1
|
von Ash T, Dunsiger SI, Williams DM, Larsen BA, Bohlen LC, Pekmezi D, Mendoza-Vasconez AS, Benitez TJ, Bock BC, Hartman SJ, Marquez B, Marcus BH. Pasos Hacia La Salud II: A Superiority RCT Utilizing Technology to Promote Physical Activity in Latinas. Am J Prev Med 2024; 67:220-230. [PMID: 38490284 DOI: 10.1016/j.amepre.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION Latinas face an increased risk for chronic diseases associated with insufficient physical activity (PA). The researchers previously showed that a website-based intervention could increase PA among insufficiently active Latinas, yet rates of meeting national PA guidelines were low. The original intervention was enhanced by adding additional features, content, and points of contact, including via text messaging. This study tests the efficacy of the enhanced intervention compared with the original, aimed at maximizing and sustaining PA gains across 24 months. It also examines if increases in PA differed by baseline PA. STUDY DESIGN The researchers conducted a superiority randomized controlled trial (data collected 2018-2022, analyzed 2023). SETTING/PARTICIPANTS Participants were 195 Spanish-speaking Latinas ages 18-65 in the Providence, RI area. INTERVENTION The original intervention is an empirically supported Spanish-language, individually-tailored, website-delivered PA intervention. The enhanced intervention includes text messaging and additional data-driven content and interactive features. MAIN OUTCOME MEASURES Total weekly minutes of moderate to vigorous PA (MVPA) was measured via accelerometry and self-report at 6, 12, 18, and 24 months. RESULTS Participants in both groups increased their MVPA over 24 months. There were no significant between-group differences at 6 or 12 months; at 18 months the enhanced intervention group had higher levels of self-reported (mean (sd): 90.35 (43.55) vs 70.18 [9.99]) and accelerometer-measured (66.21 [18.26] vs 60.27 [16.00]) MVPA compared to the original intervention group. They also had higher levels of self-reported (111.17 [23.35] vs 81.44 [1.82]) and accelerometer-measured (63.76 [15.12] vs 54.86 [14.59]) MVPA at 24 months. Baseline PA moderated the intervention effect. CONCLUSIONS This study demonstrates the potential to enhance the efficacy of website-based PA interventions by utilizing text messaging, and adding more interactive features, content, and phone support. These enhancements may be particularly beneficial in supporting long-term PA maintenance. TRIAL REGISTRATION This study is registered at www. CLINICALTRIAL gov (NCT03491592).
Collapse
Affiliation(s)
- Tayla von Ash
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island; Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island.
| | - Shira I Dunsiger
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island; Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island
| | - David M Williams
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island; Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island
| | - Britta A Larsen
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California
| | - Lauren Connell Bohlen
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island; Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island
| | - Dori Pekmezi
- Department of Health Behavior, The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama
| | - Andrea S Mendoza-Vasconez
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island; Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island
| | - Tanya J Benitez
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island; Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island
| | - Beth C Bock
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island; Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
| | - Sheri J Hartman
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California
| | - Becky Marquez
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California
| | - Bess H Marcus
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island; Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island
| |
Collapse
|
2
|
Bantjes J, Hunt X, Cuijpers P, Kazdin AE, Kennedy CJ, Luedtke A, Malenica I, Petukhova M, Sampson N, Zainal NH, Davids C, Dunn-Coetzee M, Gerber R, Stein DJ, Kessler RC. Comparative effectiveness of remote digital gamified and group CBT skills training interventions for anxiety and depression among college students: Results of a three-arm randomised controlled trial. Behav Res Ther 2024; 178:104554. [PMID: 38714104 DOI: 10.1016/j.brat.2024.104554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 04/19/2024] [Accepted: 05/01/2024] [Indexed: 05/09/2024]
Abstract
Digital interventions can enhance access to healthcare in under-resourced settings. However, guided digital interventions may be costly for low- and middle-income countries, despite their effectiveness. In this randomised control trial, we evaluated the effectiveness of two digital interventions designed to address this issue: (1) a Cognitive Behavioral Therapy Skills Training (CST) intervention that increased scalability by using remote online group administration; and (2) the SuperBetter gamified self-guided CBT skills training app, which uses other participants rather than paid staff as guides. The study was implemented among anxious and/or depressed South African undergraduates (n = 371) randomised with equal allocation to Remote Group CST, SuperBetter, or a MoodFlow mood monitoring control. Symptoms were assessed with the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Intention-to-treat analysis found effect sizes at the high end of prior digital intervention trials, including significantly higher adjusted risk differences (ARD; primary outcome) in joint anxiety/depression remission at 3-months and 6-months for Remote Group CST (ARD = 23.3-18.9%, p = 0.001-0.035) and SuperBetter (ARD = 12.7-22.2%, p = 0.047-0.006) than MoodFlow and mean combined PHQ-9/GAD-7 scores (secondary outcome) significantly lower for Remote Group CST and SuperBetter than MoodFlow. These results illustrate how innovative delivery methods can increase the scalability of standard one-on-one guided digital interventions. PREREGISTRATION INTERNATIONAL STANDARD RANDOMISED CONTROLLED TRIAL NUMBER (ISRTCN) SUBMISSION #: 47,089,643.
Collapse
Affiliation(s)
- Jason Bantjes
- Mental Health, Alcohol, Substance Use and Tobacco (MAST) Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, South Africa.
| | - Xanthe Hunt
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, South Africa
| | - Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Alan E Kazdin
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Chris J Kennedy
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Alex Luedtke
- Department of Statistics, University of Washington, Seattle, WA, USA; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ivana Malenica
- Department of Statistics, Harvard University, Cambridge, MA, USA
| | - Maria Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Nancy Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Nur Hani Zainal
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Charl Davids
- Centre for Student Counselling and Development, Student Affairs, Stellenbosch University, South Africa
| | - Munita Dunn-Coetzee
- Student Counselling and Development, University of the Free State, South Africa
| | - Rone Gerber
- Student Counselling and Development, University of Western Cape, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa; Department of Psychiatry, SAMRC Unit on Risk and Resilience in Mental Disorders, Stellenbosch University, South Africa
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
3
|
Prydz MB, Czajkowski NO, Eilertsen M, Røysamb E, Nes RB. A Web-Based Intervention Using "Five Ways to Wellbeing" to Promote Well-Being and Mental Health: Randomized Controlled Trial. JMIR Ment Health 2024; 11:e49050. [PMID: 38767958 PMCID: PMC11148523 DOI: 10.2196/49050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 10/15/2023] [Accepted: 03/09/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Compromised well-being and mental health problems pose a significant threat to individuals and societies worldwide. Resource-intensive psychological treatments alone cannot alleviate this burden. There is a need for low-cost, evidence-based interventions aimed at preventing illness and promoting well-being. Five activity domains appear to be linked with well-being promotion across populations: connecting with others, being active, taking notice, learning, and being generous/giving. The activities mentioned are part of the Five Ways to Wellbeing framework and the web-based intervention Five Ways to Wellbeing for All (5waysA). OBJECTIVE This randomized controlled trial aims to test the effects of the 5waysA intervention, a web-based, low-cost, well-being-promoting measure targeting the general population. To date, the Five Ways to Wellbeing framework has not been tested in this specific format. The 5waysA intervention comprises 2 webinars and SMS text message reminders delivered over a 10-week period. METHODS In 2021, a total of 969 study participants from various regions across Norway were openly recruited through a web page. They were then randomly assigned to either an intervention group or 1 of 2 waiting list control groups, namely, active or passive. Self-reported life satisfaction (Satisfaction With Life Scale [SWLS]), flourishing (Flourishing Scale [FS]), positive emotions, anxiety, and depression symptoms (Hopkins Symptom Checklist-8 [HSCL-8]) were assessed before the intervention, at 4 weeks into the intervention, and 1-2 weeks after the intervention (over 10 weeks). Data analysis was conducted using linear mixed (multilevel) models. RESULTS After 10 weeks, 453 participants (171 in the intervention group and 282 in the waiting list control group) were assessed on outcome variables, with a dropout rate of 53.2% (516/969). Results revealed a significantly greater increase in the intervention group compared with the controls for SWLS (b=0.13, 95% CI 0.03-0.23; P=.001), FS (b=0.19, 95% CI 0.08-0.30; P=.001), positive emotions (b=0.43, 95% CI 0.27-0.60; P<.001), and these factors combined into a global well-being measure (b=0.28, CI 0.16-0.39; P<.001). Effect sizes (Cohen d) for the well-being outcomes ranged from 0.30 to 0.49. In addition, a significant decrease in anxiety and depressive symptoms was observed (b=-0.17, 95% CI -0.30 to -0.04; P=.001) with an effect size (Cohen d) of -0.20. CONCLUSIONS The findings suggest that the web-based 5waysA intervention could serve as an effective approach for enhancing well-being and mental health within the general population. This study offers individuals, policy makers, and local stakeholders an accessible and potentially cost-effective well-being intervention that could be easily implemented. TRIAL REGISTRATION ClinicalTrials.gov NCT04784871; https://clinicaltrials.gov/study/NCT04784871.
Collapse
Affiliation(s)
- Monica Beer Prydz
- Promenta Research Centre, Department of Psychology, University of Oslo, Oslo, Norway
| | - Nikolai Olavi Czajkowski
- Promenta Research Centre, Department of Psychology, University of Oslo, Oslo, Norway
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, Oslo, Norway
| | - Maja Eilertsen
- Promenta Research Centre, Department of Psychology, University of Oslo, Oslo, Norway
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, Oslo, Norway
| | - Espen Røysamb
- Promenta Research Centre, Department of Psychology, University of Oslo, Oslo, Norway
- Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway
| | - Ragnhild Bang Nes
- Promenta Research Centre, Department of Psychology, University of Oslo, Oslo, Norway
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, Oslo, Norway
- Department of Philosophy, Classics, and History of Arts and Ideas, University of Oslo, Oslo, Norway
| |
Collapse
|
4
|
Smoktunowicz E, Maciejewski J, Lesnierowska M, Carlbring P. Bridging the adherence gap in internet interventions: A randomized controlled trial study protocol investigating context-specific self-efficacy. Internet Interv 2024; 35:100697. [PMID: 38149089 PMCID: PMC10750058 DOI: 10.1016/j.invent.2023.100697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 11/22/2023] [Accepted: 12/01/2023] [Indexed: 12/28/2023] Open
Abstract
Low adherence in self-guided internet interventions is linked to poorer outcomes. Although some predictors of adherence have been identified, few are modifiable for widespread application. One personal variable with the potential to increase adherence in internet interventions is context-specific self-efficacy. This protocol outlines a randomized controlled trial design, divided into two phases. In Phase 1 (students, N = 216), participants will complete a self-efficacy-enhancing exercise, which will be compared to a waitlist control group to test its effectiveness in increasing internet intervention adherence self-efficacy. Phase 2 will be the main two-arm trial, where all participants (medical students, N = 952) will undergo an internet intervention called Med-Stress Student. In the experimental group, the program will be preceded by the self-efficacy-enhancing exercise developed in Phase 1. We anticipate that participants in the experimental group will show higher adherence (primary outcome) to the intervention and greater improvement in intervention outcomes (secondary outcomes i.e., lower stress and higher work engagement) at posttest, as well as at six-month and one-year follow-ups. If effective, enhancing context-specific self-efficacy could be recommended before any internet intervention as a relatively simple way to boost participants' adherence.
Collapse
Affiliation(s)
- Ewelina Smoktunowicz
- StresLab Research Centre, Institute of Psychology, SWPS University, Warsaw, Poland
| | - Jan Maciejewski
- StresLab Research Centre, Institute of Psychology, SWPS University, Warsaw, Poland
| | | | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| |
Collapse
|
5
|
Welten JJE, Cox VCM, van Eijk RPA, van Heugten CM, Visser-Meily JMA, Schepers VPM. The Effects of a Blended Care Intervention in Partners of Patients With Acquired Brain Injury - Results of the CARE4Carer Randomized Controlled Trial. Arch Phys Med Rehabil 2024; 105:352-358. [PMID: 37690740 DOI: 10.1016/j.apmr.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/24/2023] [Accepted: 08/31/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To assess effects of the CARE4Carer blended care intervention on caregiver mastery and psychosocial functioning compared with usual care in partners of patients with acquired brain injury (ABI). DESIGN Multicenter randomized controlled trial. SETTING Nine sites for rehabilitation medicine. PARTICIPANTS 120 partners of outpatients with ABI were randomly allocated to blended care (N=59) or usual care (N=61). INTERVENTION The blended care intervention (20 weeks) was aimed at improving caregiving skills and consisted of 9 online sessions, combined with 2 face-to-face consultations with a social worker. MAIN OUTCOME MEASURES Mastery was assessed with the Caregiver Mastery Scale, secondary outcome measures were caregiver strain (Caregiver Strain Index), family functioning (Family Assessment Device), anxiety and depression (Hospital Anxiety and Depression Scale), burden (self-rated), and quality of life (CarerQol). Assessments were performed at baseline, 24, and 40 weeks. RESULTS The adjusted mean difference in caregiver mastery between intervention and control group at week 24 was 1.31 (SD3.48, 95% confidence interval (CI) -0.12 to 2.74, P=.072) and at week 40 was 1.31 (SD3.69, 95% CI -0.26 to 2.88, P=.100). In the per protocol analysis, the adjusted mean difference in caregiver mastery at week 24 was 1.53 (SD3.38, 95% CI 0.10 to 2.96, P=.036) and at week 40 was 1.57 (SD3.63, 95% CI 0.01 to 3.14, P=.049). Regarding secondary outcomes, caregiver strain was lower in the intervention group in the per protocol analysis at week 40. Family functioning was higher in the intervention group in week 24, whereas anxiety was lower at both timepoints. CONCLUSIONS In the subset of participants who were able to complete the intervention, caregiver mastery and psychosocial functioning improved. Future work should focus on improving adherence as this will optimize beneficial effects of blended care.
Collapse
Affiliation(s)
- Jennifer J E Welten
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
| | - Vincent C M Cox
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Ruben P A van Eijk
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Caroline M van Heugten
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands; School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands; Limburg Brain Injury Center, Maastricht, The Netherlands
| | - Johanna M A Visser-Meily
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vera P M Schepers
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
6
|
Amanvermez Y, Karyotaki E, Cuijpers P, Ciharova M, Donker M, Hurks P, Salemink E, Spinhoven P, Struijs S, de Wit LM. A Guided, Internet-Based Stress Management Intervention for University Students With High Levels of Stress: Feasibility and Acceptability Study. JMIR Form Res 2023; 7:e45725. [PMID: 37948106 PMCID: PMC10674149 DOI: 10.2196/45725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 06/26/2023] [Accepted: 08/31/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Transitioning to adulthood and challenges in university life can result in increased stress levels among university students. Chronic and severe stress is associated with deleterious psychological and physiological effects. Digital interventions could succeed in approaching and helping university students who might be at risk; however, the experiences of students with internet-based stress management interventions are insufficiently understood. OBJECTIVE This study aims to explore the feasibility; acceptability; and changes in perceived stress, depressive symptoms, and quality of life from baseline to posttest assessment of a 5-session, internet-based stress management intervention guided by an e-coach, developed for university students experiencing high levels of stress. METHODS A single-arm study was conducted. Students were recruited from different channels, mainly from a web survey. Students were eligible if they (1) scored ≥20 on the Perceived Stress Scale-10, (2) were aged ≥18 years, and (3) were studying at one of the participating universities. Feasibility and acceptability of the intervention were investigated using several indications, including satisfaction (Client Satisfaction Questionnaire-8) and usability (System Usability Scale-10). We also investigated the indicators of intervention adherence using use metrics (eg, the number of completed sessions). Our secondary goal was to explore the changes in perceived stress (Perceived Stress Scale-10), depressive symptoms (Patient Health Questionnaire-9), and quality of life (EQ-5D-5L scale) from baseline to posttest assessment. In addition, we conducted semistructured interviews with intervention completers and noncompleters to understand user experiences in depth. For all primary outcomes, descriptive statistics were calculated. Changes from baseline to posttest assessment were examined using 2-tailed paired sample t tests or the Wilcoxon signed rank test. Qualitative data were analyzed using thematic analysis. RESULTS Of 436 eligible students, 307 (70.4%) students started using the intervention. Overall, 25.7% (79/307) completed the core sessions (ie, sessions 1-3) and posttest assessment. A substantial proportion of the students (228/307, 74.3%) did not complete the core sessions or the posttest assessment. Students who completed the core sessions reported high satisfaction (mean 25.78, SD 3.30) and high usability of the intervention (mean 86.01, SD 10.25). Moreover, this group showed large reductions in perceived stress (Cohen d=0.80) and moderate improvements in depression score (Cohen d=0.47) and quality of life (Cohen d=-0.35) from baseline to posttest assessment. Qualitative findings highlight that several personal and intervention-related factors play a role in user experience. CONCLUSIONS The internet-based stress management intervention seems to be feasible, acceptable, and possibly effective for some university students with elevated stress levels. However, given the high dropout rate and qualitative findings, several adjustments in the content and features of the intervention are needed to maximize the user experience and the impact of the intervention. TRIAL REGISTRATION Netherlands Trial Register 8686; https://onderzoekmetmensen.nl/nl/trial/20889. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1016/j.invent.2021.100369.
Collapse
Affiliation(s)
- Yagmur Amanvermez
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Marianne Donker
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Petra Hurks
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Elske Salemink
- Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
| | | | - Sascha Struijs
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Leonore M de Wit
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| |
Collapse
|
7
|
Smoktunowicz E, Lesnierowska M, Ziolkowska J, Roczniewska M. Crossover of the dimensions of work-family and family-work conflict in couples: Protocol for a qualitative study. PLoS One 2023; 18:e0290216. [PMID: 37768912 PMCID: PMC10538721 DOI: 10.1371/journal.pone.0290216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 08/29/2023] [Indexed: 09/30/2023] Open
Abstract
Conflict between work and non-work is a bidirectional and a multidimensional construct that has garnered much attention from researchers and practitioners alike. Previously, studies with a dyadic design demonstrated that interrole conflict can cross over between partners in romantic relationships. The aim of the present study is to explore-from an individual and dyadic perspective-how partners perceive dimensions of interrole conflict (that is: time, strain, behaviour, and possibly others) and whether crossover between partners is dimension-dependent. This protocol outlines a qualitative interview study. Participants (N = 40) will be dual-earner couples that meet two inclusion criteria: both partners need to be professionally active, and the couples need to have lived together for at least a year. Interviews will be conducted separately with each partner. To analyse the data at the individual level we will use reflexive thematic analysis. To analyse the data at the dyadic level we will apply an adapted version of the framework method. We anticipate that findings of this study will have the potential to advance theoretical models depicting crossover processes and, more generally, the interface between work and family lives. Moreover, insights into how couples experience dimension-based interrole conflict will be important for the development of targeted interventions.
Collapse
Affiliation(s)
- Ewelina Smoktunowicz
- StresLab Research Centre, Institute of Psychology, SWPS University, Warsaw, Poland
| | | | | | - Marta Roczniewska
- Institute of Psychology, SWPS University, Sopot, Poland
- Procome Research Group, Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
8
|
Claessens JL, Maats EP, Iacob ME, Wisse RP, Jongsma KR. Introducing e-health technology to routine cataract care: patient perspectives on web-based eye test for postoperative telemonitoring. J Cataract Refract Surg 2023; 49:659-665. [PMID: 37010267 PMCID: PMC10284124 DOI: 10.1097/j.jcrs.0000000000001189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/23/2023] [Accepted: 03/23/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE To explore cataract patients' experiences with an e-health tool for self-assessing visual function (ie, a web-based eye test), and to formulate recommendations for its successful adoption in routine cataract care. SETTING Clinics in the Netherlands, Germany, and Austria. DESIGN Mixed-methods study. METHODS 22 participants were included in this study; in-depth interviews were conducted with 12. Questionnaires and in-depth semi-structured interviews were conducted alongside a multicenter randomized controlled trial evaluating the validity, safety and cost-effectiveness of remote care after cataract surgery (Cataract Online Refraction Evaluation, a Randomized Controlled Trial). Results were analyzed thematically. RESULTS Participants reported positively about performing the web-based eye test at home. 4 overarching themes were identified in the interviews. First, participants were inventive in overcoming practical barriers encountered while conducting the test. Second, participants desired a clear presentation of test results and their meaning. Third, the ability to self-monitor visual function was appreciated. Fourth, most participants preferred to keep the option to contact their eyecare professional (ECP) postoperatively, especially when experiencing symptoms. Most would be satisfied with a phone consultation or an e-consult. Participants reported positive experiences with the web-based eye test. Barriers for successful adoption were identified, including insecurity about correctly performing the test, incomplete information on how to interpret test results, and a feeling that in-hospital assessments were superior to remote assessments. CONCLUSIONS It is recommended to focus on building trust in remote eyecare delivery and that access to the ECP be retained when medically indicated or deemed necessary by the patient.
Collapse
Affiliation(s)
- Janneau L.J. Claessens
- From the Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands (Claessens, Wisse); Julius Center for Health Sciences and Primary Care, Department of Medical Humanities, University Medical Center Utrecht, Utrecht, the Netherlands (Maats, Jongsma); Department of Industrial Engineering and Business Information Systems, University of Twente, Enschede, the Netherlands (Iacob); Xpert Clinics Oogzorg, Zeist, the Netherlands (Wisse)
| | - Emma P.E. Maats
- From the Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands (Claessens, Wisse); Julius Center for Health Sciences and Primary Care, Department of Medical Humanities, University Medical Center Utrecht, Utrecht, the Netherlands (Maats, Jongsma); Department of Industrial Engineering and Business Information Systems, University of Twente, Enschede, the Netherlands (Iacob); Xpert Clinics Oogzorg, Zeist, the Netherlands (Wisse)
| | - Maria E. Iacob
- From the Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands (Claessens, Wisse); Julius Center for Health Sciences and Primary Care, Department of Medical Humanities, University Medical Center Utrecht, Utrecht, the Netherlands (Maats, Jongsma); Department of Industrial Engineering and Business Information Systems, University of Twente, Enschede, the Netherlands (Iacob); Xpert Clinics Oogzorg, Zeist, the Netherlands (Wisse)
| | - Robert P.L. Wisse
- From the Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands (Claessens, Wisse); Julius Center for Health Sciences and Primary Care, Department of Medical Humanities, University Medical Center Utrecht, Utrecht, the Netherlands (Maats, Jongsma); Department of Industrial Engineering and Business Information Systems, University of Twente, Enschede, the Netherlands (Iacob); Xpert Clinics Oogzorg, Zeist, the Netherlands (Wisse)
| | - Karin R. Jongsma
- From the Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands (Claessens, Wisse); Julius Center for Health Sciences and Primary Care, Department of Medical Humanities, University Medical Center Utrecht, Utrecht, the Netherlands (Maats, Jongsma); Department of Industrial Engineering and Business Information Systems, University of Twente, Enschede, the Netherlands (Iacob); Xpert Clinics Oogzorg, Zeist, the Netherlands (Wisse)
| |
Collapse
|
9
|
Han M, Lee K, Kim M, Heo Y, Choi H. Effects of a Metacognitive Smartphone Intervention With Weekly Mentoring Sessions for Individuals With Schizophrenia: A Quasi-Experimental Study. J Psychosoc Nurs Ment Health Serv 2023; 61:27-37. [PMID: 35858205 DOI: 10.3928/02793695-20220706-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Application (app)-based interventions using smartphones could provide effective alternatives to traditional treatment programs during and beyond the coronavirus disease 2019 pandemic. The current quasi-experimental study with a non-equivalent comparison group tested the effects of a smartphone app-based metacognitive intervention program with weekly mentoring sessions on the meta-cognitive beliefs, psychotic symptoms, and social functioning of individuals with schizophrenia from community psychosocial rehabilitation centers. The study was conducted with 20 participants with severe psychotic symptoms and low social functioning and 24 participants with relatively light psychotic symptoms and good social functioning as a comparison group. For the experimental group, the app-based intervention was combined with weekly contact mentoring sessions over 10 weeks. The comparison group received only the app-based intervention over 10 weekly sessions. No differences were observed between groups' total scores; however, the experimental group showed a tendency toward improved psychotic symptoms and social functioning over time, unlike the comparison group. These findings provide an empirical basis for managing schizophrenia symptoms with smartphone apps. [Journal of Psychosocial Nursing and Mental Health Services, 61(2), 27-37.].
Collapse
|
10
|
Cox NS, Eldridge B, Rawlings S, Dreger J, Corda J, Hauser J, Button BM, Bishop JR, Nichols A, Middleton A, Ward N, Dwyer T, Dentice R, Lazarus R, O'Halloran P, Lee JYT, Mellerick C, Mackintosh K, McNarry M, Williams CA, Holland AE. Web-based physical activity promotion in young people with CF: a randomised controlled trial. Thorax 2023; 78:16-23. [PMID: 36180067 DOI: 10.1136/thorax-2022-218702] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 09/13/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Physical activity levels are known to decline following hospitalisation for people with cystic fibrosis (pwCF). However, optimal physical activity promotion strategies are unclear. This study investigated the effect of a web-based application (ActivOnline) in promoting physical activity in young pwCF. METHODS Multicentre randomised controlled trial with assessor blinding and qualitative evaluation. People with CF (12-35 years) admitted to hospital for a respiratory cause were eligible and randomised to the 12-week ActivOnline intervention (AO) or usual care (UC). The primary outcome was change in device-based time spent in moderate-to-vigorous physical activity (MVPA) from baseline to post-intervention. Follow-up was at 6 months from hospital discharge when qualitative evaluation was undertaken. RESULTS 107 participants were randomised to AO (n=52) or UC (n=55). Sixty-three participants (59%) contributed to the intention-to-treat analysis. Mean (SD) age was 21 (6) years (n=46, <18 years). At baseline, physical activity levels were high in both groups (AO 102 (52) vs UC 127 (73) min/day). There was no statistically significant difference in MVPA between groups at either timepoint (post-intervention mean difference (95% CI) -14 mins (-45 to 16)). Uptake of the intervention was low with only 40% (n=21) of participants accessing the web application. CONCLUSION A web-based application, including individualised goal setting, real-time feedback and motivation for behavioural change, was no better than usual care at promoting physical activity in young pwCF following hospital discharge. High levels of baseline physical activity levels in both groups, and limited engagement with the intervention, suggest alternative strategies may be necessary to identify and support young pwCF who would benefit from enhanced physical activity. TRIAL REGISTRATION NUMBER ACTRN12617001009303, 13 July 13 2017.
Collapse
Affiliation(s)
- Narelle S Cox
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia .,Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Beverley Eldridge
- College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia.,Children's Medical Research Institute, Melbourne, Victoria, Australia
| | - Sarah Rawlings
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia.,Monash Health, Melbourne, Victoria, Australia
| | - Julianna Dreger
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Jennifer Corda
- Physiotherapy, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Jennifer Hauser
- Tasmanian Adult CF Service, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Brenda M Button
- Physiotherapy, Alfred Health, Melbourne, Victoria, Australia.,Allergy, Immunology and Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jennifer R Bishop
- Respiratory Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | | | - Anna Middleton
- Physiotherapy, Sydney Children's Hospital Network Westmead, Sydney, New South Wales, Australia
| | - Nathan Ward
- Physiotherapy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Tiffany Dwyer
- Discipline of Physiotherapy, Sydney School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.,Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Ruth Dentice
- Physiotherapy, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Raynuka Lazarus
- Respiratory Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Paul O'Halloran
- College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Joanna Y T Lee
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - Christie Mellerick
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | | | | | | | - Anne E Holland
- Respiratory Research@Alfred, Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia.,Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| | | |
Collapse
|
11
|
Schwartz H, McCusker J, Da Costa D, Singh S, Baskaran S, Belzile E, Van Roost K. A pilot randomized controlled trial of a lay telephone coaching and web-based intervention for postpartum depression and anxiety: The MPOWER study. Internet Interv 2022; 31:100597. [PMID: 36698424 PMCID: PMC9867972 DOI: 10.1016/j.invent.2022.100597] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 11/29/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Mental health problems are frequent in the postpartum period, but accessible treatment options are lacking. The MPOWER study investigated whether the use of trained lay coaches could increase the uptake and effectiveness of a web-based intervention (WBI) for women with postpartum depression and/or anxiety. OBJECTIVES First, to compare the feasibility and acceptability of a WBI for women with postpartum depression and anxiety, with and without the addition of telephone coaching calls. Second, to estimate the effectiveness of the WBI at decreasing symptoms of depression and anxiety at 6 months, with and without coaching calls. METHODS We conducted a pilot randomized controlled trial (RCT) that enrolled women who had recently given birth and had mild to moderate postpartum depression and/or anxiety. Study participants were provided access to the WBI. Women randomized to the intervention group also received up to 7 telephone coaching calls during the 6 months of follow up. We evaluated the feasibility of the intervention through participants' usage of the WBI, as well as the completion and fidelity of planned coach calls. We measured acceptability via two questionnaires on the usability of the WBI and participant satisfaction with the intervention. To determine the potential effectiveness of the intervention, the primary outcomes were defined as symptoms of depression and anxiety at 6 months and adjusted mean differences between groups for these outcomes were estimated using linear regression models. RESULTS We recruited 52 participants (25 intervention; 27 control). At 6 months, 88 % (22/25) of participants randomized to the intervention arm and 59 % (16/27) of participants randomized to the control arm remained in the study. The intervention group had an average of 11 (95 % CI: [5, 18]) more website logins than the control group. Intervention group participants completed a mean of 6.2 coaching calls with high fidelity. The estimates of the effect of the intervention on mental health outcomes at 6-months were imprecise but point estimates and confidence intervals were consistent with a moderate beneficial effect of the intervention on both symptoms of depression and anxiety (fully adjusted effects sizes: 0.51 (95 % CI: [-0.14, 1.17]) and 0.56 (95 % CI: [-0.09, 1.22]), respectively). CONCLUSIONS WBIs with coaching are feasible, acceptable, and potentially effective treatment options for women with mild to moderate postpartum depression and/or anxiety. The addition of coaching calls markedly increased engagement with the WBI, but a larger RCT is needed to determine the effectiveness of such an intervention.
Collapse
Affiliation(s)
- Hannah Schwartz
- St. Mary's Hospital Center, Montréal, QC, Canada,Department of Psychiatry, McGill University, Montréal, QC, Canada,Corresponding author at: St. Mary's Hospital Center, Department of Psychiatry, 3830 Avenue Lacombe, Montreal, Quebec H3T 1M5, Canada.
| | - Jane McCusker
- St. Mary's Research Centre, Montréal, QC, Canada,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, QC, Canada
| | | | - Santokh Singh
- St. Mary's Hospital Center, Montréal, QC, Canada,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | | | - Eric Belzile
- St. Mary's Research Centre, Montréal, QC, Canada
| | - Kaya Van Roost
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, QC, Canada
| |
Collapse
|
12
|
Terpstra JA, van der Vaart R, van Beugen S, van Eersel RA, Gkika I, Erdős D, Schmidt J, Radstake C, Kloppenburg M, van Middendorp H, Evers AW. Guided internet-based cognitive-behavioral therapy for patients with chronic pain: A meta-analytic review. Internet Interv 2022; 30:100587. [PMID: 36406977 PMCID: PMC9672957 DOI: 10.1016/j.invent.2022.100587] [Citation(s) in RCA: 6] [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: 08/04/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Chronic pain has a large individual and societal burden. Previous reviews have shown that internet-based cognitive-behavioral therapy (iCBT) can support patients' pain coping. However, factors related to participant experience of iCBT and effective and safe iCBT delivery for chronic pain have not recently been summarized. OBJECTIVE The aim of this review was to give an overview of the efficacy of guided iCBT for chronic pain on psychological, physical, and impact on daily life outcomes, including factors that inform optimal delivery. METHODS Cochrane, Emcare, Web of Science, PubMed, PsycINFO, and Embase were systematically searched from inception to 11 February 2022. Randomized controlled trials on guided iCBTs for adults with chronic pain were included with a broad range of outcomes. RESULTS The search yielded 7406 studies of which 33 studies were included totaling 5133 participants. ICBT was more effective than passive control conditions for psychological (ES = 0.34-0.47), physical (ES = 0.26-0.29), and impact outcomes (ES = 0.38-0.41). ICBT was more effective than active control conditions for distress (ES = 0.40), pain acceptance (ES = 0.15), and pain interference after outlier removal (ES = 0.30). Longer treatments were associated with larger effects for anxiety and quality of life than shorter treatments. Mode of therapist contact (synchronous, asynchronous or a mix of both) was not related to differences in effect sizes in most outcomes. However, studies with mixed and synchronous contact modes had higher effects on pain self-efficacy than studies with asynchronous contact modes. Treatment satisfaction was high and adverse events were minor. Dropout was related to time, health, technical issues, and lack of computer skills. CONCLUSIONS Guided iCBT is an effective and potentially safe treatment for chronic pain. Future research should more consistently report on iCBT safety and detail the effectiveness of individual treatment components to optimize iCBT in clinical practice.
Collapse
Affiliation(s)
- Jessy A. Terpstra
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands,Leiden University Medical Center, Department of Rheumatology, C1-R, PO Box 9600, 2300 RC Leiden, the Netherlands,Corresponding author at: Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, PO Box 9555, 2300 RB, Leiden, the Netherlands.
| | - Rosalie van der Vaart
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Sylvia van Beugen
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Roxy A. van Eersel
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Ioanna Gkika
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Dorottya Erdős
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Jana Schmidt
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Caroline Radstake
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Margreet Kloppenburg
- Leiden University Medical Center, Department of Rheumatology, C1-R, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Henriët van Middendorp
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Andrea W.M. Evers
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands,Leiden University Medical Center, Department of Psychiatry, B1-P, PO Box 9600, 2300 RC Leiden, the Netherlands,Medical Delta, Huismansingel 4, 2629 JH Delft, the Netherlands
| |
Collapse
|
13
|
Migliorini C, Lam DSM, Harvey C. Supporting family and friends of young people with mental health issues using online technology: A rapid scoping literature review. Early Interv Psychiatry 2022; 16:935-957. [PMID: 34729912 DOI: 10.1111/eip.13230] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/20/2021] [Accepted: 10/19/2021] [Indexed: 12/25/2022]
Abstract
AIM Family and friends are often the first and/or only support options used by young people (12-25 years) struggling with mental health issues. The overarching aim of this literature review is to map current practice in online interventions specifically targeting family and friends of young people with mental health issues, especially relevant in light of the current worldwide COVID-19 pandemic. METHODS A rapid scoping literature review was conducted searching health and psychology databases for online interventions targeting family and friends supporting a young person (12-25 years) struggling with a mental health issue. The search strategy was comprehensive and expert librarian endorsed. The final synthesis comprised 13 articles. RESULTS Identified articles were few, reporting a disparate range of research aims, intervention content and delivery modes. Studies addressing caregivers of adolescents with a mental health diagnosis were small-scale, although suggested virtual modalities are positively received and viable alternatives to other delivery methods with potential for equivalent outcomes. Five randomized control trials involving caregivers of 'at-risk' adolescents reported improved parental knowledge, but mixed effects on family functioning. CONCLUSIONS Preliminary evidence suggests flexible online options including professional and peer support, to respond to carers' busy lives are needed to maximize benefits. Content that is sufficiently individualized and targeted to address the diverse needs of parents, as well as other caregivers, is also required. Well-being and self-care, in addition to parenting skills should be given more consideration in online interventions. Examination of the value of support from peers is also warranted.
Collapse
Affiliation(s)
- Christine Migliorini
- Psychosocial Research Centre, NorthWestern Mental Health Service, Coburg, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Carol Harvey
- Psychosocial Research Centre, NorthWestern Mental Health Service, Coburg, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
14
|
Galffy M, Bichler C, Mohr T, Egeter J, Neu L, Oberhammer M, Högl B, Deisenhammer EA, Sperner-Unterweger B, Hüfner K. Adhoc Setup of an Online Mental Health Self-Help Program During the COVID-19 Pandemic: Description of the Development and Implementation Processes and Analysis of Its Users’ and Usage Profiles. Front Psychol 2022; 13:853371. [PMID: 35936283 PMCID: PMC9350598 DOI: 10.3389/fpsyg.2022.853371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/24/2022] [Indexed: 12/20/2022] Open
Abstract
BackgroundThe COVID-19 pandemic hit Austria in March 2020. This led to a considerable reduction in outpatient psychiatric therapies. People with mental disorders as well as with newly emerging mental health issues found themselves with very limited treatment options. Within only a few days our hospital set up an online mental health self-help program which went online in its first version on the first day of the lockdown in Austria. The process of this development and implementation process alongside with the user’s and usage data for the program are presented here.MethodsA small core team initiated the development of the program on a low-budget basis and using mostly freely available digital resources. The program had to be free of costs for its users and easy to navigate. Each self-help module contains a text description of the topic, a self-rating questionnaire and several psychoeducational 2–5 min videos. These videos explain, e.g., interactions of mental stress and the immune system or the vicious circle of anxiety. Additional videos provide easy to learn techniques like breathing and relaxation exercises.ResultsWe illustrate the implementation of this program following the replicating effective program (REP) model. We provide a detailed description of the implementation process starting from a simple website to a smartphone-based application with registered user area and instantaneous reporting of self-rating questionnaire results to users. The described process could be used as a model for the setup of similar programs in a very short time. As an indicator of acceptance, we report 46,100 unique video views and 3,937 completed questionnaires in the first year of use. The most accessed videos were those on anxiety, relaxation and resilience. Analysis of the sociodemographic user data indicate that they were mostly young (< 45 years; 59.7%), females (77.5%) and previously mentally healthy individuals (74.5%). An example of the collected psychometric questionnaire data over time is given.ConclusionWe show that it is possible to set up an online mental health self-help program ad hoc and without extensive prior planning, which enabled us to dynamically respond to a new situation. We are now planning on keeping the program active for a longer period of time to supplement and expand traditional treatment settings also outside the COVID-19 pandemic.
Collapse
Affiliation(s)
- Matyas Galffy
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Innsbruck Medical University, Innsbruck, Austria
| | - Carina Bichler
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Innsbruck Medical University, Innsbruck, Austria
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Thomas Mohr
- Center for Cancer Research, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Jonas Egeter
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Innsbruck Medical University, Innsbruck, Austria
| | - Leonie Neu
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Innsbruck Medical University, Innsbruck, Austria
| | - Maria Oberhammer
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry I, Innsbruck Medical University, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Eberhard A. Deisenhammer
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Innsbruck Medical University, Innsbruck, Austria
| | - Barbara Sperner-Unterweger
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Innsbruck Medical University, Innsbruck, Austria
| | - Katharina Hüfner
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Innsbruck Medical University, Innsbruck, Austria
- *Correspondence: Katharina Hüfner,
| |
Collapse
|
15
|
Brog NA, Hegy JK, Berger T, Znoj H. Age, Motivation, and Emotion Regulation Skills Predict Treatment Outcome in an Internet-Based Self-Help Intervention for COVID-19 Related Psychological Distress. Front Public Health 2022; 10:835356. [PMID: 35757638 PMCID: PMC9218094 DOI: 10.3389/fpubh.2022.835356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction First evidence suggests that internet-based self-help interventions effectively reduce COVID-19 related psychological distress. However, it is yet unclear which participant characteristics are associated with better treatment outcomes. Therefore, we conducted secondary analyses on data from a randomized controlled trial investigating the efficacy of a 3-week internet-based self-help intervention for COVID-19 related psychological distress. In this exploratory analysis, we examined several predictors ranging from sociodemographic variables to psychological distress, resource-related, and treatment-related variables. This includes, for example, age, motivation, and emotion regulation skills. Treatment outcomes were defined as post-treatment depressive symptoms and post-treatment resilience. Methods In a total of 107 participants with at least mild depressive symptoms, possible predictor variables and treatment outcomes were assessed using self-report measures. For example, emotion regulation skills were assessed by the Self-report measure for the assessment of emotion regulation skills. In a first step, we performed a separate linear regression analysis for each potential predictor. In a second step, predictors meeting a significant threshold of p < 0.05 were entered in linear multiple regression models. Baseline scores of the respective outcome measure were controlled for. Results The mean age of the participants was 40.36 years (SD = 14.59, range = 18–81 years) with the majority being female (n = 87, 81.3%). Younger age predicted lower post-treatment depressive symptoms. Additionally, higher motivation to use the intervention and better pre-treatment emotion regulation skills predicted higher post-treatment resilience. Conclusion The current study provides preliminary evidence regarding the relationship between participant characteristics and treatment outcome in internet-based self-help interventions for COVID-19 related distress. Our results suggest that under the circumstances surrounding COVID-19 such interventions might be particularly beneficial for young adults regarding depressive symptoms. Moreover, focusing on participants' existing strengths might be a promising approach to promote resilience through internet-based self-help interventions. However, since this was an exploratory analysis in an uncontrolled setting, further studies are needed to draw firm conclusions about the relationship of participant characteristics and treatment outcome in internet-based self-help interventions for COVID-19 related psychological distress.
Collapse
Affiliation(s)
- Noemi Anja Brog
- Department of Health Psychology and Behavioral Medicine, University of Bern, Bern, Switzerland
| | - Julia Katharina Hegy
- Department of Health Psychology and Behavioral Medicine, University of Bern, Bern, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Hansjörg Znoj
- Department of Health Psychology and Behavioral Medicine, University of Bern, Bern, Switzerland
| |
Collapse
|
16
|
Cimino S, Cerniglia L. The Effect of a Telehealth Intervention on Mother–Child’s Feeding Interactions During the COVID-19 Pandemic. Psychol Res Behav Manag 2022; 15:1167-1175. [PMID: 35586701 PMCID: PMC9109732 DOI: 10.2147/prbm.s364480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/29/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This study evaluated the outcomes of a telehealth intervention aimed at enhancing exchanges in mother–child dyads who showed an impoverishment of the quality of their feeding interactions and a worsening of their psychopathological symptoms during the COVID-19 pandemic. Methods N=334 mothers and their three-year-old children were recruited to assess their feeding interactions through an observational tool administered via a web platform, and maternal and offspring psychopathological symptoms were measured through the SCL/90-R and the CBCL 1.5–5. This study constitutes the third wave (T3) of a longitudinal research. Results Our results showed that the intervention significantly improved the quality of mother–child feeding interactions. Moreover, mothers’ psychopathological symptoms reduced after the intervention, especially in the interpersonal sensitivity, hostility, depression, anxiety, and obsessive-compulsive-compulsive subscales; offspring emotional/behavioral functioning and dysregulation symptoms also decreased, particularly in the subscales of withdrawn anxious/depressed attention problems and aggressive behavior. Conclusion This study adds knowledge to the literature on COVID-19 pandemic effects on psychological health of parents and young children, proposing a method of intervention that had been effectively adopted previously but whose effectiveness had not been investigated during the pandemic.
Collapse
Affiliation(s)
- Silvia Cimino
- Department of Dynamic, Clinical, and Health Psychology, Sapienza, University of Rome, Rome, Italy
| | - Luca Cerniglia
- Faculty of Psychology, International Telematic University Uninettuno, Rome, Italy
- Correspondence: Luca Cerniglia, Faculty of Psychology, International Telematic University Uninettuno, Rome, Italy, Tel +39066920761, Email
| |
Collapse
|
17
|
Peters M, Ratz T, Wichmann F, Lippke S, Voelcker-Rehage C, Pischke CR. Ecological Predictors of Older Adults' Participation and Retention in a Physical Activity Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3190. [PMID: 35328876 PMCID: PMC8949961 DOI: 10.3390/ijerph19063190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/04/2022] [Accepted: 03/06/2022] [Indexed: 11/26/2022]
Abstract
Research is still lacking regarding the question as to how programs to promote healthy ageing should be organized in order to increase acceptance and thus effectiveness. For older adults, ecological factors, such as the physical distance to program sites, might predict participation and retention. Thus, the key aim of this analysis was to examine these factors in a physical activity intervention trial. Adults (N = 8299) aged 65 to 75 years were invited to participate and n = 589 participants were randomly assigned to one of two intervention groups with 10 weeks of physical activity home practice and exercise classes or a wait-list control group. Response, participation, and dropout data were compared regarding ecological, individual, and study-related variables. Kaplan-Meier curves and Cox regression models were used to determine predictors of dropout. In total, 405 participants completed the study. Weekly class attendance rates were examined regarding significant weather conditions and holiday periods. The highest rates of nonresponse were observed in districts with very high neighborhood levels of socioeconomic status. In this study, ecological factors did not appear to be significant predictors of dropout, whereas certain individual and study-related variables were predictive. Future studies should consider these factors during program planning to mobilize and keep subjects in the program.
Collapse
Affiliation(s)
- Manuela Peters
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, 28359 Bremen, Germany;
| | - Tiara Ratz
- Department of Psychology & Methods, Jacobs University Bremen, 28759 Bremen, Germany; (T.R.); (S.L.)
| | - Frauke Wichmann
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, 28359 Bremen, Germany;
| | - Sonia Lippke
- Department of Psychology & Methods, Jacobs University Bremen, 28759 Bremen, Germany; (T.R.); (S.L.)
| | - Claudia Voelcker-Rehage
- Department of Neuromotor Behavior and Exercise, Institute of Sport and Exercise Sciences, University of Muenster, 48149 Muenster, Germany;
| | - Claudia R. Pischke
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany;
| |
Collapse
|
18
|
Yadav M, Neate S, Hassed C, Chambers R, Connaughton S, Nag N. Mining the Gems of a Web-Based Mindfulness Intervention: Qualitative Analysis of Factors Aiding Completion and Implementation (Preprint). JMIR Form Res 2022; 6:e37406. [PMID: 36197709 PMCID: PMC9582916 DOI: 10.2196/37406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 07/21/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Digital health interventions provide a cost effective and accessible means for positive behavior change. However, high participant attrition is common and facilitators for implementation of behaviors are not well understood. Objective The goal of the research was to identify elements of a digital mindfulness course that aided in course completion and implementation of teachings. Methods Inductive thematic analysis was used to assess participant comments regarding positive aspects of the online mindfulness course Mindfulness for Well-being and Peak Performance. Participants were aged 18 years and older who had self-selected to register and voluntarily completed at least 90% the course. The course comprised educator-guided lessons and discussion forums for participant reflection and feedback. Participant comments from the final discussion forum were analyzed to identify common themes pertaining to elements of the course that aided in course completion and implementation of teachings. Results Of 3355 course completers, 283 participants provided comments related to the research question. Key themes were (1) benefits from the virtual community, (2) appeal of content, (3) enablers to participation and implementation, and (4) benefits noted in oneself. Of subthemes identified, some, such as community support, variety of easily implementable content, and free content access, align with that reported previously in the literature, while other subthemes, including growing together, repeating the course, evidence-based teaching, and immediate benefits on physical and mental well-being, were novel findings. Conclusions Themes identified as key elements for aiding participant completion of a mindfulness digital health intervention and the implementation of teachings may inform the effective design of future digital health interventions to drive positive health behaviors. Future research should focus on understanding motivations for participation, identification of effective methods for participant retention, and behavior change techniques to motivate long-term adherence to healthy behaviors.
Collapse
Affiliation(s)
- Muskan Yadav
- Department of General Practice, Monash University, Melbourne, Australia
| | - Sandra Neate
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Craig Hassed
- Monash Centre for Consciousness and Contemplative Studies, Monash University, Melbourne, Australia
| | - Richard Chambers
- Monash Centre for Consciousness and Contemplative Studies, Monash University, Melbourne, Australia
| | - Sherelle Connaughton
- Monash Centre for Consciousness and Contemplative Studies, Monash University, Melbourne, Australia
| | - Nupur Nag
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
19
|
Dahlhausen F, Zinner M, Bieske L, Ehlers JP, Boehme P, Fehring L. There's an app for that, but nobody's using it: Insights on improving patient access and adherence to digital therapeutics in Germany. Digit Health 2022; 8:20552076221104672. [PMID: 35811758 PMCID: PMC9260569 DOI: 10.1177/20552076221104672] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background Mobile health applications and their subset digital therapeutics—defined as
evidence-based software interventions to prevent, manage, or treat a medical
condition—offer great potential to improve patient care. However, such
solutions often struggle to reach widespread adoption. Objective This study seeks to explore healthcare stakeholders’ roles and potential for
fostering patient access and adherence to evidence-based digital
therapeutics and thereby improve health outcomes from the perspective of
digital therapeutics developers and distributors. Methods Semi-structured qualitative and semiquantitative interviews were conducted
with 19 experts from developers and distributors of digital therapeutics in
Germany to discuss their perceived relevance of different healthcare
stakeholders and strategies in promoting patient access and adherence to
digital therapeutics. Results Healthcare professionals were found to have the greatest potential to promote
both access and patient adherence to digital therapeutics, followed by
health insurers, pharmaceutical companies, and patients themselves. In terms
of patient access, healthcare professionals have potential due to their
ability to prescribe digital therapeutics. Other stakeholders’ potential
stems from their capacity to influence healthcare professionals prescription
decision. In terms of patient adherence, only healthcare professionals are
of high relevance by onboarding patients and monitoring digital therapeutics
use. Most healthcare stakeholders currently do not fully leverage their
potential. Further educating healthcare professionals and simplifying
processes for them, empowering patients to seek treatment with digital
therapeutics, and designing digital therapeutics’ product features for
better adherence can help improve patient access and adherence. Conclusions Established healthcare stakeholders and digital therapeutics developers both
need to take action to improve patient access and adherence to digital
therapeutics. Several macro-level changes can support these efforts,
including broader information dissemination, improved financial incentives,
simplified prescription and activation processes, and a wider adoption of
blended care and pay-for-performance payment models.
Collapse
Affiliation(s)
| | | | - Linn Bieske
- Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Jan P Ehlers
- Didactics and Educational Research in Healthcare, Medical Department, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Philip Boehme
- Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Leonard Fehring
- Faculty of Health, Witten/Herdecke University, Witten, Germany
- Helios University Hospital Wuppertal, Clinic for Gastroenterology, Hepatology, Endocrinology and Diabetology, Heusnerstr. 40, 42283 Wuppertal, Germany
| |
Collapse
|
20
|
[Adherence to digital health interventions: definitions, methods, and open questions]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:1278-1284. [PMID: 34559252 PMCID: PMC8492574 DOI: 10.1007/s00103-021-03415-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 08/23/2021] [Indexed: 02/08/2023]
Abstract
Many digital interventions rely on the participation of their users to have a positive impact. In various areas it can be observed that the use of digital interventions is often reduced or fully discontinued by the users after a short period of time. This is seen as one of the main factors that can limit the effectiveness of digital interventions. In this context, the concept of adherence to digital interventions is becoming increasingly important. Adherence to digital interventions is roughly defined as "the degree to which the user followed the program as it was designed," which can also be paraphrased as "intended use" or "use as it is designed." However, both the theoretical-conceptual and practical discussions regarding adherence to digital interventions still receive too little attention.The aim of this narrative review article is to shed more light on the concept of adherence to digital interventions and to distinguish it from related concepts. It also discusses the methods and metrics that can be used to operationalize adherence and the predictors that positively influence adherence. Finally, needs for action to better address adherence are considered critically.
Collapse
|
21
|
Renfrew ME, Morton DP, Morton JK, Przybylko G. The Influence of Human Support on the Effectiveness of Digital Mental Health Promotion Interventions for the General Population. Front Psychol 2021; 12:716106. [PMID: 34489818 PMCID: PMC8416605 DOI: 10.3389/fpsyg.2021.716106] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/28/2021] [Indexed: 11/25/2022] Open
Abstract
Mental wellbeing amongst the general population is languishing—exacerbated by the Coronavirus Disease 2019 (COVID-19) pandemic. Digital mental health promotion interventions, that improve mental health literacy and encourage adoption of evidence-informed practical strategies are essential. However, attrition and non-adherence are problematic in digital interventions. Human support is often applied as an antidote; yet, there is a paucity of randomized trials that compare different human support conditions amongst general population cohorts. Limited trials generally indicate that human support has little influence on adherence or outcomes in DMHPIs. However, providing participants autonomy to self-select automated support options may enhance motivation and adherence.
Collapse
Affiliation(s)
- Melanie Elise Renfrew
- Lifestyle Medicine and Health Research Center, Avondale University College, Cooranbong, NSW, Australia
| | - Darren Peter Morton
- Lifestyle Medicine and Health Research Center, Avondale University College, Cooranbong, NSW, Australia
| | - Jason Kyle Morton
- Lifestyle Medicine and Health Research Center, Avondale University College, Cooranbong, NSW, Australia
| | - Geraldine Przybylko
- Lifestyle Medicine and Health Research Center, Avondale University College, Cooranbong, NSW, Australia
| |
Collapse
|
22
|
Gordon D, Hensel J, Bouck Z, Desveaux L, Soobiah C, Saragosa M, Jeffs L, Bhatia S, Shaw J. Developing an explanatory theoretical model for engagement with a web-based mental health platform: results of a mixed methods study. BMC Psychiatry 2021; 21:417. [PMID: 34419001 PMCID: PMC8379578 DOI: 10.1186/s12888-021-03391-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 07/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the growing need for accessible, high-quality mental health services, especially during the COVID-19 pandemic, there has been increasing development and uptake of web-based interventions in the form of self-directed mental health platforms. The Big White Wall (BWW) is a web-based platform for people experiencing mental illness and addiction that offers a range of evidence-based self-directed treatment strategies. Drawing on existing data from a large-scale evaluation of the implementation of BWW in Ontario, Canada (which involved a pragmatic randomized controlled trail with an embedded qualitative process evaluation), we sought to investigate the influences on the extent to which people engage with BWW. METHODS In this paper we drew on BWW trial participants' usage data (number of logins) and the qualitative data from the process evaluation that explored participants' experiences, engagement with and reactions to BWW. RESULTS Our results showed that there were highly complex relationships between the influences that contributed to the level of engagement with BWW intervention. We found that a) how people expected to benefit from using a platform like BWW was an important indicator of their future usage, b) moderate perceived symptoms were linked with higher engagement; whereas fewer actual depressive symptoms predicted use and anxiety had a positive linear relationship with usage, and that c) usage depended on positive early experiences with the platform. CONCLUSIONS Our findings suggest that the nature of engagement with platforms such as BWW is not easily predicted. We propose a theoretical framework for explaining the level of user engagement with BWW that might also be generalizable to other similar platforms.
Collapse
Affiliation(s)
- Dara Gordon
- Women's College Hospital, Institute of Health System Solutions and Virtual Care, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada.
- University of Toronto, 155 College St, Toronto, Ontario, M5T 1P8, Canada.
| | - Jennifer Hensel
- Women's College Hospital, Institute of Health System Solutions and Virtual Care, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada
- University of Manitoba, 66 Chancellors Cir, Winnipeg, Manitoba, R3T 2N2, Canada
| | - Zachary Bouck
- Women's College Hospital, Institute of Health System Solutions and Virtual Care, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada
- University of Toronto, 155 College St, Toronto, Ontario, M5T 1P8, Canada
- St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada
| | - Laura Desveaux
- Women's College Hospital, Institute of Health System Solutions and Virtual Care, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada
- University of Toronto, 155 College St, Toronto, Ontario, M5T 1P8, Canada
| | - Charlene Soobiah
- Women's College Hospital, Institute of Health System Solutions and Virtual Care, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada
| | - Marianne Saragosa
- Women's College Hospital, Institute of Health System Solutions and Virtual Care, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada
| | - Lianne Jeffs
- Sinai Health System, 1 Bridgepoint Dr, Toronto, Ontario, M4M 2B5, Canada
| | - Sacha Bhatia
- Women's College Hospital, Institute of Health System Solutions and Virtual Care, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada
- University of Toronto, 155 College St, Toronto, Ontario, M5T 1P8, Canada
| | - James Shaw
- Women's College Hospital, Institute of Health System Solutions and Virtual Care, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada
- University of Toronto, 155 College St, Toronto, Ontario, M5T 1P8, Canada
| |
Collapse
|
23
|
Potential of existing online 24-h dietary recall tools for national dietary surveys. Public Health Nutr 2021; 24:5361-5386. [PMID: 34392853 DOI: 10.1017/s1368980021003517] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe existing online, 24-h dietary recall (24-h DR) tools in terms of functionalities and ability to tackle challenges encountered during national dietary surveys, such as maximising response rates and collecting high-quality data from a representative sample of the population, while minimising the cost and response burden. DESIGN A search (from 2000 to 2019) was conducted in peer-reviewed and grey literature. For each tool, information on functionalities, validation and user usability studies, and potential adaptability for integration into a new context was collected. SETTING Not country-specific. PARTICIPANTS General population. RESULTS Eighteen online 24-h DR tools were identified. Most were developed in Europe, for children ≥10 years old and/or for adults. Eight followed the five multiple-pass steps but used various methodologies and features. Almost all tools (except three) validated their nutrient intake estimates, but with high heterogeneity in methodologies. User usability was not always assessed, and rarely by applying real-time methods. For researchers, eight tools developed a web platform to manage the survey and five appeared to be easily adaptable to a new context. CONCLUSIONS Among the eighteen online 24-h DR tools identified, the best candidates to be used in national dietary surveys should be those that were validated for their intake estimates, had confirmed user and researcher usability, and seemed sufficiently flexible to be adapted to new contexts. Regardless of the tool, adaptation to another context will still require time and funding, and this is probably the most challenging step.
Collapse
|
24
|
Lepore SJ, Collins BN, Killam HW, Barry B. Supportive Accountability and Mobile App Use in a Tobacco Control Intervention Targeting Low-Income Minority Mothers Who Smoke: Observational Study. JMIR Mhealth Uhealth 2021; 9:e28175. [PMID: 34255698 PMCID: PMC8285738 DOI: 10.2196/28175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/24/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Smartphone mobile apps are frequently used in standalone or multimodal smoking cessation interventions. However, factors that impede or improve app usage are poorly understood. OBJECTIVE This study used the supportive accountability model to investigate factors that influence app usage in the context of a trial designed to reduce maternal smoking in low-income and predominantly minority communities. METHODS We conducted a secondary analysis of data (N=181) from a randomized controlled trial that included a smoking cessation app (QuitPal-m). Supportive accountability was measured by the number of times a participant was advised by their cessation counselor to use QuitPal-m. Participants reported app use helpfulness and barriers. Investigators tracked reported phone and technical problems that impeded app use. RESULTS Most participants rated the app as very helpful (103/155, 66.5%), but daily use declined rapidly over time. App use was positively related to the level of perceived app helpfulness (P=.02) and education (P=.002) and inversely related to perceived barriers (P=.003), phone technical problems (P<.001), and cigarettes smoked per day at the end of treatment (P<.001). Participants used the app a greater proportion of the days following app advice than those preceding app advice (0.45 versus 0.34; P<.001). The positive relation between counselor app advice and app usage 24 hours after receiving advice was stronger among smokers with no plan to quit than in those planning to quit (P=.03), independent of education and phone or app problems. CONCLUSIONS Findings show the utility of supportive accountability for increasing smoking cessation app use in a predominantly low-income, minority population, particularly if quit motivation is low. Results also highlight the importance of addressing personal and phone/technical barriers in addition to adding supportive accountability. TRIAL REGISTRATION ClinicalTrials.gov NCT02602288; https://clinicaltrials.gov/ct2/show/NCT02602288.
Collapse
Affiliation(s)
- Stephen J Lepore
- Department of Social and Behavioral Sciences, Temple University, Philadelphia, PA, United States
| | - Bradley N Collins
- Department of Social and Behavioral Sciences, Temple University, Philadelphia, PA, United States
| | | | - Barbara Barry
- User Centered Design Inc, Ashburn, VA, United States
| |
Collapse
|
25
|
Hämäläinen T, Kaipainen K, Lappalainen P, Puolakanaho A, Keinonen K, Lappalainen R, Kiuru N. Usage activity, perceived usefulness, and satisfaction in a web-based acceptance and commitment therapy program among Finnish ninth-grade adolescents. Internet Interv 2021; 25:100421. [PMID: 34401380 PMCID: PMC8350586 DOI: 10.1016/j.invent.2021.100421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 01/07/2023] Open
Abstract
Understanding adolescent usage activity and experiences in web-based psychological intervention programs helps in developing universal programs that can be adopted for promotion of adolescent well-being and prevention of mental health problems. This study examined the usage activity, perceived usefulness (i.e., learning of mindfulness, acceptance and value-related skills), and program satisfaction of 157 Finnish ninth-grade adolescents, who participated in a school-based five-week universal acceptance and commitment therapy web intervention called Youth Compass. Individual and growth environment-related antecedents were measured before the five-week intervention, adolescents' usage activity during the intervention, and perceived usefulness and satisfaction after the intervention. The results showed that female adolescents and adolescents with high self-regulation were more active program users and had more positive experiences of the program. Most of the adolescents used the program on at least a moderate level and perceived it to be moderately or highly useful and satisfactory. Four subgroups of adolescents were identified based on their usage activity, perceived usefulness, and satisfaction: adolescents in the satisfied group (41%) had average activity and high perceived usefulness and intervention satisfaction, the dissatisfied group (18%) had low activity and very low perceived usefulness and intervention satisfaction, the active group (8%) had very high activity and average perceived usefulness and intervention satisfaction, and the moderate group (33%) had average activity, perceived usefulness and intervention satisfaction. Gender, academic achievement, closeness to mother and teacher, and conflict with teacher were significantly related to subgroup membership. The results suggested that adolescent usage activity, perceived usefulness, and satisfaction with the Youth Compass program may to some extent be predicted based on different factors.
Collapse
Affiliation(s)
- Tetta Hämäläinen
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Finland,Corresponding author at: Department of Psychology, University of Jyväskylä, P.O. Box 35, 40014 Jyväskylä, Finland.
| | - Kirsikka Kaipainen
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Finland,Faculty of Information Technology and Communication Sciences, Tampere University, Finland
| | - Päivi Lappalainen
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Finland
| | - Anne Puolakanaho
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Finland
| | - Katariina Keinonen
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Finland
| | - Raimo Lappalainen
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Finland
| | - Noona Kiuru
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Finland
| |
Collapse
|
26
|
Andrade AQ, Beleigoli A, Diniz MDF, Ribeiro AL. Influence of Baseline User Characteristics and Early Use Patterns (24-Hour) on Long-Term Adherence and Effectiveness of a Web-Based Weight Loss Randomized Controlled Trial: Latent Profile Analysis. J Med Internet Res 2021; 23:e26421. [PMID: 34081012 PMCID: PMC8212621 DOI: 10.2196/26421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/22/2021] [Accepted: 05/06/2021] [Indexed: 01/20/2023] Open
Abstract
Background Low adherence to real-world online weight loss interventions reduces long-term efficacy. Baseline characteristics and use patterns are determinants of long-term adherence, but we lack cohesive models to guide how to adapt interventions to users’ needs. We also lack information whether very early use patterns (24 hours) help describe users and predict interventions they would benefit from. Objective We aim to understand the impact of users’ baseline characteristics and early (initial 24 hours) use patterns of a web platform for weight loss on user adherence and weight loss in the long term (24 weeks). Methods We analyzed data from the POEmaS randomized controlled trial, a study that compared the effectiveness of a weight loss platform with or without coaching and a control approach. Data included baseline behavior and use logs from the initial 24 hours after platform access. Latent profile analysis (LPA) was used to identify classes, and Kruskal-Wallis was used to test whether class membership was associated with long-term (24 weeks) adherence and weight loss. Results Among 828 participants assigned to intervention arms, 3 classes were identified through LPA: class 1 (better baseline health habits and high 24-hour platform use); class 2 (better than average health habits, but low 24-hour platform use); class 3 (worse baseline health habits and low 24-hour platform use). Class membership was associated with long-term adherence (P<.001), and class 3 members had the lowest adherence. Weight loss was not associated with class membership (P=.49), regardless of the intervention arm (platform only or platform + coach). However, class 2 users assigned to platform + coach lost more weight than those assigned to platform only (P=.02). Conclusions Baseline questionnaires and use data from the first 24 hours after log-in allowed distinguishing classes, which were associated with long-term adherence. This suggests that this classification might be a useful guide to improve adherence and assign interventions to individual users. Trial Registration ClinicalTrials.gov NCT03435445; https://clinicaltrials.gov/ct2/show/NCT03435445 International Registered Report Identifier (IRRID) RR2-10.1186/s12889-018-5882-y
Collapse
Affiliation(s)
- Andre Q Andrade
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, Australia
| | - Alline Beleigoli
- Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia.,Caring Futures Institute, Flinders University, Adelaide, Australia.,Adult Health Sciences Post Graduation Course, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria De Fatima Diniz
- Adult Health Sciences Post Graduation Course, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Antonio Luiz Ribeiro
- Centre of Telehealth of the Hospital das Clinicas da UFMG, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|
27
|
Sweeney L, Moss-Morris R, Czuber-Dochan W, Norton C. Pain management in inflammatory bowel disease: feasibility of an online therapist-supported CBT-based self-management intervention. Pilot Feasibility Stud 2021; 7:95. [PMID: 33863398 PMCID: PMC8050888 DOI: 10.1186/s40814-021-00829-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 03/29/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chronic pain is a poorly managed symptom of inflammatory bowel disease (IBD). Cognitive behavioural therapy (CBT) has an evidence base in functional gastrointestinal conditions and chronic pain. This study aimed to test the feasibility and acceptability of a 9-week online facilitator-supported CBT intervention, tailored for people with chronic IBD-related pain. DESIGN A single-arm pre-post design with nested qualitative interviews was used. Twenty individuals with IBD and chronic pain were recruited through an online IBD charity and had consented to research in a previous survey or responded to an online charity advert. Individuals who indicated a pain-interference score of ≥ 4/10 (Brief Pain Inventory) and met inclusion criteria were invited to take part. Outcomes included recruitment and retention rates, pain interference and severity, quality of life (QoL) and psychosocial measures. RESULTS Of 145 individuals contacted, 55 (37.9%) responded. Two individuals were recruited from the study advertisement. Twenty out of 57 (35.1%) met screening and eligibility criteria. Eighty-five percent of the sample engaged with intervention sessions and 55% completed at least 5/9 sessions. Eighty percent of recruited participants completed the post-intervention questionnaire at week 9. The mean score for overall acceptability was 43.4 (0-70). Qualitative feedback demonstrated the value of thought monitoring and facilitator support. Scores improved for QoL and pain self-efficacy and reduced for depression, anxiety, pain catastrophising and avoidance resting behaviour. CONCLUSIONS Online CBT for chronic IBD-related pain appears feasible and acceptable. The study suggests positive effects for improving QoL and reducing psychological distress; however, online and face-to-face recruitment methods are recommended and establishing efficacy through larger randomised controlled trials is required.
Collapse
Affiliation(s)
- Louise Sweeney
- Health Psychology Section, King's College London, London, UK.
| | | | - Wladyslawa Czuber-Dochan
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| |
Collapse
|
28
|
Tu M, Wang F, Shen S, Wang H, Feng J. Influences of Psychological Intervention on Negative Emotion, Cancer-Related Fatigue and Level of Hope in Lung Cancer Chemotherapy Patients Based on the PERMA Framework. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:728-736. [PMID: 34183922 PMCID: PMC8219625 DOI: 10.18502/ijph.v50i4.5997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background: Psychological status is a decisive factor for regulating the lung cancer chemotherapy patients’ levels of fatigue and hope. Using the PERMA (Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment) framework. We aimed to explore the influences of the psychological intervention on the patients’ negative emotion, cancer-related fatigue, and level of hope. Method: A total of 100 lung cancer chemotherapy patients admitted in Wuhan No.4 Hospital, China, from Jan 2018 to Aug 2019 were enrolled as research objects divided into the control group and observation group. Positive psychological intervention using the PERMA framework was given to the observation group. The scores of Post-Traumatic Growth Inventory (PTGI), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Cancer Fatigue Scale (CFS), and Herth Hope Index (HHI) were evaluated and compared in the two groups. Results: After the intervention, PTGI score in the observation group is higher than that in the control group, whereas the SAS and SDS scores are lower in the observation group than in the control group, and the differences are statistically significant (P<0.05). Score of each CFS dimension and total CFS score in the observation group are all lower than those in the control group, with statistically significant differences (P<0.05). Score of each HHI dimension and total HHI score are higher than those in the control group, and the differences are statistically significant (P<0.05). Conclusion: Positive psychological intervention using the PERMA framework can improve the emotional and fatigue state of lung cancer chemotherapy patients and elevate their level of hope.
Collapse
Affiliation(s)
- Min Tu
- Department of Respiratory Medicine, Wuhan No.4 Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fan Wang
- Department of Drug and Equipment, Wuhan Prevention and Treatment Center for Occupational Diseases, Wuhan, China
| | - Sanying Shen
- Department of Respiratory Medicine, Wuhan No.4 Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Wang
- Nursing College, Chongqing Three Gorges Medical College, Chongqing, China
| | - Jing Feng
- Department of Nursing, Wuhan No.4 Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
29
|
Sanatkar S, Baldwin P, Huckvale K, Christensen H, Harvey S. e-Mental Health Program Usage Patterns in Randomized Controlled Trials and in the General Public to Inform External Validity Considerations: Sample Groupings Using Cluster Analyses. J Med Internet Res 2021; 23:e18348. [PMID: 33704070 PMCID: PMC7995072 DOI: 10.2196/18348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 09/30/2020] [Accepted: 12/11/2020] [Indexed: 01/19/2023] Open
Abstract
Background Randomized controlled trials (RCTs) with vigorous study designs are vital for determining the efficacy of treatments. Despite the high internal validity attributed to RCTs, external validity concerns limit the generalizability of results to the general population. Bias can be introduced, for example, when study participants who self-select into a trial are more motivated to comply with study conditions than are other individuals. These external validity considerations extend to e-mental health (eMH) research, especially when eMH tools are designed for public access and provide minimal or no supervision. Objective Clustering techniques were employed to identify engagement profiles of RCT participants and community users of a self-guided eMH program. This exploratory approach inspected actual, not theorized, RCT participant and community user engagement patterns. Both samples had access to the eMH program over the same time period and received identical usage recommendations on the eMH program website. The aim of this study is to help gauge expectations of similarities and differences in usage behaviors of an eMH tool across evaluation and naturalistic contexts. Methods Australian adults signed up to myCompass, a self-guided online treatment program created to reduce mild to moderate symptoms of negative emotions. They did so either by being part of an RCT onboarding (160/231, 69.6% female) or by accessing the program freely on the internet (5563/8391, 66.30% female) between October 2011 and October 2012. During registration, RCT participants and community users provided basic demographic information. Usage metrics (number of logins, trackings, and learning activities) were recorded by the system. Results Samples at sign-up differed significantly in age (P=.003), with community users being on average 3 years older (mean 41.78, SD 13.64) than RCT participants (mean 38.79, SD 10.73). Furthermore, frequency of program use was higher for RCT participants on all usage metrics compared to community users through the first 49 days after registration (all P values <.001). Two-step cluster analyses revealed 3 user groups in the RCT sample (Nonstarters, 10-Timers, and 30+-Timers) and 2 user groups in the community samples (2-Timers and 20-Timers). Groups seemed comparable in patterns of use but differed in magnitude, with RCT participant usage groups showing more frequent engagement than community usage groups. Only the high-usage group among RCT participants approached myCompass usage recommendations. Conclusions Findings suggested that external validity concerns of RCT designs may arise with regards to the predicted magnitude of eMH program use rather than overall usage styles. Following up RCT nonstarters may help provide unique insights into why individuals choose not to engage with an eMH program despite generally being willing to participate in an eMH evaluation study. Overestimating frequency of engagement with eMH tools may have theoretical implications and potentially impact economic considerations for plans to disseminate these tools to the general public.
Collapse
Affiliation(s)
- Samineh Sanatkar
- Black Dog Institute, The University of New South Wales Sydney, Randwick, Australia.,School of Psychiatry, The University of New South Wales Sydney, Randwick, Australia
| | - Peter Baldwin
- Black Dog Institute, The University of New South Wales Sydney, Randwick, Australia
| | - Kit Huckvale
- Black Dog Institute, The University of New South Wales Sydney, Randwick, Australia.,School of Psychiatry, The University of New South Wales Sydney, Randwick, Australia
| | - Helen Christensen
- Black Dog Institute, The University of New South Wales Sydney, Randwick, Australia
| | - Samuel Harvey
- Black Dog Institute, The University of New South Wales Sydney, Randwick, Australia
| |
Collapse
|
30
|
Juengst SB, Terhorst L, Nabasny A, Wallace T, Weaver JA, Osborne CL, Burns SP, Wright B, Wen PS, Kew CLN, Morris J. Use of mHealth Technology for Patient-Reported Outcomes in Community-Dwelling Adults with Acquired Brain Injuries: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2173. [PMID: 33672183 PMCID: PMC7926536 DOI: 10.3390/ijerph18042173] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 11/26/2022]
Abstract
The purpose of our scoping review was to describe the current use of mHealth technology for long-term assessment of patient-reported outcomes in community-dwelling individuals with acquired brain injury (ABI). Following PRISMA guidelines, we conducted a scoping review of literature meeting these criteria: (1) civilians or military veterans, all ages; (2) self-reported or caregiver-reported outcomes assessed via mobile device in the community (not exclusively clinic/hospital); (3) published in English; (4) published in 2015-2019. We searched Ovid MEDLINE(R) < 1946 to 16 August 2019, MEDLINE InProcess, EPub, Embase, and PsycINFO databases for articles. Thirteen manuscripts representing 12 distinct studies were organized by type of ABI [traumatic brain injury (TBI) and stroke] to extract outcomes, mHealth technology used, design, and inclusion of ecological momentary assessment (EMA). Outcomes included post-concussive, depressive, and affective symptoms, fatigue, daily activities, stroke risk factors, and cognitive exertion. Overall, collecting patient-reported outcomes via mHealth was feasible and acceptable in the chronic ABI population. Studies consistently showed advantage for using EMA despite variability in EMA timing/schedules. To ensure best clinical measurement, research on post-ABI outcomes should consider EMA designs (versus single time-point assessments) that provide the best timing schedules for their respective aims and outcomes and that leverage mHealth for data collection.
Collapse
Affiliation(s)
- Shannon B. Juengst
- UT Southwestern Medical Center, Department of Physical Medicine & Rehabilitation, Dallas, TX 75390, USA; (A.N.); (C.L.O.); (B.W.); (C.-L.N.K.)
- UT Southwestern Medical Center, Department of Applied Clinical Research, Dallas, TX 75390, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA 15219, USA;
| | - Andrew Nabasny
- UT Southwestern Medical Center, Department of Physical Medicine & Rehabilitation, Dallas, TX 75390, USA; (A.N.); (C.L.O.); (B.W.); (C.-L.N.K.)
- UT Southwestern Medical Center, Department of Applied Clinical Research, Dallas, TX 75390, USA
| | | | - Jennifer A. Weaver
- Department of Clinical Research & Leadership, George Washington University, Washington, DC 20006, USA;
| | - Candice L. Osborne
- UT Southwestern Medical Center, Department of Physical Medicine & Rehabilitation, Dallas, TX 75390, USA; (A.N.); (C.L.O.); (B.W.); (C.-L.N.K.)
| | - Suzanne Perea Burns
- School of Occupational Therapy, Texas Woman’s University, Denton, TX 76204, USA;
| | - Brittany Wright
- UT Southwestern Medical Center, Department of Physical Medicine & Rehabilitation, Dallas, TX 75390, USA; (A.N.); (C.L.O.); (B.W.); (C.-L.N.K.)
- UT Southwestern Medical Center, Department of Applied Clinical Research, Dallas, TX 75390, USA
| | - Pey-Shan Wen
- Department of Occupational Therapy, Georgia State University, Atlanta, GA 30303, USA;
| | - Chung-Lin Novelle Kew
- UT Southwestern Medical Center, Department of Physical Medicine & Rehabilitation, Dallas, TX 75390, USA; (A.N.); (C.L.O.); (B.W.); (C.-L.N.K.)
- UT Southwestern Medical Center, Department of Applied Clinical Research, Dallas, TX 75390, USA
| | - John Morris
- Shepherd Center, Atlanta, GA 30309, USA; (T.W.); (J.M.)
| |
Collapse
|
31
|
The effects of mobile apps on stress, anxiety, and depression: overview of systematic reviews. Int J Technol Assess Health Care 2020; 37:e4. [PMID: 33314997 DOI: 10.1017/s0266462320002093] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Despite a large number of mobile apps in the field of mental health, it is difficult to find a useful and reliable one, mainly due to the fact that the effectiveness of many apps has not been assessed scientifically. The present study aimed to assess the effects of mental health apps on managing the symptoms of stress, anxiety, and depression. METHODS A comprehensive literature search was conducted in PubMed, Scopus, EMBASE, Cochrane, and Web of Science databases for the papers published from 2000 to 2019. Studies were included if they reviewed articles or mobile apps for their effectiveness in stress, anxiety, and depression. The reviews that had considered mobile apps or web-based mobile applications as an intervention or part of intervention were included, as well. RESULTS A total of 4,999 peer-reviewed articles were identified, out of which nine systematic reviews met the inclusion criteria. Seven systematic reviews measured depression outcomes, three measured stress, and five systematic reviews measured anxiety symptoms. The applications that used behavior change strategies, such as Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, and Behavioral Activation, reported significant effects on depression, anxiety, and stress. CONCLUSION It seems that mental health apps can be promising media for reducing depressive symptoms. This field is an emerging area of mobile health, and further research should be done in future in order to reach conclusive evidence.
Collapse
|
32
|
Nordholt PU, Christalle E, Zill JM, Dirmaier J. Engagement With a Web-Based Intervention to Reduce Harmful Drinking: Secondary Analysis of a Randomized Controlled Trial. J Med Internet Res 2020; 22:e18826. [PMID: 33216008 PMCID: PMC7718095 DOI: 10.2196/18826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 07/18/2020] [Accepted: 08/03/2020] [Indexed: 01/22/2023] Open
Abstract
Background Engagement with digital behavior change interventions (DBCIs) is considered a prerequisite for intervention efficacy. However, in many trials on DBCIs, participants use the intervention either only little or not at all. Objective To analyze engagement with a web-based intervention to reduce harmful drinking, we explored (1) whether engagement with a web-based alcohol intervention is related to drinking outcomes, (2) which user characteristics are associated with measures of engagement, and (3) whether reported outcomes are associated with data captured by voluntary intervention questionnaires. Methods We analyzed data of the intervention arm of a randomized controlled trial on a DBCI to reduce risky alcohol consumption. Data were collected at baseline (T0), after 90 days (T1), and at the end of the 180-day usage period (T2). Engagement with the intervention was measured via system usage data as well as self-reported usage. Drinking behavior was measured as average daily alcohol consumption as well as the number of binge drinking days. User characteristics included demographics, baseline drinking behavior, readiness to change, alcohol-related outcome expectancies, and alcohol abstinence self-efficacy. Following a bivariate approach, we performed two-tailed Welch’s t tests and Wilcoxon signed rank/Mann-Whitney U tests or calculated correlation coefficients. Results The data of 306 users were analyzed. Time spent engaging with the intervention as measured by system usage did not match self-reported usage. Higher self-reported usage was associated with higher reductions in average daily alcohol consumption (T1: ρ=0.39, P<.001; T2: ρ=0.29, P=.015) and in binge drinking days (T1: ρ=0.62, P<.001; T2: ρ=0.3, P=.006). Higher usage was reported from users who were single (T1: P<.001; T2: P<.001), users without children (T1: P<.001; T2: P<.001), users who did not start or finish secondary education (T1: P<.001; T2: P<.001), users without academic education (T1: P<.001; T2: P<.001), and those who worked (T1: P=.001; T2: P=.004). Relationships between self-reported usage and clinical or psychological baseline characteristics were complex. For system usage, the findings were mixed. Reductions in drinking captured by intervention questionnaires were associated with reported outcomes. Conclusions Though self-reported usage could be consistently linked to better outcomes and multiple user characteristics, our findings add to the overall inconclusive evidence that can be found throughout the literature. Our findings indicate potential benefits of self-reports as measures of engagement and intervention questionnaires as a basis for tailoring of intervention content. Future studies should adopt a theory-driven approach to engagement research utilizing psychometrically sound self-report questionnaires and include short ecological momentary assessments within the DBCIs. Trial Registration German Clinical Trials Register DRKS00006104; https://tinyurl.com/y22oc5jo
Collapse
Affiliation(s)
- Paul U Nordholt
- Department of Nursing and Management, Faculty of Business and Social Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Eva Christalle
- Institute and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jördis M Zill
- Institute and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Dirmaier
- Institute and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
33
|
Hind D, Drabble SJ, Arden MA, Mandefield L, Waterhouse S, Maguire C, Cantrill H, Robinson L, Beever D, Scott A, Keating S, Hutchings M, Bradley J, Nightingale J, Allenby MI, Dewar J, Whelan P, Ainsworth J, Walters SJ, Wildman MJ, O'Cathain A. Feasibility study for supporting medication adherence for adults with cystic fibrosis: mixed-methods process evaluation. BMJ Open 2020; 10:e039089. [PMID: 33109661 PMCID: PMC7592300 DOI: 10.1136/bmjopen-2020-039089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/27/2020] [Accepted: 09/29/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To undertake a process evaluation of an adherence support intervention for people with cystic fibrosis (PWCF), to assess its feasibility and acceptability. SETTING Two UK cystic fibrosis (CF) units. PARTICIPANTS Fourteen adult PWCF; three professionals delivering adherence support ('interventionists'); five multi-disciplinary CF team members. INTERVENTIONS Nebuliser with data recording and transfer capability, linked to a software platform, and strategies to support adherence to nebulised treatments facilitated by interventionists over 5 months (± 1 month). PRIMARY AND SECONDARY MEASURES Feasibility and acceptability of the intervention, assessed through semistructured interviews, questionnaires, fidelity assessments and click analytics. RESULTS Interventionists were complimentary about the intervention and training. Key barriers to intervention feasibility and acceptability were identified. Interventionists had difficulty finding clinic space and time in normal working hours to conduct review visits. As a result, fewer than expected intervention visits were conducted and interviews indicated this may explain low adherence in some intervention arm participants. Adherence levels appeared to be >100% for some patients, due to inaccurate prescription data, particularly in patients with complex treatment regimens. Flatlines in adherence data at the start of the study were linked to device connectivity problems. Content and delivery quality fidelity were 100% and 60%-92%, respectively, indicating that interventionists needed to focus more on intervention 'active ingredients' during sessions. CONCLUSIONS The process evaluation led to 14 key changes to intervention procedures to overcome barriers to intervention success. With the identified changes, it is feasible and acceptable to support medication adherence with this intervention. TRIAL REGISTRATION NUMBER ISRCTN13076797; Results.
Collapse
Affiliation(s)
- Daniel Hind
- Clincal Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Sarah J Drabble
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Madelynne A Arden
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, UK
| | | | - Simon Waterhouse
- Clincal Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Chin Maguire
- Clincal Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Hannah Cantrill
- Clincal Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Louisa Robinson
- Clincal Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Daniel Beever
- Clincal Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Alex Scott
- Clincal Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Sam Keating
- Clincal Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Marlene Hutchings
- Sheffield Adult Cystic Fibrosis Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, Sheffield, UK
| | - Judy Bradley
- Wellcome-Wolfson Institute For Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Julia Nightingale
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark I Allenby
- Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jane Dewar
- Wolfson Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Pauline Whelan
- Health eResearch Centre - Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - John Ainsworth
- Health eResearch Centre - Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Stephen J Walters
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Martin J Wildman
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- Sheffield Adult Cystic Fibrosis Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, Sheffield, UK
| | - Alicia O'Cathain
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| |
Collapse
|
34
|
Godinho A, Cunningham JA, Schell C. The particular case of conducting addiction intervention research on Mechanical Turk. Addiction 2020; 115:1971-1972. [PMID: 32427392 DOI: 10.1111/add.15097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/22/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Alexandra Godinho
- Centre for Addiction and Mental Health, Institute of Mental Health and Policy Research, Toronto, Canada
| | - John A Cunningham
- Centre for Addiction and Mental Health, Institute of Mental Health and Policy Research, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Australian National University, Canberra, Australia
| | - Christina Schell
- Centre for Addiction and Mental Health, Institute of Mental Health and Policy Research, Toronto, Canada
| |
Collapse
|
35
|
Renfrew ME, Morton DP, Morton JK, Hinze JS, Przybylko G, Craig BA. The Influence of Three Modes of Human Support on Attrition and Adherence to a Web- and Mobile App-Based Mental Health Promotion Intervention in a Nonclinical Cohort: Randomized Comparative Study. J Med Internet Res 2020; 22:e19945. [PMID: 32990633 PMCID: PMC7556377 DOI: 10.2196/19945] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/22/2020] [Accepted: 08/03/2020] [Indexed: 12/21/2022] Open
Abstract
Background The escalating prevalence of mental health disorders necessitates a greater focus on web- and mobile app–based mental health promotion initiatives for nonclinical groups. However, knowledge is scant regarding the influence of human support on attrition and adherence and participant preferences for support in nonclinical settings. Objective This study aimed to compare the influence of 3 modes of human support on attrition and adherence to a digital mental health intervention for a nonclinical cohort. It evaluated user preferences for support and assessed whether adherence and outcomes were enhanced when participants received their preferred support mode. Methods Subjects participated in a 10-week digital mental health promotion intervention and were randomized into 3 comparative groups: standard group with automated emails (S), standard plus personalized SMS (S+pSMS), and standard plus weekly videoconferencing support (S+VCS). Adherence was measured by the number of video lessons viewed, points achieved for weekly experiential challenge activities, and the total number of weeks that participants recorded a score for challenges. In the postquestionnaire, participants ranked their preferred human support mode from 1 to 4 (S, S+pSMS, S+VCS, S+pSMS & VCS combined). Stratified analysis was conducted for those who received their first preference. Preintervention and postintervention questionnaires assessed well-being measures (ie, mental health, vitality, depression, anxiety, stress, life satisfaction, and flourishing). Results Interested individuals (N=605) enrolled on a website and were randomized into 3 groups (S, n=201; S+pSMS, n=202; S+VCS, n=201). Prior to completing the prequestionnaire, a total of 24.3% (147/605) dropped out. Dropout attrition between groups was significantly different (P=.009): 21.9% (44/201) withdrew from the S group, 19.3% (39/202) from the S+pSMS
group, and 31.6% (64/202) from the S+VCS group. The remaining 75.7% (458/605) registered and completed the prequestionnaire (S, n=157; S+pSMS, n=163; S+VCS, n=138). Of the registered participants, 30.1% (138/458) failed to complete the postquestionnaire (S, n=54; S+pSMS, n=49; S+VCS, n=35), but there were no between-group differences (P=.24). For the 69.9% (320/458; S, n=103; S+pSMS, n=114; S+VCS, n=103) who completed the postquestionnaire, no between-group differences in adherence were observed for mean number of videos watched (P=.42); mean challenge scores recorded (P=.71); or the number of weeks that challenge scores were logged (P=.66). A total of 56 participants (17.5%, 56/320) received their first preference in human support (S, n=22; S+pSMS, n=26; S+VCS, n=8). No differences were observed between those who received their first preference and those who did not with regard to video adherence (P=.91); challenge score adherence (P=.27); or any of the well-being measures including, mental health (P=.86), vitality (P=.98), depression (P=.09), anxiety (P=.64), stress (P=.55), life satisfaction (P=.50), and flourishing (P=.47). Conclusions Early dropout attrition may have been influenced by dissatisfaction with the allocated support mode. Human support mode did not impact adherence to the intervention, and receiving the preferred support style did not result in greater adherence or better outcomes. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR): 12619001009101; http://www.anzctr.org.au/ACTRN12619001009101.aspx
Collapse
Affiliation(s)
- Melanie Elise Renfrew
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, Australia
| | - Darren Peter Morton
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, Australia
| | - Jason Kyle Morton
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, Australia
| | - Jason Scott Hinze
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, Australia
| | - Geraldine Przybylko
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, Australia
| | - Bevan Adrian Craig
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, Australia
| |
Collapse
|
36
|
Collins DA, Harvey SB, Lavender I, Glozier N, Christensen H, Deady M. A Pilot Evaluation of a Smartphone Application for Workplace Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186753. [PMID: 32947994 PMCID: PMC7576478 DOI: 10.3390/ijerph17186753] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 12/24/2022]
Abstract
Interventions delivered via mobile apps show particular promise in tackling the burden of common mental disorders. Appropriately targeting these interventions to at-risk populations is critical to their success. This pilot study aimed to assess the usability, feasibility, acceptability, and preliminary effects of an app-based intervention designed to target depressive symptoms in a stressed working population. Anchored, a smartphone app including a 30-day program of mindfulness and cognitive and behavioural therapeutic components, was tested in a pre-post pilot study with participants recruited via social media advertisements. Eligible participants (N = 81) were Australian adults who were employed and reported elevated stress levels on a single-item screening measure. Follow-up assessment occurred 5 weeks after baseline. The primary outcome measure was change in depressive symptoms, with secondary outcomes measuring change in anxiety, wellbeing, stress, resilience, exercise, alcohol use, absenteeism, and work performance. User feedback and in-app data were analysed to assess engagement and intervention adherence. At follow-up, there were significant reductions in depressive symptoms (t61 = 6.35; p < 0.001) and anxiety symptoms (t60 = 7.35; p < 0.001), along with significantly reduced cases of likely new onset depression compared to baseline (24% vs. 6%, p = 0.012). Significant improvements were also seen in wellbeing (t60 = -5.64; p < 0.001), resilience (t60 = -3.89; p < 0.001), stress (t61 = 11.18; p < 0.001), and alcohol use (t60 = 3.40; p = 0.001). Participants reported no significant changes in work performance, absenteeism or exercise. There were satisfactory levels of app usability, feasibility, and acceptability. Most participants found the app easy to use (93.2%), understood the app content well (83.0%), and rated the app highly or very highly overall (72.9%). User feedback suggestions were predominantly focused on improving app navigation and user interface. This pilot study provides encouraging evidence that Anchored has potentially beneficial effects, and is usable, feasible, and acceptable as an app-based intervention for the working population experiencing elevated stress. Further testing of Anchored in a randomised controlled trial is required to investigate its efficacy as an intervention for workplace mental ill-health.
Collapse
Affiliation(s)
- Daniel A.J. Collins
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Randwick, NSW 2031, Australia; (S.B.H.); (I.L.); (H.C.); (M.D.)
- Correspondence:
| | - Samuel B. Harvey
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Randwick, NSW 2031, Australia; (S.B.H.); (I.L.); (H.C.); (M.D.)
| | - Isobel Lavender
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Randwick, NSW 2031, Australia; (S.B.H.); (I.L.); (H.C.); (M.D.)
| | - Nicholas Glozier
- Brain and Mind Centre, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia;
| | - Helen Christensen
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Randwick, NSW 2031, Australia; (S.B.H.); (I.L.); (H.C.); (M.D.)
| | - Mark Deady
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Randwick, NSW 2031, Australia; (S.B.H.); (I.L.); (H.C.); (M.D.)
| |
Collapse
|
37
|
Hesser H. Estimating causal effects of internet interventions in the context of nonadherence. Internet Interv 2020; 21:100346. [PMID: 32983907 PMCID: PMC7495102 DOI: 10.1016/j.invent.2020.100346] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/02/2020] [Accepted: 07/14/2020] [Indexed: 12/25/2022] Open
Abstract
A substantial proportion of participants who are offered internet-based psychological treatments in randomized trials do not adhere and may therefore not receive treatment. Despite the availability of justified statistical methods for causal inference in such situations, researchers often rely on analytical strategies that either ignore adherence altogether or fail to provide causal estimands. The objective of this paper is to provide a gentle nontechnical introduction to complier average causal effect (CACE) analysis, which, under clear assumptions, can provide a causal estimate of the effect of treatment for a subsample of compliers. The article begins with a brief review of the potential outcome model for causal inference. After clarifying assumptions and model specifications for CACE in the latent variable framework, data from a previously published trial of an internet-based psychological treatment for irritable bowel syndrome are used to demonstrate CACE-analysis. Several model extensions are then briefly reviewed. The paper offers practical recommendations on how to analyze randomized trials of internet interventions in the context of nonadherence. It is argued that CACE-analysis, whenever it is considered appropriate, should be carried out as a complement to the standard intention-to-treat analysis and that the format of internet-based treatments is particularly well suited to such an analytical approach.
Collapse
Affiliation(s)
- Hugo Hesser
- School of Law, Psychology and Social Work, Örebro university, SE-701 82 Örebro, Sweden.
| |
Collapse
|
38
|
Crafoord MT, Fjell M, Sundberg K, Nilsson M, Langius-Eklöf A. Engagement in an Interactive App for Symptom Self-Management during Treatment in Patients With Breast or Prostate Cancer: Mixed Methods Study. J Med Internet Res 2020; 22:e17058. [PMID: 32663140 PMCID: PMC7445604 DOI: 10.2196/17058] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 05/05/2020] [Accepted: 05/20/2020] [Indexed: 12/17/2022] Open
Abstract
Background Using mobile technology for symptom management and self-care can improve patient-clinician communication and clinical outcomes in patients with cancer. The interactive app Interaktor has been shown to reduce symptom burden during cancer treatment. It includes symptom assessment, an alert system for contact with health care professionals, access to self-care advice, and visualization of symptom history. It is essential to understand how digital interventions operate; one approach is to examine engagement by assessing usage and exploring user experiences. Actual usage in relation to the intended use—adherence—is an essential factor of engagement. Objective This study aimed to describe engagement with the Interaktor app among patients with breast or prostate cancer during treatment. Methods Patients from the intervention groups of two separate randomized controlled trials were included: patients with breast cancer receiving neoadjuvant chemotherapy (n=74) and patients with locally advanced prostate cancer receiving treatment with radiotherapy (n=75). The patients reported their symptoms daily. Sociodemographic and clinical data were obtained from baseline questionnaires and medical records. Logged data usage was retrieved from the server and analyzed descriptively and with multiple regression analysis. Telephone interviews were conducted with patients about their perceptions of using the app and analyzed using content analysis. Results The median adherence percentage to daily symptom reporting was 83%. Most patients used the self-care advice and free text message component. Among the patients treated for breast cancer, higher age predicted a lower total number of free text messages sent (P=.04). Among the patients treated for prostate cancer, higher age (P=.01) and higher education level (P=.04), predicted an increase in total views on self-care advice, while higher comorbidity (P=.004) predicted a decrease in total views on self-care advice. Being married or living with a partner predicted a higher adherence to daily symptom reporting (P=.02). Daily symptom reporting created feelings of having continuous contact with health care professionals, being acknowledged, and safe. Being contacted by a nurse after a symptom alert was considered convenient and highly valued. Treatment and time-related aspects influenced engagement. Daily symptom reporting was perceived as particularly meaningful at the beginning of treatment. Requests were made for advice on diet and psychological symptoms, as well as for more comprehensive and detailed information as the patient progressed through treatment. Conclusions Patient engagement in the interactive app Interaktor was high. The app promoted patient participation in their care through continuous and convenient contact with health care professionals. The predictive ability of demographic variables differed between patient groups, but higher age and a higher educational level predicted usage of specific app functions for both patient groups. Patients’ experience of relevance and interactivity influenced their engagement positively.
Collapse
Affiliation(s)
- Marie-Therése Crafoord
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Maria Fjell
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Kay Sundberg
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Marie Nilsson
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ann Langius-Eklöf
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
39
|
Engagement with a Web-Based Health Promotion Intervention among Vocational School Students: A Secondary User and Usage Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072180. [PMID: 32218251 PMCID: PMC7177298 DOI: 10.3390/ijerph17072180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/11/2020] [Accepted: 03/17/2020] [Indexed: 12/27/2022]
Abstract
Engagement with web-based interventions is both generally low and typically declining. Visits and revisits remain a challenge. Based on log data of a web-based cluster randomized controlled trial conducted in vocational schools, the present secondary analysis aimed to identify influencing factors on initially logging in to a health promotion platform among young adults and to examine the engagement over the course of an eight-week intervention. Data of 336 students (62.2% female, age span 18–25) from two intervention arms (web-based intervention and web-based intervention with an additional initial face-to-face contact) was included. Binary logistic regression and log-data visualization were performed. An additional initial face-to-face contact (odds ratio (OR) = 2.971, p = 0.005), female sex (OR = 2.237, p = 0.046) and the health-related skill “dealing with health information” (OR = 2.179, p = 0.030) significantly increased the likelihood of initially logging in. Other variables showed no influence. 16.6% of all potential users logged in at least once, of which 57.4% revisited the platform. Most logins were tracked at the beginning of the intervention and repeated engagement was low. To increase the engagement with web-based interventions, health-related skills should be fostered. In addition, a strategy could be to interlink comparable interventions in vocational schools more regularly with everyday teaching through multi-component interventions.
Collapse
|
40
|
Kazlauskas E, Eimontas J, Olff M, Zelviene P, Andersson G. Adherence Predictors in Internet-Delivered Self-Help Intervention for Life Stressors-Related Adjustment Disorder. Front Psychiatry 2020; 11:137. [PMID: 32231597 PMCID: PMC7083090 DOI: 10.3389/fpsyt.2020.00137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 02/14/2020] [Indexed: 12/19/2022] Open
Abstract
Background: There is a growing body of evidence to show that low-intensity self-help internet-delivered interventions are effective in the treatment of mental disorders. Despite the promising effectiveness of internet-delivered interventions, there is still a challenge for mental health services to implement internet-delivered interventions in routine health care. The aim of this study was to analyze the predictors of adherence to a self-help internet-delivered intervention for adjustment disorder. Methods: This was a secondary report of data, including unpublished data, from a randomized controlled trial of an internet-delivered self-help intervention for adjustment disorder. The study included 1,077 participants who had completed online baseline assessments. All participants had experienced significant life stressors over the last 2 years and had high levels of adjustment disorder symptoms. We analyzed the role of sociodemographic variables, pre-treatment adjustment disorder symptoms, outcome expectations, and perceived barriers to mental health services on the use of the intervention. Results: We found that usage of internet-delivered self-help intervention and higher adherence was associated with female gender, greater age, higher pre-intervention outcome expectations, exposure to other forms of psychological therapy in addition to the internet-intervention at the time of the study, and reported perceived barriers to mental health services by the study participants. Conclusions: The findings of the study indicated the importance of non-specific therapeutic factors on adherence during internet-delivered intervention. Perceived barriers to mental health services were associated with higher adherence to self-help intervention, which indicated that communities with restricted access to mental health services could benefit from low-intensity internet-delivered interventions.
Collapse
Affiliation(s)
- Evaldas Kazlauskas
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Jonas Eimontas
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Miranda Olff
- Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Arq Psychotrauma Expert Group, Diemen, Netherlands
| | - Paulina Zelviene
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
41
|
Cunningham JA, Hodgins DC, Keough M, Hendershot CS, Schell C, Godinho A. Online interventions for problem gamblers with and without co-occurring unhealthy alcohol use: Randomized controlled trial. Internet Interv 2020; 19:100307. [PMID: 32042600 PMCID: PMC7000801 DOI: 10.1016/j.invent.2020.100307] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS Problem gambling and unhealthy alcohol use often co-occur. The current trial sought to establish whether adding a brief online intervention for unhealthy alcohol use to an online problem gambling intervention would lead to improvements in gambling and drinking among those with both of these concerns. METHODS Participants were recruited from across Canada using an advertisement targeting those concerned about their gambling who were interested in online help. No mention of unhealthy alcohol use was made in the advertisement. Participants meeting criteria for problem gambling were randomized to either receive just an online intervention for gambling (G-only) or to receive an online gambling intervention plus a brief personalized feedback intervention for unhealthy alcohol use (G + A). Participants were followed up at 3 and 6 months. RESULTS A total of 282 participants were recruited for the trial. Follow-up rates were good (80% and 84% at 3 and 6 months). There were significant reductions in gambling (p < .001) across time but no significant differences (p > .05) between those who received either the G-only or G + A interventions. Further, for those with unhealthy alcohol use (41% of the sample), there were no significant reductions in alcohol consumption (p > .05) across time or differences between condition. DISCUSSION AND CONCLUSION The addition of a brief intervention for unhealthy alcohol use to an online intervention for gambling did not appear to improve either gambling or drinking outcomes among people concerned about their gambling. Further research is merited to examine whether a combined intervention (with gambling and drinking components integrated) might result in improved outcomes and whether such an intervention might benefit the subgroup of participants who would specifically seek help for both gambling and alcohol concerns.Trial registration:ClinicalTrials.govNCT03323606; Registration date: October 24, 2017.
Collapse
Affiliation(s)
- John A. Cunningham
- Centre for Addiction and Mental Health, Toronto, Canada
- University of Toronto, Toronto, Canada
- Australian National University, Canberra, Australia
| | | | | | - Christian S. Hendershot
- Centre for Addiction and Mental Health, Toronto, Canada
- University of Toronto, Toronto, Canada
| | | | | |
Collapse
|
42
|
Dejonghe LAL, Rudolf K, Becker J, Stassen G, Froboese I, Schaller A. Health coaching for promoting physical activity in low back pain patients: a secondary analysis on the usage and acceptance. BMC Sports Sci Med Rehabil 2020; 12:2. [PMID: 32025308 PMCID: PMC6996177 DOI: 10.1186/s13102-019-0154-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 12/22/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Multicomponent interventions combined with health coaching are widely recommended to improve a healthy lifestyle. The aim of the present study was to analyse the usage and acceptance of a multicomponent intervention (telephone, web and face-to-face coaching) for low back pain patients, and thereby gain an understanding of why this intervention was not as effective as expected. METHODS A secondary analysis of a randomised controlled trial, aimed at promoting physical activity, was conducted. It was a cross-sectional study based on data of a multicomponent intervention group (baseline = 201 participants). For evaluating the usage and acceptance, descriptive statistics were applied. RESULTS Over half (n = 118) of the patients participated at least once in the telephone coaching. Approximately half of the participants (44 of 90) rated the telephone coaching as "good".34 of 92 (37%) participants reported of visiting the web-platform. The web-platform was comprehensible for nearly one-quarter (n = 8 of 33) and very useful for one participant.The face-to-face-contact was rated highly (range: 79.4-88.2 out of 100). CONCLUSION Usage of the telephone coaching approach was moderate with even fewer participants visiting the web-platform. In addition, these approaches were not rated as very useful. The acceptance of the face-to-face contact was high.Since the usage and acceptance could influence the effectiveness, utilisation and acceptance studies might help to explain the reason for non-effective lifestyle interventions. Therefore, more studies analysing the usage and acceptance are needed. To improve the usage and acceptance, a stronger participatory orientation in the design of interventions and the integration of face-to-face contact could be helpful.
Collapse
Affiliation(s)
- Lea Anna Lisa Dejonghe
- Institute of Movement Therapy and Movement-Orientated Prevention and Rehabilitation, German Sport University Cologne, Am Sportpark Muengersdorf 6, 50933 Cologne, Germany
| | - Kevin Rudolf
- Institute of Movement Therapy and Movement-Orientated Prevention and Rehabilitation, German Sport University Cologne, Am Sportpark Muengersdorf 6, 50933 Cologne, Germany
| | - Jennifer Becker
- Department of Community Health, University of Applied Sciences, Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Gerrit Stassen
- Institute of Movement Therapy and Movement-Orientated Prevention and Rehabilitation, German Sport University Cologne, Am Sportpark Muengersdorf 6, 50933 Cologne, Germany
- Working Group Physical Activity-Related Prevention Research, German Sport University Cologne, Am Sportpark Muengersdorf 6, 50933 Cologne, Germany
| | - Ingo Froboese
- Institute of Movement Therapy and Movement-Orientated Prevention and Rehabilitation, German Sport University Cologne, Am Sportpark Muengersdorf 6, 50933 Cologne, Germany
- Center for Health through Sport and Movement, German Sport University, Cologne, Am Sportpark Muengersdorf 6, 50933 Cologne, Germany
| | - Andrea Schaller
- Institute of Movement Therapy and Movement-Orientated Prevention and Rehabilitation, German Sport University Cologne, Am Sportpark Muengersdorf 6, 50933 Cologne, Germany
- Working Group Physical Activity-Related Prevention Research, German Sport University Cologne, Am Sportpark Muengersdorf 6, 50933 Cologne, Germany
| |
Collapse
|
43
|
Sanatkar S, Baldwin PA, Huckvale K, Clarke J, Christensen H, Harvey S, Proudfoot J. Using Cluster Analysis to Explore Engagement and e-Attainment as Emergent Behavior in Electronic Mental Health. J Med Internet Res 2019; 21:e14728. [PMID: 31778115 PMCID: PMC6908978 DOI: 10.2196/14728] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/22/2019] [Accepted: 09/24/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In most e-mental health (eMH) research to date, adherence is defined according to a trial protocol. However, adherence to a study protocol may not completely capture a key aspect of why participants engage with eMH tools, namely, to achieve personal mental health goals. As a consequence, trial attrition reported as non-adherence or dropout may reflect e-attainment, the discontinuation of eMH engagement after personal goals have been met. Clarifying engagement patterns, such as e-attainment, and how these align with mental health trajectories, may help optimize eMH design and implementation science. OBJECTIVE This study aimed to use clustering techniques to identify real-world engagement profiles in a community of eMH users and examine if such engagement profiles are associated with different mental health outcomes. The novelty of this approach was our attempt to identify actual user engagement behaviors, as opposed to employing engagement benchmarks derived from a trial protocol. The potential of this approach is to link naturalistic behaviors to beneficial mental health outcomes, which would be especially informative when designing eMH programs for the general public. METHODS Between May 2013 and June 2018, Australian adults (N=43,631) signed up to myCompass, a self-guided eMH program designed to help alleviate mild to moderate symptoms of depression, anxiety, and stress. Recorded usage data included number of logins, frequency of mood tracking, number of started and completed learning activities, and number of tracking reminders set. A subset of users (n=168) completed optional self-assessment mental health questionnaires (Patient Health Questionnaire-9 item, PHQ-9; Generalized Anxiety Disorder Questionnaire-7 item, GAD-7) at registration and at 28 and 56 days after sign-up. Another subset of users (n=861) completed the PHQ-9 and GAD-7 at registration and at 28 days. RESULTS Two-step cluster analyses revealed 3 distinct usage patterns across both subsamples: moderates, trackers, and super users, signifying differences both in the frequency of use as well as differences in preferences for program functionalities. For both subsamples, repeated measures analysis of variances showed significant decreases over time in PHQ-9 and GAD-7 scores. Time-by-cluster interactions, however, did not yield statistical significance in both subsamples, indicating that clusters did not predict symptom reduction over time. Interestingly, users who completed the self-assessment questionnaires twice had slightly but significantly lower depression and anxiety levels at sign-up compared with users who completed the questionnaires a third time at 56 days. CONCLUSIONS Findings suggested that although users engaged with myCompass in different but measurable ways, those different usage patterns evoked equivalent mental health benefits. Furthermore, the randomized controlled trial paradigm may unintentionally limit the scope of eMH engagement research by mislabeling early mental health goal achievers as dropouts. More detailed and naturalistic approaches to study engagement with eMH technologies may improve program design and, ultimately, program effectiveness.
Collapse
Affiliation(s)
- Samineh Sanatkar
- Black Dog Institute, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Peter Andrew Baldwin
- Black Dog Institute, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Kit Huckvale
- Black Dog Institute, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Janine Clarke
- Black Dog Institute, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Helen Christensen
- Black Dog Institute, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Samuel Harvey
- Black Dog Institute, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Judy Proudfoot
- Black Dog Institute, School of Psychiatry, University of New South Wales, Sydney, Australia
| |
Collapse
|
44
|
Bouwman T, van Tilburg T, Aartsen M. Attrition in an Online Loneliness Intervention for Adults Aged 50 Years and Older: Survival Analysis. JMIR Aging 2019; 2:e13638. [PMID: 31518268 PMCID: PMC6715013 DOI: 10.2196/13638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/10/2019] [Accepted: 06/08/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Online interventions can be as effective as in-person interventions. However, attrition in online intervention is high and potentially biases the results. More importantly, high attrition rates might reduce the effectiveness of online interventions. Therefore, it is important to discover the extent to which factors affect adherence to online interventions. The setting for this study is the online Friendship Enrichment Program, a loneliness intervention for adults aged 50 years and older. OBJECTIVE This study examined the contribution of severity of loneliness, coping preference, activating content, and engagement in attrition within an online intervention. METHODS Data were collected from 352 participants in an online loneliness intervention for Dutch people aged 50 years and older. Attrition was defined as not completing all 10 intervention lessons. The number of completed lessons was assessed through the management system of the intervention. We tested 4 hypotheses on attrition by applying survival analysis (Cox regression). RESULTS Of the 352 participants who subscribed to the intervention, 46 never started the introduction. The remaining 306 participants were divided into 2 categories: 73 participants who did not start the lessons of the intervention and 233 who started the lessons of the intervention. Results of the survival analysis (n=233) showed that active coping preference (hazard ratio [HR]=0.73), activating content (HR=0.71), and 2 indicators of engagement (HR=0.94 and HR=0.79) lowered attrition. Severity of loneliness was not related to attrition. CONCLUSIONS To reduce attrition, developers of online (loneliness) interventions may focus on stimulating active behavior within the intervention.
Collapse
Affiliation(s)
- Tamara Bouwman
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Theo van Tilburg
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marja Aartsen
- Norwegian Social Research, Oslo Metropolitan University, Oslo, Norway
| |
Collapse
|
45
|
Patient acceptance of a telemedicine service for rehabilitation care: A focus group study. Int J Med Inform 2019; 125:22-29. [DOI: 10.1016/j.ijmedinf.2019.01.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 12/17/2018] [Accepted: 01/21/2019] [Indexed: 11/22/2022]
|
46
|
Hartmann R, Sander C, Lorenz N, Böttger D, Hegerl U. Utilization of Patient-Generated Data Collected Through Mobile Devices: Insights From a Survey on Attitudes Toward Mobile Self-Monitoring and Self-Management Apps for Depression. JMIR Ment Health 2019; 6:e11671. [PMID: 30942693 PMCID: PMC6468343 DOI: 10.2196/11671] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/30/2018] [Accepted: 12/31/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Depression is a severe psychiatric disease with high prevalence and an elevated risk for recurrence and chronicity. A substantial proportion of individuals with a diagnosis of unipolar depressive disorder do not receive treatment as advised by national guidelines. Consequently, self-monitoring and self-management become increasingly important. New mobile technologies create unique opportunities to obtain and utilize patient-generated data. As common adherence rates to mobile technologies are scarce, a profound knowledge of user behavior and attitudes and preferences is important throughout any developmental process of mobile technologies and apps. OBJECTIVE The aim of this survey was to provide descriptive data upon usage and anticipated usage of self-monitoring and self-management of depression and preferences of potential users in terms of documented parameters and data-sharing options. METHODS A Web-based survey comprising 55 questions was conducted to obtain data on the usage of mobile devices, app usage, and participant's attitudes and preferences toward mobile health apps for the self-monitoring and self-management of depression. RESULTS A total of 825 participants provided information. Moreover, two-thirds of the sample self-reported to be affected by depressive symptoms, but only 12.1% (81/668) of those affected by depression have ever used any mobile self-monitoring or self-management app. Analysis showed that people want personally relevant information and feedback but also focus on handling sensitive data. CONCLUSIONS New mobile technologies and smartphone apps, especially in combination with mobile sensor systems, offer unique opportunities to overcome challenges in the treatment of depression by utilizing the potential of patient-generated data. Focus on patient-relevant information, security and safe handling of sensitive personal data, as well as options to share data with self-selected third parties should be considered mandatory throughout any development process.
Collapse
Affiliation(s)
- Ralf Hartmann
- Research Center of the German Depression Foundation, Leipzig, Germany
| | - Christian Sander
- Research Center of the German Depression Foundation, Leipzig, Germany
| | - Noah Lorenz
- Research Center of the German Depression Foundation, Leipzig, Germany
| | - Daniel Böttger
- Research Center of the German Depression Foundation, Leipzig, Germany
| | - Ulrich Hegerl
- Department of Psychiatry, University of Leipzig, Leipzig, Germany
| |
Collapse
|
47
|
Hageman PA, Mroz JE, Yoerger MA, Pullen CH. User Engagement Associated with Web-Intervention Features to Attain Clinically Meaningful Weight Loss and Weight Maintenance in Rural Women. J Obes 2019; 2019:7932750. [PMID: 30944736 PMCID: PMC6421718 DOI: 10.1155/2019/7932750] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 11/24/2018] [Accepted: 01/30/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Purely web-based weight loss and weight-loss maintenance interventions show promise to influence behavior change. Yet, little is known about user engagement with features of web-based interventions that predict clinically meaningful weight loss (≥5% bodyweight loss). This study examines level of website feature engagement with the likelihood of attaining ≥5% bodyweight loss after 6 and 18 months participation in a web-based intervention, among rural women at high risk of obesity-related diseases and disability. METHODS In this secondary analysis of clinical trial data of 201 rural women, we examined weight change and user engagement, measured as clicks on specific web-based intervention features (messaging and self-tracking), as associated with clinically meaningful weight loss (baseline to 6 months) and weight-loss maintenance (6 to 18 months). RESULTS Generalized estimating equations, adjusted for age, intervention group, and intervention phase, revealed high engagement with messaging predicted whether women achieved ≥5% weight loss at 6 months and at 18 months. There was no effect of self-tracking. CONCLUSIONS Being engaged with messages was associated with attaining clinically meaningful short-term and longer-term weight loss. This trial is registered with NCT01307644.
Collapse
Affiliation(s)
- Patricia A. Hageman
- Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA
| | - Joseph E. Mroz
- Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA
| | - Michael A. Yoerger
- Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA
| | - Carol H. Pullen
- College of Nursing, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE 68198-5330, USA
| |
Collapse
|
48
|
Milward J, Deluca P, Drummond C, Kimergård A. Developing Typologies of User Engagement With the BRANCH Alcohol-Harm Reduction Smartphone App: Qualitative Study. JMIR Mhealth Uhealth 2018; 6:e11692. [PMID: 30545806 PMCID: PMC6315270 DOI: 10.2196/11692] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/19/2018] [Accepted: 10/04/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Understanding how users engage with electronic screening and brief intervention (eSBI) is a critical research objective to improve effectiveness of app-based interventions to reduce harmful alcohol consumption. Although quantitative measures of engagement provide a strong indicator of how the user engages with an app at the group level, they do not elucidate finer-grained details of how apps function from an individual, experiential perspective and why, or how, users engage with an intervention in a particular manner. OBJECTIVE The aim of this study was to (1) understand why and how participants engaged with the BRANCH app, (2) explore facilitators and barriers to engagement with app features, (3) explore how the BRANCH app impacted drinking behavior, (4) use these data to identify typologies of users of the BRANCH app in terms of engagement behaviors, and (5) identify future eSBI app design implications. METHODS In total, 20 one-to-one semistructured telephone interviews were conducted with participants recruited from a randomized controlled trial, which evaluated the effectiveness of engagement-promoting strategies in the BRANCH app targeting harmful drinking in young adults (aged 18-30 years). The topic guide explored users' current engagement levels with existing health promotion apps, their views toward the effectiveness of such apps, and what they liked and disliked about BRANCH, specifically focusing on how they engaged with the app. Framework analysis was used to develop typologies of user engagement. RESULTS The study identified 3 typologies of engagers. Trackers were defined by their motivations to use health-tracking apps to monitor and understand quantified self-data. They did not have intentions necessarily to cut down and predominantly used only the drinking diary. Cut-downers were motivated to use the app because they wanted to reduce their alcohol consumption Unlike Trackers, they did not use a range of different health apps daily, but saw the BRANCH app as an opportunity to test out a different method of trying to cut down their alcohol use. This typology used more features than Trackers, such as the goal setting function. Noncommitters were characterized as a group of users who were initially enthusiastic about using the app; however, this enthusiasm quickly waned and they gained no benefit from it. CONCLUSIONS This was the first study to identify typologies of user engagement with eSBI apps. Although in need of replication, it provides a first step in understanding independent categories of eSBI users, who may benefit from apps tailored to a user's typology or motivation. It also provides new evidence to suggest that apps may be used more effectively as a tool to raise awareness of drinking, instead of reducing alcohol use, and be a step in the care pathway, identifying at-risk individuals and signposting them to more intensive treatment. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number ISRCTN70980706; http://www.isrctn.com /ISRCTN70980706 (Archived by WebCite at http://www.webcitation.org/73vfDXYEZ).
Collapse
Affiliation(s)
- Joanna Milward
- Addictions Department, King's College London, London, United Kingdom
| | - Paolo Deluca
- Addictions Department, King's College London, London, United Kingdom
| | - Colin Drummond
- Addictions Department, King's College London, London, United Kingdom
| | - Andreas Kimergård
- Addictions Department, King's College London, London, United Kingdom
| |
Collapse
|
49
|
Short CE, DeSmet A, Woods C, Williams SL, Maher C, Middelweerd A, Müller AM, Wark PA, Vandelanotte C, Poppe L, Hingle MD, Crutzen R. Measuring Engagement in eHealth and mHealth Behavior Change Interventions: Viewpoint of Methodologies. J Med Internet Res 2018; 20:e292. [PMID: 30446482 PMCID: PMC6269627 DOI: 10.2196/jmir.9397] [Citation(s) in RCA: 192] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 08/01/2018] [Accepted: 09/10/2018] [Indexed: 12/30/2022] Open
Abstract
Engagement in electronic health (eHealth) and mobile health (mHealth) behavior change interventions is thought to be important for intervention effectiveness, though what constitutes engagement and how it enhances efficacy has been somewhat unclear in the literature. Recently published detailed definitions and conceptual models of engagement have helped to build consensus around a definition of engagement and improve our understanding of how engagement may influence effectiveness. This work has helped to establish a clearer research agenda. However, to test the hypotheses generated by the conceptual modules, we need to know how to measure engagement in a valid and reliable way. The aim of this viewpoint is to provide an overview of engagement measurement options that can be employed in eHealth and mHealth behavior change intervention evaluations, discuss methodological considerations, and provide direction for future research. To identify measures, we used snowball sampling, starting from systematic reviews of engagement research as well as those utilized in studies known to the authors. A wide range of methods to measure engagement were identified, including qualitative measures, self-report questionnaires, ecological momentary assessments, system usage data, sensor data, social media data, and psychophysiological measures. Each measurement method is appraised and examples are provided to illustrate possible use in eHealth and mHealth behavior change research. Recommendations for future research are provided, based on the limitations of current methods and the heavy reliance on system usage data as the sole assessment of engagement. The validation and adoption of a wider range of engagement measurements and their thoughtful application to the study of engagement are encouraged.
Collapse
Affiliation(s)
- Camille E Short
- Freemasons Foundation Centre for Men's Health, School of Medicine, University of Adelaide, Adelaide, Australia
| | - Ann DeSmet
- Department of Movement and Sports Sciences, Ghent University, Brussels, Belgium
| | - Catherine Woods
- Health Research Institute, Centre for Physical Activity and Health, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Susan L Williams
- Physical Activity Research Group, Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Carol Maher
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute, School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Anouk Middelweerd
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Andre Matthias Müller
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Centre for Sport and Exercise Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Petra A Wark
- Centre for Innovative Research Across the Life Course, Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom
| | - Corneel Vandelanotte
- Physical Activity Research Group, Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Louise Poppe
- Department of Movement and Sports Sciences, Ghent University, Brussels, Belgium
| | - Melanie D Hingle
- Department of Nutritional Sciences, College of Agriculture & Life Sciences, University of Arizona, Tucson, AZ, United States
| | - Rik Crutzen
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
50
|
Lin PH, Grambow S, Intille S, Gallis JA, Lazenka T, Bosworth H, Voils CL, Bennett GG, Batch B, Allen J, Corsino L, Tyson C, Svetkey L. The Association Between Engagement and Weight Loss Through Personal Coaching and Cell Phone Interventions in Young Adults: Randomized Controlled Trial. JMIR Mhealth Uhealth 2018; 6:e10471. [PMID: 30341051 PMCID: PMC6245957 DOI: 10.2196/10471] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/15/2018] [Accepted: 07/26/2018] [Indexed: 01/04/2023] Open
Abstract
Background Understanding how engagement in mobile health (mHealth) weight loss interventions relates to weight change may help develop effective intervention strategies. Objective This study aims to examine the (1) patterns of participant engagement overall and with key intervention components within each intervention arm in the Cell Phone Intervention For You (CITY) trial; (2) associations of engagement with weight change; and (3) participant characteristics related to engagement. Methods The CITY trial tested two 24-month weight loss interventions. One was delivered with a smartphone app (cell phone) containing 24 components (weight tracking, etc) and included prompting by the app in predetermined frequency and forms. The other was delivered by a coach via monthly calls (personal coaching) supplemented with limited app components (18 overall) and without any prompting by the app. Engagement was assessed by calculating the percentage of days each app component was used and the frequency of use. Engagement was also examined across 4 weight change categories: gained (≥2%), stable (±2%), mild loss (≥2% to <5%), and greater loss (≥5%). Results Data from 122 cell phone and 120 personal coaching participants were analyzed. Use of the app was the highest during month 1 for both arms; thereafter, use dropped substantially and continuously until the study end. During the first 6 months, the mean percentage of days that any app component was used was higher for the cell phone arm (74.2%, SD 20.1) than for the personal coaching arm (48.9%, SD 22.4). The cell phone arm used the apps an average of 5.3 times/day (SD 3.1), whereas the personal coaching participants used them 1.7 times/day (SD 1.2). Similarly, the former self-weighed more than the latter (57.1% days, SD 23.7 vs 32.9% days, SD 23.3). Furthermore, the percentage of days any app component was used, number of app uses per day, and percentage of days self-weighed all showed significant differences across the 4 weight categories for both arms. Pearson correlation showed a negative association between weight change and the percentage of days any app component was used (cell phone: r=−.213; personal coaching: r=−.319), number of apps use per day (cell phone: r=−.264; personal coaching: r=−.308), and percentage of days self-weighed (cell phone: r=−.297; personal coaching: r=−.354). None of the characteristics examined, including age, gender, race, education, income, energy expenditure, diet quality, and hypertension status, appeared to be related to engagement. Conclusions Engagement in CITY intervention was associated with weight loss during the first 6 months. Nevertheless, engagement dropped substantially early on for most intervention components. Prompting may be helpful initially. More flexible and less intrusive prompting strategies may be needed during different stages of an intervention to increase or sustain engagement. Future studies should explore the motivations for engagement and nonengagement to determine meaningful levels of engagement required for effective intervention. Trial Registration ClinicalTrials.gov NCT01092364; https://clinicaltrials.gov/ct2/show/NCT01092364 (Archived by WebCite at http://www.webcitation.org/72V8A4e5X)
Collapse
Affiliation(s)
- Pao-Hwa Lin
- Nephrology Division, Department of Medicine, Duke University Medical Center, Durham, NC, United States.,Sarah W Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC, United States
| | - Steven Grambow
- Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, United States
| | - Stephen Intille
- College of Computer and Information Science, Northeastern University, Boston, MA, United States.,Bouvé College of Health Sciences, Northeastern University, Boston, MA, United States
| | - John A Gallis
- Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, United States.,Duke Global Health Institute, Duke University Medical Center, Durham, NC, United States
| | - Tony Lazenka
- College of Computer and Information Science, Northeastern University, Boston, MA, United States
| | - Hayden Bosworth
- Population Health Sciences, Duke University Medical Center, Durham, NC, United States.,Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, NC, United States.,School of Nursing, Duke University Medical Center, Durham, NC, United States.,Department of Psychiatry, School of Medicine, Duke University Medical Center, Durham, NC, United States.,Department of Medicine, School of Medicine, Duke University Medical Center, Durham, NC, United States
| | - Corrine L Voils
- William S Middleton Memorial Veterans Hospital, Madison, WI, United States.,School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - Gary G Bennett
- Global Digital Health Science Center, Duke University Medical Center, Durham, NC, United States.,Department of Psychology & Neuroscience, Duke University Medical Center, Durham, NC, United States
| | - Bryan Batch
- Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - Jenifer Allen
- Clinical & Translational Science Institute, Duke University Medical Center, Kannapolis, NC, United States
| | - Leonor Corsino
- Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - Crystal Tyson
- Nephrology Division, Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - Laura Svetkey
- Nephrology Division, Department of Medicine, Duke University Medical Center, Durham, NC, United States.,Sarah W Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC, United States
| |
Collapse
|