Feasibility of computerized psychological testing with psychiatric outpatients

Usability evaluation of a web-based patient information system for individuals with severe mental health problems

AIM

This paper is a report of a study conducted to compare service users', nursing students' and Registered Nurses' evaluations of the usability of a patient education website intended for individuals with severe mental health problems.

BACKGROUND

There is an obvious need for reliable mental health information on the Internet. When evaluating the usability of Internet-based patient education methods, the opinions of all parties need to be ascertained.

METHODS

An explorative descriptive design was used. Twenty-one service users, 20 nursing students and 35 Registered Nurses were recruited for the study in 2003 and 2004. Data were collected using a self-developed questionnaire on the content, structure and visual appearance of the website.

RESULTS

Service users had positive attitudes towards computer and Internet use but they needed support when using the computer and Internet. According to the evaluations, the content, structure and visual appearance of the website were good and it could be adopted for clinical practise after minor revisions. There were some differences in the evaluations between participant groups. Nurses were the most critical group, and the service user group was the most satisfied, although they were less experienced with using both computers and the Internet.

CONCLUSION

It is especially important to include service users' evaluations at the early stages of the development process of Web-based patient education systems. It is possible to produce an information technology-based patient education system for individuals with severe mental health problems. Nurses working in psychiatric services need to pay more attention to supporting service users in computer and Internet use.

Computer-assisted assessment of depression and function in older primary care patients

We wanted to test the psychometric reliability and validity of self-reported information on psychological and functional status gathered by computer in a sample of primary care outpatients. Persons aged 65 years and older visiting a primary care medical practice in Baltimore (n=240) were approached. Complete baseline data were obtained for 54 patients and 34 patients completed 1-week retest follow-up. Standard instruments were administered by computer and also given as paper and pencil tests. Test-retest reliability estimates were calculated and comparisons across mode of administration were made. Separately, an interviewer administered a questionnaire to gauge patient attitudes and feelings after using the computer. Most participants (72%) reported no previous computer use. Nevertheless, inter-method reliability of the GDS15 at baseline (0.719, n=47), intra-method reliability of the computer in time (0.797, n=31), inter-method reliability of the CESDR20 at baseline (0.740, n=53), and the correlation between the CESDR20 computer version at baseline and follow-up (0.849, n=34) were all excellent. The inter-method reliability of the CESDR20 at follow-up (0.615, n=37) was lower but still acceptable. Although 28% were anxious prior to using the computer testing system, that percent decreased to 19% while using the system. The efficiency and reliability in comparison to the paper instruments were good or better. Even though most participants had not ever used a computer prior to participating in the study, they had generally favorable attitudes toward the use of computers, and also reported having favorable experience with the computer testing system.

The role of information technology in evidenced-based practice

Clinical Computing is a natural tool for evidence-based practice. Automated self-report produces accurate clinical assessments both in research and clinical settings, thus assuring that patients in each satisfy the same symptom criteria. The Electronic Medical Record (EMR) eventually will form a real-time Information bridge between research and clinical settings. Despite substantial literature demonstrating the efficacy of clinical computing in psychiatric care and research, however, psychiatrists have been slow to adopt computers, and research has dwindled. The steady emergence of system-wide EMRs, will spark a resurgence.

Bias in computerized neuropsychological assessment of depressive disorders caused by computer attitude

OBJECTIVE

Psychiatric patients are increasingly confronted to computerized psychological and psychopathological assessment. Patients' attitude to computers was reported to affect acceptance of computerized assessment.

METHOD

In 78 psychiatric in-patients neuropsychological impairment was examined following admission on an open ward by conventional as well as computerized memory and attention tasks. Besides psychopathological assessment, self ratings of computer attitude and acceptance of the computerized assessment were completed.

RESULTS

A more negative attitude to computers was found to be significantly correlated to higher nervousness in patients' self report (R=0.38, P=0.0005) as well as to poorer results of computerized attention tasks (R=0.39, P=0.0007). Particularly in patients with depressive disorders computer attitude could be shown to explain 39% of the variance of attention performance.

CONCLUSION

Results indicate a significant effect of negative computer attitude on acceptance and thus reliability of computerized examination, resulting in a bias in computerized attention-related assessment in patients with depressive disorders.

Computerized psychological test usage in APA-accredited training programs

Despite the advantages of computerized psychological assessment and the proliferation of assessment software, many psychologists still do not use computerized assessment, and its utilization has not increased during the past decade. Two-hundred-fifty-one APA-accredited training programs in clinical and counseling psychology were surveyed concerning their use of computerized psychological assessment. Directors reported a median of only three computerized tests used in their training programs. Twenty-five percent of the respondents reported no computerized psychological tests in their training programs. The computerized tests most-often used in psychology programs were compared to results of surveys of psychological tests most-often used in clinical practice.

Computerized self-assessment in psychiatric in-patients: acceptability, feasibility and influence of computer attitude

In recent years various approaches using computerized assessments and tests in psychiatry have been published. In our study, the acceptability and feasibility of computerized self-assessments and attitude to computers were examined in psychiatric in-patients, using an improved interactive schedule, the Interactive Self-Assessment Scale (ISAS), based on the Windows operating system. In general we found a good level of acceptability and feasibility of the computerized self-assessment. Our results confirm the influence of attitude to computers on acceptability, and indicate a lack of self-confidence in interacting with computers, accompanied by a less positive attitude to computers than reported by healthy subjects and psychiatric out-patients. Computerized self-assessment is suitable for psychiatric in-patients. Nevertheless, further research is necessary in order to improve attitude to computers and the patient-computer interaction.

Personality: individual differences and clinical assessment

Research in clinical personality assessment continues to be produced at a high rate. The MMPI/MMPI-2 remains the most popular instrument for both clinical application and psychopathology research. Two other clinical personality instruments, the Rorschach and TAT, continue to find a place in research and clinical assessment. Some new instruments have surfaced recently to deal with areas, such as personality disorders, that have been considered inadequately addressed. There is a growing recognition that the Five-Factor Model is too superficial for clinical assessment that requires more refined and broadened patient information. Clinical personality assessment has successfully survived a number of past challenges. The newest challenge stems from the health-care revolution, in which managed-care providers are reluctant to pay for assessment because of shrinking funds. Psychologists need to develop models for incorporating assessment information into the treatment process. The future is likely to see more extensive research and theoretical development in this endeavor.