PMID: 31969272 DOI: 10.1016/j.jad.2019.11.167] [Citation(s) in RCA: 207] [Impact Index Per Article: 51.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/13/2019] [Accepted: 11/30/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Low engagement and attrition from app interventions is an increasingly recognized challenge for interpreting and translating the findings from digital health research. Focusing on randomized controlled trials (RCTs) of smartphone apps for depressive symptoms, we aimed to establish overall dropout rates, and how this differed between different types of apps. METHODS A systematic review of RCTs of apps targeting depressive symptoms in adults was conducted in May 2019. Random-effects meta-analysis were applied to calculate the pooled dropout rates in intervention and control conditions. Trim-and-fill analyses were used to adjust estimates after accounting for publication bias. RESULTS The systematic search retrieved 2,326 results. 18 independent studies were eligible for inclusion, using data from 3,336 participants randomized to either smartphone interventions for depression (n = 1,786) or control conditions (n = 1,550). The pooled dropout rate was 26.2%. This increased to 47.8% when adjusting for publication bias. Study retention rates did not differ between depression vs. placebo apps, clinically-diagnosed vs. self-reported depression, paid vs. unpaid assessments, CBT vs. non-CBT apps, or mindfulness vs. non-mindfulness app studies. Dropout rates were higher in studies with large samples, but lower in studies offering human feedback and in-app mood monitoring. DISCUSSION High dropout rates present a threat to the validity of RCTs of mental health apps. Strategies to improve retention may include providing human feedback, and enabling in-app mood monitoring. However, it critical to consider bias when interpreting results of apps for depressive symptoms, especially given the strong indication of publication bias, and the higher attrition in larger studies.
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Affiliation(s)
- John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Jessica Lipschitz
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Michelle Ng
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Joseph Firth
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; NICM Health Research Institute, Western Sydney University, Westmead, Australia.
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286
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Pywell J, Vijaykumar S, Dodd A, Coventry L. Barriers to older adults' uptake of mobile-based mental health interventions. Digit Health 2020; 6:2055207620905422. [PMID: 32110429 PMCID: PMC7016304 DOI: 10.1177/2055207620905422] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 01/14/2020] [Indexed: 11/29/2022] Open
Abstract
Background To address increasing demand of mental healthcare treatments for older adults and the need to reduce delivery costs, healthcare providers are turning to mobile applications. The importance of psychological barriers have been highlighted in the uptake of mobile-based mental health interventions and efforts have been made to identify these barriers in order to facilitate initial uptake and acceptance. However, limited research has focused on older adults’ awareness of these applications and factors that might be hindering their use. Objective The purpose of this study was to explore the perceived barriers that older adults experience in the uptake of mobile-based mental health interventions. Methods Semi-structured interviews were conducted with a sample of 10 older adults, 50 years or older (female = 7, mean age = 68 years), who experienced periods of low mood. National Health Service applications were demonstrated to facilitate conversation and explore participants’ understanding of mental health and mobile-based mental health interventions. Thematic analysis was used to analyse the interview transcripts. Results The social ecological model was adopted as an organising framework for the thematic analysis which identified six distinct barriers to older adults’ uptake of mobile-based mental health interventions: mental electronic-health (e-health) awareness, interaction with technology, discontinuation, ‘seeing’ facilitates therapeutic alliance, incongruent role of the general practitioner and privacy and confidentiality. Conclusions Older adults experience a number of barriers to uptake ranging from the individual level to a macro, organisational level. The practical implications of these barriers are discussed such as the need for increased awareness of mobile-based mental health interventions among older adults.
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Affiliation(s)
- Jake Pywell
- Jake Pywell, PaCT Lab, Northumberland Building, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK.
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287
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Mei C, Fitzsimons J, Allen N, Alvarez-Jimenez M, Amminger GP, Browne V, Cannon M, Davis M, Dooley B, Hickie IB, Iyer S, Killackey E, Malla A, Manion I, Mathias S, Pennell K, Purcell R, Rickwood D, Singh SP, Wood SJ, Yung A, McGorry PD. Global research priorities for youth mental health. Early Interv Psychiatry 2020; 14:3-13. [PMID: 31960595 DOI: 10.1111/eip.12878] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 07/16/2019] [Accepted: 09/12/2019] [Indexed: 12/11/2022]
Abstract
AIM Over the past two decades, the youth mental health field has expanded and advanced considerably. Yet, mental disorders continue to disproportionately affect adolescents and young adults. Their prevalence and associated morbidity and mortality in young people have not substantially reduced, with high levels of unmet need and poor access to evidence-based treatments even in high-income countries. Despite the potential return on investment, youth mental disorders receive insufficient funding. Motivated by these continual disparities, we propose a strategic agenda for youth mental health research. METHOD Youth mental health experts and funders convened to develop youth mental health research priorities, via thematic roundtable discussions, that address critical evidence-based gaps. RESULTS Twenty-one global youth mental health research priorities were developed, including population health, neuroscience, clinical staging, novel interventions, technology, socio-cultural factors, service delivery, translation and implementation. CONCLUSIONS These priorities will focus attention on, and provide a basis for, a systematic and collaborative strategy to globally improve youth mental health outcomes.
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Affiliation(s)
- Cristina Mei
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Joanna Fitzsimons
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Nicholas Allen
- Department of Psychology, University of Oregon, Eugene, Oregon
| | - Mario Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Günter Paul Amminger
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Vivienne Browne
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maryann Davis
- Transitions to Adulthood Center for Research, Systems and Psychosocial Advances Research Center, Department of Psychiatry, University of Massachusetts Medical School, Shrewsbury, Massachusetts
| | - Barbara Dooley
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Ian B Hickie
- Youth Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Srividya Iyer
- Department of Psychiatry, McGill University, Montreal, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada.,ACCESS Open Minds (Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Canada.,Frayme, International Knowledge Translation Platform, Ottawa, Canada
| | - Eóin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Ashok Malla
- Department of Psychiatry, McGill University, Montreal, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada.,ACCESS Open Minds (Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Canada
| | - Ian Manion
- Frayme, International Knowledge Translation Platform, Ottawa, Canada.,Royal Ottawa Hospital, Institute of Mental Health Research, University of Ottawa, Ottawa, Canada
| | - Steve Mathias
- Frayme, International Knowledge Translation Platform, Ottawa, Canada.,Foundry, Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Kerryn Pennell
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Rosemary Purcell
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia.,Frayme, International Knowledge Translation Platform, Ottawa, Canada
| | - Debra Rickwood
- Headspace National Youth Mental Health Foundation, Melbourne, Australia.,Faculty of Health, University of Canberra, Canberra, Australia
| | - Swaran P Singh
- Centre for Mental Health and Wellbeing Research, University of Warwick, Coventry, UK
| | - Stephen J Wood
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia.,School of Psychology, University of Birmingham, Birmingham, UK
| | - Alison Yung
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
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288
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Multiple uses of app instead of using multiple apps - a case for rethinking the digital health technology toolbox. Epidemiol Psychiatr Sci 2020; 29:e100. [PMID: 32000876 PMCID: PMC7216034 DOI: 10.1017/s2045796020000013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
There are tens of thousands of mental health-related apps available today - representing extreme duplication in this digital age. Instead of a plethora of apps, there is a need for a few that meet the needs of many. Focusing on transparency and free sharing of software, we argue that a collaborative approach towards apps can advance care through creating customisable and future proofed digital tools that allow all stakeholders to engage in their design and use.
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289
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Murphy C, Thorpe L, Trefusis H, Kousoulis A. Unlocking the potential for digital mental health technologies in the UK: a Delphi exercise. BJPsych Open 2020; 6:e12. [PMID: 31987060 PMCID: PMC7001470 DOI: 10.1192/bjo.2019.95] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Digitally enabled services can contribute to the support, treatment and prevention of mental health difficulties; however, questions remain regarding how we can most usefully harness such technology in primary and secondary mental healthcare settings. AIMS To identify barriers and facilitators to enable the potential of digital mental health in England, Scotland, Wales and Northern Ireland. METHOD A three-round Delphi exercise was carried out online with 16 participants from across the four nations of the UK representing the following stakeholder groups: service providers, health professionals, policymakers, lived experience, small and medium enterprises and academics. Qualitative data were collected in the first round (80 fragments) that were then coded to produce a 26-item round-two questionnaire for participant rating. Participants were given the opportunity to reconsider their scores in light of the group responses in round three. RESULTS Eight statements under the following five themes reached consensus with median scores between 8 and 10 (i.e. important/very important): co-production; the human element; data security; funding; and regulation. CONCLUSIONS The Delphi process allowed consensus to be achieved regarding the factors that experts consider important for harnessing technology in primary and secondary mental healthcare. Knowledge of these factors can help users and providers of mental health services negotiate how best to move forward with digitally enabled systems of care.
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Affiliation(s)
- Clare Murphy
- Digital Research and Policy Officer, The Mental Health Foundation, UK
| | - Lucy Thorpe
- Head of Policy, The Mental Health Foundation, UK
| | - Harriet Trefusis
- Digital Research and Policy Assistant, The Mental Health Foundation, UK
| | - Antonis Kousoulis
- Director of England and Wales, Development and Delivery, The Mental Health Foundation, UK
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290
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A Narrative Review of Methods for Applying User Experience in the Design and Assessment of Mental Health Smartphone Interventions. Int J Technol Assess Health Care 2020; 36:64-70. [DOI: 10.1017/s0266462319003507] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AbstractObjectivesUser experience (UX) plays a key role in uptake and usage of mental health smartphone interventions, yet remains underinvestigated. This review aimed to characterize and compare UX evaluation approaches that have been applied in this specific context, and to identify implications for research and practice.MethodsA narrative review was conducted of UX-themed studies published in PubMed, PsycINFO, and Scopus up to February 2019. Eligible studies reported on data reflecting users' interactions with a smartphone intervention for any mental health condition. Studies were categorized into “situated” versus “construct-based” methods according to whether or not an established UX construct was used to acquire and analyze data.ResultsSituated approaches used bespoke UX metrics, including quantitative measures of usage and performance, as well as grounded interview data. Construct-based approaches such as assessments of usability and acceptability were based on conceptual frameworks, with methodologically stronger versions featuring construct definitions, validated measurement tools, and an ability to compare data across studies. Constructs and measures were sometimes combined to form bespoke construct-based approaches.ConclusionsBoth situated and construct-based UX data may provide benefits during design and implementation of a mental health smartphone intervention by helping to clarify the needs of users and the impact of new features. Notable however was the omission of UX methods, such as split testing. Future research should consider these unaddressed methods, aim to improve the rigor of UX assessment, integrate their use alongside clinical outcomes, and explore UX assessment of more complex, adaptive interventions.
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291
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Abstract
Mental health applications hold great promise as interventions for addressing common mental issues. Although many people with mental health issues use mobile app interventions, their adherence level remains low. Low engagement affects the effectiveness of mobile interventions. However, there is still a dearth of research to explain the reasons for low engagement. User experience and usability are two factors that determine the adoption and usage of apps. Analyzing user reviews of mobile apps for mental health issues reveals user experience and what features users liked and disliked in the apps and hence informs future app design and refinements. This research aims to analyze user reviews of publicly available mental health applications to uncover their strengths, weaknesses, and gaps, hence revealing why users are likely to cease using these applications. We mined reviews of 106 mental health apps retrieved from Apple's App Store and Google Play and employed thematic analysis on 13,549 reviews. The review analysis shows that users placed more emphasis on the user interface and the user-friendliness of the app. Users also appreciated apps that present them with a variety of options, functionalities, and content that they can choose. Again, apps that offer adaptive functionalities that allow users to adapt some app features also received high ratings. In contrast, poor usability emerged as the most common reason for abandoning mental health apps. Other pitfalls include lack of a content variety, lack of personalization, lack of customer service and trust, and security and privacy issues.
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Affiliation(s)
- Felwah Alqahtani
- Dalhousie University, Canada; King Khalid University, Saudi Arabia
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292
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Inal Y, Wake JD, Guribye F, Nordgreen T. Usability Evaluations of Mobile Mental Health Technologies: Systematic Review. J Med Internet Res 2020; 22:e15337. [PMID: 31904579 PMCID: PMC6971511 DOI: 10.2196/15337] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 12/31/2022] Open
Abstract
Background Many mobile health (mHealth) apps for mental health have been made available in recent years. Although there is reason to be optimistic about their effect on improving health and increasing access to care, there is a call for more knowledge concerning how mHealth apps are used in practice. Objective This study aimed to review the literature on how usability is being addressed and measured in mHealth interventions for mental health problems. Methods We conducted a systematic literature review through a search for peer-reviewed studies published between 2001 and 2018 in the following electronic databases: EMBASE, CINAHL, PsycINFO, PubMed, and Web of Science. Two reviewers independently assessed all abstracts against the inclusion and exclusion criteria, following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Results A total of 299 studies were initially identified based on the inclusion keywords. Following a review of the title, abstract, and full text, 42 studies were found that fulfilled the criteria, most of which evaluated usability with patients (n=29) and health care providers (n=11) as opposed to healthy users (n=8) and were directed at a wide variety of mental health problems (n=24). Half of the studies set out to evaluate usability (n=21), and the remainder focused on feasibility (n=10) or acceptability (n=10). Regarding the maturity of the evaluated systems, most were either prototypes or previously tested versions of the technology, and the studies included few accounts of sketching and participatory design processes. The most common reason referred to for developing mobile mental health apps was the availability of mobile devices to users, their popularity, and how people in general became accustomed to using them for various purposes. Conclusions This study provides a detailed account of how evidence of usability of mHealth apps is gathered in the form of usability evaluations from the perspective of computer science and human-computer interaction, including how users feature in the evaluation, how the study objectives and outcomes are stated, which research methods and techniques are used, and what the notion of mobility features is for mHealth apps. Most studies described their methods as trials, gathered data from a small sample size, and carried out a summative evaluation using a single questionnaire, which indicates that usability evaluation was not the main focus. As many studies described using an adapted version of a standard usability questionnaire, there may be a need for developing a standardized mHealth usability questionnaire.
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Affiliation(s)
- Yavuz Inal
- Department of Information Science and Media Studies, University of Bergen, Bergen, Norway
| | | | - Frode Guribye
- Department of Information Science and Media Studies, University of Bergen, Bergen, Norway
| | - Tine Nordgreen
- Psychiatric Division, Haukeland University Hospital, Bergen, Norway
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293
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Wilhelm S, Weingarden H, Greenberg JL, McCoy TH, Ladis I, Summers BJ, Matic A, Harrison O. Development and Pilot Testing of a Cognitive-Behavioral Therapy Digital Service for Body Dysmorphic Disorder. Behav Ther 2020; 51:15-26. [PMID: 32005333 DOI: 10.1016/j.beth.2019.03.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/14/2019] [Accepted: 03/08/2019] [Indexed: 10/26/2022]
Abstract
Body dysmorphic disorder (BDD) has a severe presentation and chronic course when untreated. Although effective BDD treatments exist, most individuals do not have access to them. We therefore developed and pilot tested the first smartphone-delivered individual cognitive-behavioral therapy (CBT) treatment for adults with BDD. The digital service was developed via user-centered design, integrating input from engineering, design, and psychology experts, plus BDD patient consultants. We conducted a 12-week open pilot trial (N = 10) to describe preliminary results for feasibility, acceptability, and treatment outcome. Attrition rates (0%) and feedback on usability and satisfaction indicated that smartphone-based CBT for BDD may be feasible, acceptable, and satisfactory. Initial results suggest that smartphone-based CBT for BDD may hold promise for improving BDD symptom severity, BDD-related insight, functional impairment, and quality of life, as scores from baseline to posttreatment improved with large-to-very large effects; depression improved with a medium effect. Ninety percent of participants were responders at posttreatment and 3-month follow-up. Smartphone-based CBT for BDD may have strong potential as a standardized, low cost, and accessible treatment for this debilitating illness. A test of efficacy is merited as a next step, using a well-powered, randomized control trial design.
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Affiliation(s)
| | | | | | | | - Ilana Ladis
- Massachusetts General Hospital/Harvard Medical School
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294
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Morton E, Barnes SJ, Michalak EE. Participatory digital health research: A new paradigm for mHealth tool development. Gen Hosp Psychiatry 2020; 66:67-69. [PMID: 32702489 PMCID: PMC7354771 DOI: 10.1016/j.genhosppsych.2020.07.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/08/2020] [Accepted: 07/08/2020] [Indexed: 01/29/2023]
Affiliation(s)
- Emma Morton
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
| | - Steven J Barnes
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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295
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Wilhelm S, Weingarden H, Ladis I, Braddick V, Shin J, Jacobson NC. Cognitive-Behavioral Therapy in the Digital Age: Presidential Address. Behav Ther 2020; 51:1-14. [PMID: 32005328 PMCID: PMC7155747 DOI: 10.1016/j.beth.2019.08.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 12/11/2022]
Abstract
Our field has come a long way in establishing cognitive-behavioral therapy as the empirically supported treatment of choice for a wide range of mental and behavioral health problems. Nevertheless, most individuals with mental disorders do not receive any care at all, and those who do often have difficulty accessing care that is consistently high in quality. Addressing these issues is complex and costly and thus progress has been slow. We are entering an exciting stage in which emerging technologies might offer novel solutions to the treatment gap. This paper discusses a number of technology-enabled solutions to our field's challenges, including Internet-based and smartphone-based cognitive-behavioral therapy. Nevertheless, we must remain attentive to potential pitfalls of these emerging technologies. The paper incorporates suggestions for how the field may approach these potential pitfalls and provides a vision for how we might develop powerful, scalable, precisely timed, personalized interventions to enhance global mental health.
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Affiliation(s)
| | | | - Ilana Ladis
- Massachusetts General Hospital/Harvard Medical School
| | | | - Jin Shin
- Massachusetts General Hospital/Harvard Medical School
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296
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Alhuwail D, Albaj R, Ahmad F, Aldakheel K. The state of mental digi-therapeutics: A systematic assessment of depression and anxiety apps available for Arabic speakers. Int J Med Inform 2019; 135:104056. [PMID: 31918341 DOI: 10.1016/j.ijmedinf.2019.104056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 11/10/2019] [Accepted: 12/17/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Mental disorders are a major public health problem leading to premature mortality, homelessness, addiction problems, poor physical health, and suicide. The prevalence of mental disorders in Arab countries, is high. The proliferation and ubiquity of smartphones and their apps in the Arab world may be the long-awaited for digital therapeutic for mental health disorders. However, the evidence about the availability and characteristics of mental health apps available to Arabic speakers remains poor. OBJECTIVE To conduct a systematic assessment of the features of depression and anxiety mobile apps available for Arabic speakers. METHODS A critical review of all the currently available depression and anxiety apps, available free of charge to Arabic speakers. The apps are evaluated using the Mobile App Rating Scale (MARS). Further, a categorization of apps' main functions, inspired by the mhGAP guidelines, is developed to classify the apps based on their main functions. RESULTS A total of 23 apps are identified with far more apps available on the Google Play Store (n = 21) versus only two apps on the iOS App Store. The majority of the apps (n = 16) provide general information about either anxiety, depression, or both. Six apps are of spiritual nature mainly referring to the Islamic faith and the Holy Quran, with one app referring to the Christian faith. Another five apps provide advice on alternative treatments, mainly concerning herbal medicine recipes. Only two apps provided utilities for users, specifically about medication reminders. CONCLUSIONS Mental health digi-threaputics have huge potentials to transform mental health care delivery. However, more empirical studies are needed to assure their quality and efficacy. The results of this study clearly highlight the current gaps to address the needs of Arabic speakers; only 23 apps were identified in this study, mostly with low app quality scores. There is a need to involve expert healthcare professionals in the development of mental health apps and for healthcare providers to empower patients through discussing apps that are useful and discern them from those that can potentially cause harm.
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Affiliation(s)
- Dari Alhuwail
- Information Science Department, Kuwait University, Kuwait; Health Informatics Unit, Dasman Diabetes Institute, Kuwait.
| | - Rama Albaj
- Information Science Department, Kuwait University, Kuwait
| | - Fatma Ahmad
- Information Science Department, Kuwait University, Kuwait
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297
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Zhang R, Nicholas J, Knapp AA, Graham AK, Gray E, Kwasny MJ, Reddy M, Mohr DC. Clinically Meaningful Use of Mental Health Apps and its Effects on Depression: Mixed Methods Study. J Med Internet Res 2019; 21:e15644. [PMID: 31859682 PMCID: PMC6942194 DOI: 10.2196/15644] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/04/2019] [Accepted: 10/20/2019] [Indexed: 02/06/2023] Open
Abstract
Background User engagement is key to the effectiveness of digital mental health interventions. Considerable research has examined the clinical outcomes of overall engagement with mental health apps (eg, frequency and duration of app use). However, few studies have examined how specific app use behaviors can drive change in outcomes. Understanding the clinical outcomes of more nuanced app use could inform the design of mental health apps that are more clinically effective to users. Objective This study aimed to classify user behaviors in a suite of mental health apps and examine how different types of app use are related to depression and anxiety outcomes. We also compare the clinical outcomes of specific types of app use with those of generic app use (ie, intensity and duration of app use) to understand what aspects of app use may drive symptom improvement. Methods We conducted a secondary analysis of system use data from an 8-week randomized trial of a suite of 13 mental health apps. We categorized app use behaviors through a mixed methods analysis combining qualitative content analysis and principal component analysis. Regression analyses were used to assess the association between app use and levels of depression and anxiety at the end of treatment. Results A total of 3 distinct clusters of app use behaviors were identified: learning, goal setting, and self-tracking. Each specific behavior had varied effects on outcomes. Participants who engaged in self-tracking experienced reduced depression symptoms, and those who engaged with learning and goal setting at a moderate level (ie, not too much or not too little) also had an improvement in depression. Notably, the combination of these 3 types of behaviors, what we termed “clinically meaningful use,” accounted for roughly the same amount of variance as explained by the overall intensity of app use (ie, total number of app use sessions). This suggests that our categorization of app use behaviors succeeded in capturing app use associated with better outcomes. However, anxiety outcomes were neither associated with specific behaviors nor generic app use. Conclusions This study presents the first granular examination of user interactions with mental health apps and their effects on mental health outcomes. It has important implications for the design of mobile health interventions that aim to achieve greater user engagement and improved clinical efficacy.
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Affiliation(s)
- Renwen Zhang
- Department of Communication Studies, Northwestern University, Evanston, IL, United States
| | - Jennifer Nicholas
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Ashley A Knapp
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Andrea K Graham
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Elizabeth Gray
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Mary J Kwasny
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Madhu Reddy
- Department of Communication Studies, Northwestern University, Evanston, IL, United States.,Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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298
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Willcox JC, Dobson R, Whittaker R. Old-Fashioned Technology in the Era of "Bling": Is There a Future for Text Messaging in Health Care? J Med Internet Res 2019; 21:e16630. [PMID: 31859678 PMCID: PMC6942182 DOI: 10.2196/16630] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/26/2019] [Accepted: 12/09/2019] [Indexed: 01/20/2023] Open
Abstract
In the quest to discover the next high-technology solution to solve many health problems, proven established technologies are often overlooked in favor of more "technologically advanced" systems that have not been fully explored for their applicability to support behavior change theory, or used by consumers. Text messages or SMS is one example of an established technology still used by consumers, but often overlooked as part of the mobile health (mHealth) toolbox. The purpose of this paper is to describe the benefits of text messages as a health promotion modality and to advocate for broader scale implementation of efficacious text message programs. Text messaging reaches consumers in a ubiquitous real-time exchange, contrasting the multistep active engagement required for apps and wearables. It continues to be the most widely adopted and least expensive mobile phone function. As an intervention modality, text messaging has taught researchers substantial lessons about tailored interactive health communication; reach and engagement, particularly in low-resource settings; and embedding of behavior change models into digital health. It supports behavior change techniques such as reinforcement, prompts and cues, goal setting, feedback on performance, support, and progress review. Consumers have provided feedback to indicate that text messages can provide them with useful information, increase perceived support, enhance motivation for healthy behavior change, and provide prompts to engage in health behaviors. Significant evidence supports the effectiveness of text messages alone as part of an mHealth toolbox or in combination with health services, to support healthy behavior change. Systematic reviews have consistently reported positive effects of text message interventions for health behavior change and disease management including smoking cessation, medication adherence, and self-management of long-term conditions and health, including diabetes and weight loss. However, few text message interventions are implemented on a large scale. There is still much to be learned from investing in text messaging delivered research. When a modality is known to be effective, we should be learning from large-scale implementation. Many other technologies currently suffer from poor long-term engagement, the digital divide within society, and low health and technology literacy of users. Investing in and incorporating the learnings and lessons from large-scale text message interventions will strengthen our way forward in the quest for the ultimate digitally delivered behavior change model.
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Affiliation(s)
- Jane C Willcox
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Rosie Dobson
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
- Waitemata District Health Board, Auckland, New Zealand
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299
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Weisel KK, Fuhrmann LM, Berking M, Baumeister H, Cuijpers P, Ebert DD. Standalone smartphone apps for mental health-a systematic review and meta-analysis. NPJ Digit Med 2019; 2:118. [PMID: 31815193 PMCID: PMC6889400 DOI: 10.1038/s41746-019-0188-8] [Citation(s) in RCA: 170] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 10/24/2019] [Indexed: 12/11/2022] Open
Abstract
While smartphone usage is ubiquitous, and the app market for smartphone apps targeted at mental health is growing rapidly, the evidence of standalone apps for treating mental health symptoms is still unclear. This meta-analysis investigated the efficacy of standalone smartphone apps for mental health. A comprehensive literature search was conducted in February 2018 on randomized controlled trials investigating the effects of standalone apps for mental health in adults with heightened symptom severity, compared to a control group. A random-effects model was employed. When insufficient comparisons were available, data was presented in a narrative synthesis. Outcomes included assessments of mental health disorder symptom severity specifically targeted at by the app. In total, 5945 records were identified and 165 full-text articles were screened for inclusion by two independent researchers. Nineteen trials with 3681 participants were included in the analysis: depression (k = 6), anxiety (k = 4), substance use (k = 5), self-injurious thoughts and behaviors (k = 4), PTSD (k = 2), and sleep problems (k = 2). Effects on depression (Hedges’ g = 0.33, 95%CI 0.10–0.57, P = 0.005, NNT = 5.43, I2 = 59%) and on smoking behavior (g = 0.39, 95%CI 0.21–0.57, NNT = 4.59, P ≤ 0.001, I2 = 0%) were significant. No significant pooled effects were found for anxiety, suicidal ideation, self-injury, or alcohol use (g = −0.14 to 0.18). Effect sizes for single trials ranged from g = −0.05 to 0.14 for PTSD and g = 0.72 to 0.84 for insomnia. Although some trials showed potential of apps targeting mental health symptoms, using smartphone apps as standalone psychological interventions cannot be recommended based on the current level of evidence.
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Affiliation(s)
- Kiona K Weisel
- 1Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Lukas M Fuhrmann
- 1Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Berking
- 1Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Harald Baumeister
- 2Department of Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
| | - Pim Cuijpers
- 3Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,4Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - David D Ebert
- 1Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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300
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RABBI MASHFIQUI, LI KATHERINE, YAN HYANNA, HALL KELLY, KLASNJA PREDRAG, MURPHY SUSAN. ReVibe: A Context-assisted Evening Recall Approach to Improve Self-report Adherence. PROCEEDINGS OF THE ACM ON INTERACTIVE, MOBILE, WEARABLE AND UBIQUITOUS TECHNOLOGIES 2019; 3:1-27. [PMID: 34164595 PMCID: PMC8218636 DOI: 10.1145/3369806] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Besides passive sensing, ecological momentary assessments (EMAs) are one of the primary methods to collect in-the-moment data in ubiquitous computing and mobile health. While EMAs have the advantage of low recall bias, a disadvantage is that they frequently interrupt the user and thus long-term adherence is generally poor. In this paper, we propose a less-disruptive self-reporting method, "assisted recall," in which in the evening individuals are asked to answer questions concerning a moment from earlier in the day assisted by contextual information such as location, physical activity, and ambient sounds collected around the moment to be recalled. Such contextual information is automatically collected from phone sensor data, so that self-reporting does not require devices other than a smartphone. We hypothesized that providing assistance based on such automatically collected contextual information would increase recall accuracy (i.e., if recall responses for a moment match the EMA responses at the same moment) as compared to no assistance, and we hypothesized that the overall completion rate of evening recalls (assisted or not) would be higher than for in-the-moment EMAs. We conducted a two-week study (N=54) where participants completed recalls and EMAs each day. We found that providing assistance via contextual information increased recall accuracy by 5.6% (p = 0.032) and the overall recall completion rate was on average 27.8% (p < 0.001) higher than that of EMAs.
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Affiliation(s)
- MASHFIQUI RABBI
- Harvard University, 1 Oxford Street, Cambridge, MA, 02134, USA
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