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Cronström A, Sjödahl Hammarlund C. "A feeling of being part of the future": a qualitative study on physical therapists' experiences of delivering digital first-line treatment for hip and knee osteoarthritis. Physiother Theory Pract 2024:1-10. [PMID: 39034494 DOI: 10.1080/09593985.2024.2380478] [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: 03/14/2024] [Accepted: 07/10/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Digital options for osteoarthritis (OA) treatment are increasingly available with high patient satisfaction and acceptability. Little is, however, known about physical therapists' (PT) perception of this treatment modality. OBJECTIVE To investigate PT's experience of delivering digital treatment for hip and knee OA using a smart-phone application. METHOD Nine PTs (mean age 36 years, women n = 5) with 3-24 months experience of delivering digital OA treatment were interviewed using a semi-structured interview guide. The interviews were transcribed verbatim and analyzed using content analysis. RESULTS Four main categories arose; 1) A feeling of being part of the future, 2) Making an osteoarthritis diagnosis in a digital setting, 3) Facilitators and barriers of digital OA management and 4) Where to go from here? PTs were in general positive for digital treatment delivery but felt that a lack of visual assessments and physical examinations to enhance exercise evaluations and diagnosis accuracy was sometimes a disadvantage. CONCLUSION Digital treatment delivery was in general perceived as a time-efficient way of providing high-quality care that may increase patient motivation and adherence without violating the therapeutic alliance. Future implementations of digital OA treatment programs should consider the possibility of including real-time video calls for visual assessment.
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Affiliation(s)
- Anna Cronström
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Catharina Sjödahl Hammarlund
- Department of Health Sciences, Lund University, Lund, Sweden
- The Pro-care Group, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
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Kim M, Patrick K, Nebeker C, Godino J, Stein S, Klasnja P, Perski O, Viglione C, Coleman A, Hekler E. The Digital Therapeutics Real-World Evidence Framework: An Approach for Guiding Evidence-Based Digital Therapeutics Design, Development, Testing, and Monitoring. J Med Internet Res 2024; 26:e49208. [PMID: 38441954 PMCID: PMC10951831 DOI: 10.2196/49208] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 01/13/2024] [Accepted: 01/29/2024] [Indexed: 03/07/2024] Open
Abstract
Digital therapeutics (DTx) are a promising way to provide safe, effective, accessible, sustainable, scalable, and equitable approaches to advance individual and population health. However, developing and deploying DTx is inherently complex in that DTx includes multiple interacting components, such as tools to support activities like medication adherence, health behavior goal-setting or self-monitoring, and algorithms that adapt the provision of these according to individual needs that may change over time. While myriad frameworks exist for different phases of DTx development, no single framework exists to guide evidence production for DTx across its full life cycle, from initial DTx development to long-term use. To fill this gap, we propose the DTx real-world evidence (RWE) framework as a pragmatic, iterative, milestone-driven approach for developing DTx. The DTx RWE framework is derived from the 4-phase development model used for behavioral interventions, but it includes key adaptations that are specific to the unique characteristics of DTx. To ensure the highest level of fidelity to the needs of users, the framework also incorporates real-world data (RWD) across the entire life cycle of DTx development and use. The DTx RWE framework is intended for any group interested in developing and deploying DTx in real-world contexts, including those in industry, health care, public health, and academia. Moreover, entities that fund research that supports the development of DTx and agencies that regulate DTx might find the DTx RWE framework useful as they endeavor to improve how DTxcan advance individual and population health.
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Affiliation(s)
- Meelim Kim
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, United States
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- The Qualcomm Institute, University of California San Diego, La Jolla, CA, United States
- The Design Lab, University of California San Diego, La Jolla, CA, United States
| | - Kevin Patrick
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, United States
- The Qualcomm Institute, University of California San Diego, La Jolla, CA, United States
| | - Camille Nebeker
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, United States
- The Qualcomm Institute, University of California San Diego, La Jolla, CA, United States
- The Design Lab, University of California San Diego, La Jolla, CA, United States
| | - Job Godino
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, United States
- The Qualcomm Institute, University of California San Diego, La Jolla, CA, United States
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, United States
| | | | - Predrag Klasnja
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Olga Perski
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, United States
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Clare Viglione
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, United States
| | - Aaron Coleman
- Small Steps Labs LLC dba Fitabase Inc, San Diego, CA, United States
| | - Eric Hekler
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, United States
- The Qualcomm Institute, University of California San Diego, La Jolla, CA, United States
- The Design Lab, University of California San Diego, La Jolla, CA, United States
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Li L, Yang P, Duan Y, Xie J, Liu M, Zhou Y, Luo X, Zhang C, Li Y, Wang J, Chen Z, Zhang X, Cheng ASK. Association between dietary diversity, sedentary time outside of work and depressive symptoms among knowledge workers: a multi-center cross-sectional study. BMC Public Health 2024; 24:53. [PMID: 38166945 PMCID: PMC10762993 DOI: 10.1186/s12889-023-17567-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Low-diversity diets and sedentary status are risk factors for depressive symptoms, while knowledge workers were ignored before. The purpose of this current study was to examine the relationship between dietary diversity, sedentary time spent outside of work, and depressive symptoms among knowledge workers. STUDY DESIGN AND METHODS This was a multicenter and cross-sectional design that included 118,723 knowledge workers. Participants self-reported online between January 2018 and December 2020. Demographic information, the Dietary Diversity Scale, the Patient Health Questionnaire-9, dietary habits (which included eating three meals on time, midnight snacking, overeating, social engagement, coffee consumption, sugary drink consumption, smoking and alcohol use), sedentary time spent outside of work and physical activity were investigated. RESULTS The relationships between demographic information, dietary habits and dietary diversity, and depressive symptoms were estimated. Compared with the first and second levels of dietary diversity, the third level of dietary diversity (OR: 0.91; 95% CI: 0.84-0.98) reduced the risk of depressive symptoms. Knowledge workers with different degrees of sedentary status (2-4 h (OR: 1.11; 95% CI: 1.07-1.14), 4-6 h (OR: 1.21; 95% CI: 1.17-1.26), and > 6 h (OR: 1.49; 95% CI: 1.43-1.56), presented a progressively higher risk of depressive symptoms. CONCLUSION High amounts of sedentary time spent after work and low levels of dietary diversity are risk factors for depressive symptoms. In addition, an irregular diet and overeating are also major risk factors for knowledge workers.
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Affiliation(s)
- Lijun Li
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, China
- Nursing Department, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Pingting Yang
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Yinglong Duan
- Nursing Department, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jianfei Xie
- Nursing Department, The Third Xiangya Hospital of Central South University, Changsha, China.
| | - Min Liu
- Nursing Department, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Yi Zhou
- Xiangya Nursing School of Central South University, Changsha, China
| | - Xiaofei Luo
- Xiangya Nursing School of Central South University, Changsha, China
| | - Chun Zhang
- Xiangya Nursing School of Central South University, Changsha, China
| | - Ying Li
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jiangang Wang
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Zhiheng Chen
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Xiaohong Zhang
- Nursing Department, The Third Xiangya Hospital of Central South University, Changsha, China.
| | - Andy S K Cheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Nourse R, Dingler T, Kelly J, Kwasnicka D, Maddison R. The Role of a Smart Health Ecosystem in Transforming the Management of Chronic Health Conditions. J Med Internet Res 2023; 25:e44265. [PMID: 38109188 PMCID: PMC10758944 DOI: 10.2196/44265] [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: 11/13/2022] [Revised: 06/07/2023] [Accepted: 06/29/2023] [Indexed: 12/19/2023] Open
Abstract
The effective management of chronic conditions requires an approach that promotes a shift in care from the clinic to the home, improves the efficiency of health care systems, and benefits all users irrespective of their needs and preferences. Digital health can provide a solution to this challenge, and in this paper, we provide our vision for a smart health ecosystem. A smart health ecosystem leverages the interoperability of digital health technologies and advancements in big data and artificial intelligence for data collection and analysis and the provision of support. We envisage that this approach will allow a comprehensive picture of health, personalization, and tailoring of behavioral and clinical support; drive theoretical advancements; and empower people to manage their own health with support from health care professionals. We illustrate the concept with 2 use cases and discuss topics for further consideration and research, concluding with a message to encourage people with chronic conditions, their caregivers, health care professionals, policy and decision makers, and technology experts to join their efforts and work toward adopting a smart health ecosystem.
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Affiliation(s)
- Rebecca Nourse
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Tilman Dingler
- School of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - Jaimon Kelly
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Dominika Kwasnicka
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Ralph Maddison
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
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Mitra S, Kroeger CM, Xu J, Avery L, Masedunskas A, Cassidy S, Wang T, Hunyor I, Wilcox I, Huang R, Chakraborty B, Fontana L. Testing the Effects of App-Based Motivational Messages on Physical Activity and Resting Heart Rate Through Smartphone App Compliance in Patients With Vulnerable Coronary Artery Plaques: Protocol for a Microrandomized Trial. JMIR Res Protoc 2023; 12:e46082. [PMID: 37782531 PMCID: PMC10580140 DOI: 10.2196/46082] [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: 03/13/2023] [Revised: 06/29/2023] [Accepted: 07/24/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Achieving the weekly physical activity recommendations of at least 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity aerobic exercise is important for reducing cardiometabolic risk, but evidence shows that most people struggle to meet these goals, particularly in the mid to long term. OBJECTIVE The Messages Improving Resting Heart Health (MIRTH) study aims to determine if (1) sending daily motivational messages through a research app is effective in improving motivation and in promoting adherence to physical activity recommendations in men and women with coronary heart disease randomized to a 12-month intensive lifestyle intervention, and (2) the time of the day when the message is delivered impacts compliance with exercise training. METHODS We will conduct a single-center, microrandomized trial. Participants will be randomized daily to either receive or not receive motivational messages over two 90-day periods at the beginning (phase 1: months 4-6) and at the end (phase 2: months 10-12) of the Lifestyle Vulnerable Plaque Study. Wrist-worn devices (Fitbit Inspire 2) and Bluetooth pairing with smartphones will be used to passively collect data for proximal (ie, physical activity duration, steps walked, and heart rate within 180 minutes of receiving messages) and distal (ie, change values for resting heart rate and total steps walked within and across both phases 1 and 2 of the trial) outcomes. Participants will be recruited from a large academic cardiology office practice (Central Sydney Cardiology) and the Royal Prince Alfred Hospital Departments of Cardiology and Radiology. All clinical investigations will be undertaken at the Charles Perkins Centre Royal Prince Alfred clinic. Individuals aged 18-80 years (n=58) with stable coronary heart disease who have low attenuation plaques based on a coronary computed tomography angiography within the past 3 months and have been randomized to an intensive lifestyle intervention program will be included in MIRTH. RESULTS The Lifestyle Vulnerable Plaque Study was funded in 2020 and started enrolling participants in February 2022. Recruitment for MIRTH commenced in November 2022. As of September 2023, 2 participants were enrolled in the MIRTH study and provided baseline data. CONCLUSIONS This MIRTH microrandomized trial will represent the single most detailed and integrated analysis of the effects of a comprehensive lifestyle intervention delivered through a customized mobile health app on smart devices on time-based motivational messaging for patients with coronary heart disease. This study will also help inform future studies optimizing for just-in-time adaptive interventions. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12622000731796; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382861. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46082.
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Affiliation(s)
- Sayan Mitra
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, Australia
| | - Cynthia M Kroeger
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, Australia
| | - Jing Xu
- Office of Education, Duke-National University of Singapore Medical School, Singapore, Singapore
- Program in Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore, Singapore
- Centre for Quantitative Medicine, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Leah Avery
- School of Health & Life Sciences, Teesside University, Tees Valley, England, United Kingdom
| | - Andrius Masedunskas
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, Australia
| | - Sophie Cassidy
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, Australia
| | - Tian Wang
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, Australia
| | - Imre Hunyor
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
- Central Sydney Cardiology, Royal Prince Alfred Medical Centre, Sydney, Australia
| | - Ian Wilcox
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
- Central Sydney Cardiology, Royal Prince Alfred Medical Centre, Sydney, Australia
| | - Robin Huang
- School of Computer Science, The University of Sydney, Darlington, Australia
| | - Bibhas Chakraborty
- Program in Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore, Singapore
- Centre for Quantitative Medicine, Duke-National University of Singapore Medical School, Singapore, Singapore
- Department of Statistics and Data Science, National University of Singapore, Singapore, Singapore
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, United States
| | - Luigi Fontana
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, Australia
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
- Department of Clinical and Experimental Sciences, Brescia University, Brescia, Italy
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Schafer M, Lachman JM, Gardner F, Zinser P, Calderon F, Han Q, Facciola C, Clements L. Integrating intimate partner violence prevention content into a digital parenting chatbot intervention during COVID-19: Intervention development and remote data collection. BMC Public Health 2023; 23:1708. [PMID: 37667352 PMCID: PMC10476288 DOI: 10.1186/s12889-023-16649-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/29/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is a serious public health issue which experienced a sharp incline during the onset of COVID-19. Increases in other forms of violence, such as violence against children (VAC), have also been linked to the pandemic, and there have been calls for greater prevention efforts that tackle both forms of violence concurrently. The COVID-19 crisis has highlighted the urgent need for evidence-based and scalable violence prevention interventions that target multiple forms of family violence. Parenting programmes have shown promising results in preventing various forms of family violence, including IPV and VAC, and have recently experienced an expansion in delivery, with digital intervention formats growing. This paper describes the development and evaluation of the IPV prevention content designed and integrated into ParentText, a chatbot parenting intervention adapted from Parenting for Lifelong Health programmes. METHODS The ParentText IPV prevention content was developed using the Six Steps in Quality Intervention Development (6SQuID) framework. This involved targeted literature searches for key studies to identify causal factors associated with IPV and determining those with greatest scope for change. Findings were used to develop the intervention content and theory of change. Consultations were held with academic researchers (n = 5), practitioners (n = 5), and local community organisations (n = 7), who reviewed the content. A formative evaluation was conducted with parents in relationships (n = 96) in Jamaica to better understand patterns in user engagement with the intervention and identify strategies to further improve engagement. RESULTS Using the 6SQuID model, five topics on IPV prevention were integrated into the ParentText chatbot. Text-messages covering each topic, including additional materials such as cartoons and videos, were also developed. The formative evaluation revealed an average user-engagement length of 14 days, 0.50 chatbot interactions per day, and over half of participants selected to view additional relationship content. CONCLUSIONS This article provides a unique contribution as the first to integrate IPV prevention content into a remotely delivered, digital parenting intervention for low-resource settings. The findings from this research and formative evaluation shed light on the promising potential of chatbots as scalable and accessible forms of violence prevention, targeting multiple types of family violence.
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Affiliation(s)
- Moa Schafer
- Centre for Evidence Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom.
| | - Jamie M Lachman
- Centre for Evidence Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Frances Gardner
- Centre for Evidence Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Paula Zinser
- Centre for Evidence Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Francisco Calderon
- Centre for Evidence Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Qing Han
- Centre for Evidence Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
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Biddle L, Derges J, Cliffe B, Gooberman-Hill R, Linton MJ, Moran P, Bould H. "Pouring their heart out in Sainsbury's": qualitative study of young people's, parents' and mental health practitioners' experiences of adapting to remote online mental health appointments during COVID-19. BMC Psychiatry 2023; 23:641. [PMID: 37658298 PMCID: PMC10474770 DOI: 10.1186/s12888-023-05126-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/21/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, technologies such as videoconferencing were used to deliver mental health appointments remotely online. For many people, this was a change from previous methods of mental healthcare receipt and delivery. We aimed to explore in-depth how practitioners, young people and parents in the UK experienced this transition. METHODS We used qualitative methods to collect data, triangulating between free-text online survey data (n = 38), focus groups (n = 5) (3 young adult groups (total n = 11); 2 practitioner groups (total n = 7)), and semi-structured interviews (practitioners n = 8; parents n = 4). Data were analysed using reflexive thematic analysis. RESULTS Participants held mixed views about remote appointments, which were encompassed within the five themes of: home as clinic; disrupted therapeutic relationships; difficulties with engagement; uncontained risk; and scope of care provision. While appointments at home could be regarded as more comfortable, naturalistic and accessible, it was also recognised that remoteness compromised practitioner control with consequences for their ability to monitor patient engagement, manage risk and ensure confidentiality when others were present in the home. This could create an additional burden for parents as they tried to facilitate appointments but felt unsupported in this role. Relatedly, remoteness was seen to hinder interpersonal communication, formation of trust, communication of empathy and opportunities to observe body language, all of which were deemed important to building and maintaining effective therapeutic relationships. Despite this, others thought the anonymity of a remote exchange may allow earlier disclosure. There was disagreement as to whether remote provision narrowed or expanded the scope of practice. CONCLUSIONS While some had positive views of remote mental health appointments, others found them challenging. Findings highlight key areas requiring attention and mitigation in future offerings of remote provision, namely: risk management, parental burden, and problematic engagement.
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Affiliation(s)
- Lucy Biddle
- Population Health Sciences, Bristol University Medical School, Canynge Hall, 39 Whatley Road, Bristol, UK.
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
- Centre for Academic Mental Health, Bristol University Medical School, Oakfield House, Oakfield Road, Bristol, UK.
- Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
| | - Jane Derges
- Population Health Sciences, Bristol University Medical School, Canynge Hall, 39 Whatley Road, Bristol, UK
| | - Bethany Cliffe
- Population Health Sciences, Bristol University Medical School, Canynge Hall, 39 Whatley Road, Bristol, UK
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Rachael Gooberman-Hill
- Translational Health Sciences, Bristol University Medical School, Learning and Research Building, Southmead Hospital, Bristol, UK
- Elizabeth Blackwell Institute, University of Bristol, Royal Fort House, Bristol, UK
| | - Myles-Jay Linton
- Population Health Sciences, Bristol University Medical School, Canynge Hall, 39 Whatley Road, Bristol, UK
| | - Paul Moran
- Population Health Sciences, Bristol University Medical School, Canynge Hall, 39 Whatley Road, Bristol, UK
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Centre for Academic Mental Health, Bristol University Medical School, Oakfield House, Oakfield Road, Bristol, UK
- Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Helen Bould
- Population Health Sciences, Bristol University Medical School, Canynge Hall, 39 Whatley Road, Bristol, UK
- Centre for Academic Mental Health, Bristol University Medical School, Oakfield House, Oakfield Road, Bristol, UK
- Gloucestershire Health and Care NHS Foundation Trust, Gloucester, UK
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
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Ekanayake SKDM, Ward AE, Heart D, Valery P, Soar J. Improving primary care referral to specialist services: a protocol for a 10-year global systematic review in the Australian context. BMJ Open 2023; 13:e068927. [PMID: 37643858 PMCID: PMC10465904 DOI: 10.1136/bmjopen-2022-068927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Barriers to accessing specialist services impart a significant burden on patient outcomes and experience as well as a cost and administrative burden on health systems due to healthcare wastage and inefficiencies. This paper outlines the planned protocol for a systematic review relating to how health systems perform with regard to patient access to specialist care, and the efficacy of interventions aimed at improving this. METHODS AND ANALYSIS Systematic review of the literature will be carried out on publications retrieved by searching the following electronic literature databases: EBSCOhost Megafile Ultimate (Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Ultimate, APA Psychological Abstracts (PsycINFO), HealthSource), PubMed (Medical Literature Analysis and Retrieval System Online (MEDLINE)), Elsevier Bibliographic Database (Scopus), Excerpta Medica Database (EMBASE), Web of Science and The Cochrane Library. Articles published over a 10-year period (2012-2022) will be analysed to determine; current accessibility and availability problems faced by primary care services when referring patients to specialist care, and the effectiveness of interventions to improve primary care access to specialist services. Grey literature publications (ie, government reports, policy statements and issues papers, conference proceedings) will not be analysed in this review. Articles not published in English, Spanish or Portuguese will not be included. Two independent reviewers will conduct the initial screening, disagreements will be resolved by a third independent reviewer, following which data extraction and selection of eligible sources will be carried out. Selected articles will be categorised on study design, setting and participants. Methodological quality and heterogeneity will subsequently be assessed using the Mixed Methods Appraisal Tool. A descriptive approach will be used to review and synthesise the findings. ETHICS AND DISSEMINATION This study does not require ethics committee review as it solely focuses on analysing published literature. Findings will be published and disseminated through a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42022354890.
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Affiliation(s)
- Siyaguna Kosgamage Dilum Manthinda Ekanayake
- School of Nursing and Midwifery, University of Southern Queensland, Darling Heights, Queensland, Australia
- Population Health, Cancer and Chronic Disease Group QIMR-Berghofer Medical Research Institute, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Aletha E Ward
- Faculty of Health, Sciences and Engineering, University of Southern Queensland - Ipswich Campus, Ipswich, Queensland, Australia
| | - Diane Heart
- Faculty of Health, Sciences and Engineering, University of Southern Queensland - Ipswich Campus, Ipswich, Queensland, Australia
| | - Patricia Valery
- Population Health, Cancer and Chronic Disease Group QIMR-Berghofer Medical Research Institute, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Jeffrey Soar
- School of Business, University of Southern Queensland, Darling Heights, Queensland, Australia
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Wolframm IA, Douglas J, Pearson G. Changing Hearts and Minds in the Equestrian World One Behaviour at a Time. Animals (Basel) 2023; 13:ani13040748. [PMID: 36830535 PMCID: PMC9952075 DOI: 10.3390/ani13040748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/05/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
Equestrianism is currently facing a range of pressing challenges. These challenges, which are largely based on evolving attitudes to ethics and equine wellbeing, have consequences for the sport's social licence to operate. The factors that may have contributed to the current situation include overarching societal trends, specific aspects of the equestrian sector, and factors rooted in human nature. If equestrianism is to flourish, it is evident that much needs to change, not the least, human behaviour. To this end, using established behaviour change frameworks that have been scientifically validated and are rooted in practice-most notably, Michie et al.'s COM-B model and Behaviour Change Wheel-could be of practical value for developing and implementing equine welfare strategies. This review summarises the theoretical underpinnings of some behaviour change frameworks and provides a practical, step-by-step approach to designing an effective behaviour change intervention. A real-world example is provided through the retrospective analysis of an intervention strategy that aimed to increase the use of learning theory in (educational) veterinary practice. We contend that the incorporation of effective behaviour change interventions into any equine welfare improvement strategy may help to safeguard the future of equestrianism.
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Affiliation(s)
- Inga A. Wolframm
- Applied Research Centre, Van Hall Larenstein University of Applied Sciences, Larensteinselaan 26-A, 6882 CT Velp, The Netherlands
- Correspondence:
| | - Janet Douglas
- World Horse Welfare, Anne Colvin House, Snetterton, Norwich NR16 2LR, UK
| | - Gemma Pearson
- The Horse Trust, Slad Lane, Princes Risborough, Buckinghamshire HP27 0PP, UK
- Easter Bush Campus, The University of Edinburgh, Midlothian EH25 9RG, UK
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10
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Mavragani A, Smulders LM, Noordzij ML, Swinkels LTA, Goudriaan AE, Popma A, van der Pol TM. Forensic Psychiatric Outpatients' and Therapists' Perspectives on a Wearable Biocueing App (Sense-IT) as an Addition to Aggression Regulation Therapy: Qualitative Focus Group and Interview Study. JMIR Form Res 2023; 7:e40237. [PMID: 36724008 PMCID: PMC9932871 DOI: 10.2196/40237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 12/01/2022] [Accepted: 12/01/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Given the increased use of smart devices and the advantages of individual behavioral monitoring and assessment over time, wearable sensor-based mobile health apps are expected to become an important part of future (forensic) mental health care. For successful implementation in clinical practice, consideration of barriers and facilitators is of utmost importance. OBJECTIVE The aim of this study was to provide insight into the perspectives of both psychiatric outpatients and therapists in a forensic setting on the use and implementation of the Sense-IT biocueing app in aggression regulation therapy. METHODS A combination of qualitative methods was used. First, we assessed the perspectives of forensic outpatients on the use of the Sense-IT biocueing app using semistructured interviews. Next, 2 focus groups with forensic therapists were conducted to gain a more in-depth understanding of their perspectives on facilitators of and barriers to implementation. RESULTS Forensic outpatients (n=21) and therapists (n=15) showed a primarily positive attitude toward the addition of the biocueing intervention to therapy, with increased interoceptive and emotional awareness as the most frequently mentioned advantage in both groups. In the semistructured interviews, patients mainly reported barriers related to technical or innovation problems (ie, connection and notification issues, perceived inaccuracy of the feedback, and limitations in the ability to personalize settings). In the focus groups with therapists, 92 facilitator and barrier codes were identified and categorized into technical or innovation level (n=13, 14%), individual therapist level (n=28, 30%), individual patient level (n=33, 36%), and environmental and organizational level (n=18, 20%). The predominant barriers were limitations in usability of the app, patients' motivation, and both therapists' and patients' knowledge and skills. Integration into treatment, expertise within the therapists' team, and provision of time and materials were identified as facilitators. CONCLUSIONS The chances of successful implementation and continued use of sensor-based mobile health interventions such as the Sense-IT biocueing app can be increased by considering the barriers and facilitators from patients' and therapists' perspectives. Technical or innovation-related barriers such as usability issues should be addressed first. At the therapist level, increasing integration into daily routines and enhancing affinity with the intervention are highly recommended for successful implementation. Future research is expected to be focused on further development and personalization of biocueing interventions considering what works for whom at what time in line with the trend toward personalizing treatment interventions in mental health care.
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Affiliation(s)
| | - Lisanne M Smulders
- Inforsa Forensic Mental Healthcare, Amsterdam, Netherlands.,Department of Child and Adolescent Psychiatry and Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Matthijs L Noordzij
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Lise T A Swinkels
- Inforsa Forensic Mental Healthcare, Amsterdam, Netherlands.,Department of Child and Adolescent Psychiatry and Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Anna E Goudriaan
- Department of Research and Quality of Care, Arkin Institute for Mental Health, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands.,Amsterdam Institute for Addiction Research, Amsterdam, Netherlands
| | - Arne Popma
- Department of Child and Adolescent Psychiatry and Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Thimo M van der Pol
- Inforsa Forensic Mental Healthcare, Amsterdam, Netherlands.,Department of Child and Adolescent Psychiatry and Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Research and Quality of Care, Arkin Institute for Mental Health, Amsterdam, Netherlands
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11
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Willms A, Rhodes RE, Liu S. The Development of a Hypertension Prevention and Financial Incentive Mobile Health Program Using a “No-Code” Mobile App Builder: A Development and Usability Study (Preprint). JMIR Form Res 2022; 7:e43823. [PMID: 37018038 PMCID: PMC10131686 DOI: 10.2196/43823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/15/2023] [Accepted: 03/09/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Regular physical activity (PA) is a key lifestyle component for hypertension prevention. Previous studies have shown that mobile health (mHealth) apps can be an effective tool for improving PA behaviors. However, adherence to and poor engagement with these apps is a challenge. A potential solution to overcome this challenge may be to combine financial incentives with innovative behavior theory, such as the Multiprocess Action Control (M-PAC) framework. Currently, there is a lack of PA financial incentive-driven M-PAC mHealth programs aimed at hypertension prevention. OBJECTIVE We aimed to describe the process of developing an 8-week mHealth PA and financial-incentive hypertension education program (Healthy Hearts) and to evaluate usability of the Healthy Hearts program. METHODS The first 2 stages of the Integrate, Design, Assess, and Share framework were used to guide the development of the Healthy Hearts program. The development process consisted of 2 phases. In phase 1, the research team met to discuss implementing the M-PAC framework to adopt an existing web-based hypertension prevention program to a mobile app. The app was developed using a no-code app development platform, Pathverse (Pathverse Inc), to help decrease overall development time. In phase 2, we created a prototype and conducted usability testing to evaluate lesson 1 of the Healthy Hearts program to further enhance the user experience. We used semistructured interviews and the mHealth App Usability Questionnaire to evaluate program acceptability and usability. RESULTS Intervention development among the research team successfully created an 8-week financial-incentive hypertension education program for adults aged 40-65 years who did not currently meet the Canadian Physical Activity Guidelines (<150 minutes of moderate to vigorous PA per week). This program lasted 8 weeks and comprised 25 lessons guided by the M-PAC framework. The program used various behavior change techniques to further support PA adherence. Usability testing of the first lesson was successful, with 6 participants recruited for 2 rounds of testing. Feedback was gathered to enhance the content, layout, and design of the Healthy Hearts program to prepare the mHealth program for feasibility testing. Results of round 1 of usability testing suggested that the content delivered in the lessons was long. Therefore, the content was divided into multiple lessons before round 2 of usability testing, where feedback was only on design preferences. A minimum viable product was created with these results. CONCLUSIONS The iterative development process and the usability assessments suggested by the Integrate, Design, Assess, and Share framework enabled participants to provide valuable feedback on the content, design, and layout of the program before advancing to feasibility testing. Furthermore, the use of the "no-code" app development tool enabled our team to rapidly make changes to the app based on user feedback during the iterative design process.
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Affiliation(s)
- Amanda Willms
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Ryan E Rhodes
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Sam Liu
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
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MacLeod J, Abdelrahim M, Painter S, Maddula R, Steward A, Hamid A, Cheng RK, Zaha V, Addison D, Bauer B, Brown SA. Ten step academic-industry digital health collaboration methodology: A case-based guide for digital health research teams with the example of cardio-oncology. Front Cardiovasc Med 2022; 9:982059. [PMID: 36247469 PMCID: PMC9562627 DOI: 10.3389/fcvm.2022.982059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- James MacLeod
- Medical College of Wisconsin, Milwaukee, WI, United States
| | | | - Sabrina Painter
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | | | - Austin Steward
- Medical College of Wisconsin, Milwaukee, WI, United States
| | | | - Richard K. Cheng
- Division of Cardiovascular Medicine, University of Washington, Seattle, WA, United States
| | - Vlad Zaha
- Cardiology Division, University of Texas Southwestern, Dallas, TX, United States
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, United States
| | - Brenton Bauer
- COR Healthcare Associates, Torrance Memorial Medical Center, Torrance, CA, United States
| | - Sherry-Ann Brown
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
- *Correspondence: Sherry-Ann Brown
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13
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Kruzan KP, Fitzsimmons-Craft EE, Dobias M, Schleider JL, Pratap A. Developing, Deploying, and Evaluating Digital Mental Health Interventions in Spaces of Online Help- and Information-Seeking. PROCEDIA COMPUTER SCIENCE 2022; 206:6-22. [PMID: 37063642 PMCID: PMC10104522 DOI: 10.1016/j.procs.2022.09.081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The internet is frequently the first point of contact for people seeking support for their mental health symptoms. Digital interventions designed to be deployed through the internet have significant promise to reach diverse populations who may not have access to, or are not yet engaged in, treatment and deliver evidence-based resources to address symptoms. The liminal nature of online interactions requires designing to prioritize needs detection, intervention potency, and efficiency. Real-world implementation, data privacy and safety are equally important and can involve transparent partnerships with stakeholders in industry and non-profit organizations. This commentary highlights challenges and opportunities for research in this space, grounded in learnings from multiple research projects and teams aligned with this effort.
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Affiliation(s)
- Kaylee P. Kruzan
- Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | | | - Mallory Dobias
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794, USA
| | | | - Abhishek Pratap
- Center for Addiction and Mental Health, Toronto, ON, M5T 1R8 Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
- Vector Institute for Artificial Intelligence, Toronto, ON, M5T 1R8, Canada
- Kings College London, London, WC2R 2LS, UK
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA 98195, USA
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Duffy A, Christie GJ, Moreno S. The Challenges Toward Real-world Implementation of Digital Health Design Approaches: Narrative Review. JMIR Hum Factors 2022; 9:e35693. [PMID: 36083628 PMCID: PMC9508664 DOI: 10.2196/35693] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/19/2022] [Accepted: 07/18/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Digital health represents an important strategy in the future of health care delivery. Over the past decade, mobile health has accelerated the agency of health care users. Despite prevailing excitement about the potential of digital health, questions remain on efficacy, uptake, usability, and patient outcome. This challenge is confounded by 2 industries, digital and health, which have vastly different approaches to research, design, testing, and implementation. In this regard, there is a need to examine prevailing design approaches, weigh their benefits and challenges toward implementation, and recommend a path forward that synthesizes the needs of this complex stakeholder group. OBJECTIVE In this review, we aimed to study prominent digital health intervention design approaches that mediate the digital health space. In doing so, we sought to examine the origins, perceived benefits, contrasting nuances, challenges, and typical use-case scenarios of each methodology. METHODS A narrative review of digital health design approaches was performed between September 2020 and April 2021 by referencing keywords such as "digital health design," "mHealth design," "e-Health design," "agile health," and "agile healthcare." The studies selected after screening were those that discussed the design and implementation of digital health design approaches. A total of 120 studies were selected for full-text review, of which 62 (51.6%) were selected for inclusion in this review. RESULTS A review identifying the 5 overarching digital health design approaches was compiled: user-centered design, person-based design, human-centered design, patient-centered design, and patient-led design. The findings were synthesized in a narrative structure discussing the origins, advantages, disadvantages, challenges, and potential use-case scenarios. CONCLUSIONS Digital health is experiencing the growing pains of rapid expansion. Currently, numerous design approaches are being implemented to harmonize the needs of a complex stakeholder group. Whether the end user is positioned as a person, patient, or user, the challenge to synthesize the constraints and affordances of both digital design and health care, built equally around user satisfaction and clinical efficacy, remains paramount. Further research that works toward a transdisciplinarity in digital health may help break down friction in this field. Until digital health is viewed as a hybridized industry with unique requirements rather than one with competing interests, the nuances that each design approach posits will be difficult to realize in a real-world context. We encourage the collaboration of digital and health experts within hybrid design teams, through all stages of intervention design, to create a better digital health culture and design ethos.
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Affiliation(s)
- Anthony Duffy
- School of Interactive Arts & Technology, Simon Fraser University, Surrey, BC, Canada
| | | | - Sylvain Moreno
- School of Interactive Arts & Technology, Simon Fraser University, Surrey, BC, Canada
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15
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Schultz CL, Bocarro JN, Hipp JA, Bennett GJ, Floyd MF. Prescribing Time in Nature for Human Health and Well-Being: Study Protocol for Tailored Park Prescriptions. Front Digit Health 2022; 4:932533. [PMID: 35928047 PMCID: PMC9343582 DOI: 10.3389/fdgth.2022.932533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/24/2022] [Indexed: 11/24/2022] Open
Abstract
Background eHealth technologies offer an efficient method to integrate park prescriptions into clinical practice by primary health care (PHC) providers to help patients improve their health via tailored, nature-based health behavior interventions. This paper describes the protocol of the GoalRx Prescription Intervention (GPI) which was designed to leverage community resources to provide tailored park prescriptions for PHC patients. Methods The GPI study was designed as a 3-arm, multi-site observational study. We enrolled low-income, rural adults either at-risk of or living with hypertension or diabetes (n = 75) from Federally Qualified Health Centers (FQHC) in two counties in North Carolina, USA into the 3-month intervention. Eligible participants self-selected to receive (1) a tailored park prescription intervention; (2) a tailored home/indoor PA prescription intervention; or (3) a healthy eating prescription (with no PA prescription beyond standard PA counseling advice that is already routinely provided in PHC) as the comparison group. The GPI app paired patient health data from the electronic health record with stated patient preferences and triggered app-integrated SMS motivation and compliance messaging directly to the patient. Patients were assessed at baseline and at a 3-month follow-up upon the completion of the intervention. The primary outcome (mean difference in weekly physical activity from baseline (T0) to post-intervention (T1) as measured by the Fitbit Flex 2) was assessed at 3 months. Secondary outcomes included assessment of the relationship between the intervention and biological markers of health, including body mass index (BMI), systolic and diastolic blood pressure, HbA1c or available glucose test (if applicable), and a depression screen score using the Patient Health Questionnaire 9. Secondary outcomes also included the total number of SMS messages sent, number of SMS messages responded to, number of SMS messages ignored, and opt-out rate. Discussion The goal was to create a protocol utilizing eHealth technologies that addressed the specific needs of rural low-income communities and fit into the natural rhythms and processes of the selected FQHC clinics in North Carolina. This protocol offered a higher standard of health care by connecting patients to their PHC teams and increasing patient motivation to make longer-lasting health behavior changes.
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Affiliation(s)
- Courtney L. Schultz
- Health & Technology Partners, Milwaukee, WI, United States
- *Correspondence: Courtney L. Schultz
| | - Jason N. Bocarro
- Department of Parks, Recreation & Tourism Management, College of Natural Resources, NC State University, Raleigh, NC, United States
| | - J. Aaron Hipp
- Department of Parks, Recreation & Tourism Management, College of Natural Resources, NC State University, Raleigh, NC, United States
| | - Gary J. Bennett
- Global Health Institute, Duke University, Durham, NC, United States
| | - Myron F. Floyd
- Department of Parks, Recreation & Tourism Management, College of Natural Resources, NC State University, Raleigh, NC, United States
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16
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Jenkins CL, Imran S, Mahmood A, Bradbury K, Murray E, Stevenson F, Hamilton FL. Digital Health Intervention Design and Deployment for Engaging Demographic Groups Likely to Be Affected by the Digital Divide: Protocol for a Systematic Scoping Review. JMIR Res Protoc 2022; 11:e32538. [PMID: 35302946 PMCID: PMC8976245 DOI: 10.2196/32538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/25/2021] [Accepted: 11/27/2021] [Indexed: 12/02/2022] Open
Abstract
Background Digital health interventions refer to interventions designed to support health-related knowledge transfer and are delivered via digital technologies, such as mobile apps. Digital health interventions are a double-edged sword: they have the potential to reduce health inequalities, for example, by making treatments available remotely to rural populations underserved by health care facilities or by helping to overcome language barriers via in-app translation services; however, if not designed and deployed with care, digital health interventions also have the potential to increase health inequalities and exacerbate the effects of the digital divide. Objective The aim of this study is to review ways to mitigate the digital divide through digital health intervention design, deployment, and engagement mechanisms sensitive to the needs of digitally excluded populations. Methods This protocol outlines the procedure for a systematic scoping review that follows the methodology recommended by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidance. The following databases will be searched for primary research studies published in English from October 1, 2011, to October 1, 2021: Cochrane Library, Epistemonikos, NICE Evidence, PROSPERO, PubMed (with MEDLINE and Europe PMC), and Trip. In addition, the following sources of gray literature will be searched: Conference Proceedings Citation Index, Health Management Information Consortium, International HTA Database, OpenGrey, The Grey Literature Report, Google Scholar Basic Search UK, MedNar Deep Web Search Engine, and Carrot2. We will select publications that meet the following inclusion criteria: primary research papers that evaluated digital health interventions that describe features of digital health intervention design and deployment that enable or hinder access to and engagement with digital health interventions by adults from demographic groups likely to be affected by the digital divide (eg, older age, minority ethnic groups, lower income, and lower education level). A random selection of 25 publications identified from the search will be double screened by four reviewers. If there is >75% agreement for included/excluded publications, the team will continue to screen all the identified publications. For all included publications, study characteristics will be extracted by one author and checked for agreement by a second author, with any disagreements resolved by consensus among the study team. Consultation digital health intervention design and deployment, and digital health intervention users will also be conducted in parallel. Results The review is underway and is anticipated to be completed by September 2022. Conclusions The results will have implications for researchers and policy makers using digital health interventions for health improvement peripandemic and post pandemic, and will inform best practices in the design and delivery of digital health interventions. International Registered Report Identifier (IRRID) PRR1-10.2196/32538
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Affiliation(s)
| | - Sumayyah Imran
- eHealth Unit, Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Aamina Mahmood
- eHealth Unit, Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Katherine Bradbury
- School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Elizabeth Murray
- eHealth Unit, Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Fiona Stevenson
- eHealth Unit, Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Fiona L Hamilton
- eHealth Unit, Research Department of Primary Care & Population Health, University College London, London, United Kingdom
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17
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Folkvord F, Peschke L, Ağca YG, van Houten K, Stazi G, Lupiáñez-Villanueva F. Preferences in the willingness to download a Covid tracing app: An experimental study in the Netherlands and Turkey (Preprint). JMIR Form Res 2022; 6:e37891. [PMID: 35867840 PMCID: PMC9337617 DOI: 10.2196/37891] [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: 03/10/2022] [Revised: 05/29/2022] [Accepted: 05/31/2022] [Indexed: 12/03/2022] Open
Abstract
Background Despite the worldwide growth in using COVID-19 contact tracing apps (CTAs) and the potential benefits for citizens, governments, health care professionals, businesses, and other organizations, only a few studies have examined the factors affecting the levels of willingness to download a CTA. Objective This study aimed to investigate individuals’ preferences in the willingness to download a health app. Methods We conducted an experimental study in 2 countries, the Netherlands (N=62) and Turkey (N=83), using 4 different vignettes (ie, data protection, manufacturer, reward, and gaming models) with different attributes. Participants were randomly assigned to 1 of the conditions within the vignettes. Results The results showed that data protection and gaming elements are factors that influence the willingness to download a COVID-19 CTA. More specifically, we see that data protection is an important factor explaining the willingness to download the app in Turkey, whereas including gaming elements significantly affects the willingness to download the app in the Netherlands. Conclusions COVID-19 CTAs are highly promising to reduce the spread of the virus and make it easier to open up society faster, especially because they can be used quickly and share information rapidly. COVID-19 CTA developers must ensure that their apps satisfactorily and sufficiently address ethical considerations, even in times of crisis. Furthermore, integrating gaming elements in the CTA could enhance the willingness to download the CTA.
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Affiliation(s)
- Frans Folkvord
- Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands
- PredictBy, PredictBy Research, Barcelona, Spain
| | - Lutz Peschke
- Department of Communication and Design, Bilkent University, Ankara, Turkey
| | - Yasemin Gümüş Ağca
- Department of Communication and Design, Bilkent University, Ankara, Turkey
| | | | | | - Francisco Lupiáñez-Villanueva
- PredictBy, PredictBy Research, Barcelona, Spain
- Department of Information and Communication Science, Universitat Oberta de Catalunya, Barcelona, Spain
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Asbjørnsen RA, Hjelmesæth J, Smedsrød ML, Wentzel J, Ollivier M, Clark MM, van Gemert-Pijnen JEWC, Solberg Nes L. Combining Persuasive System Design Principles and Behavior Change Techniques in Digital Interventions Supporting Long-term Weight Loss Maintenance: Design and Development of eCHANGE (Preprint). JMIR Hum Factors 2022; 9:e37372. [PMID: 35622394 PMCID: PMC9187967 DOI: 10.2196/37372] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/29/2022] [Accepted: 04/22/2022] [Indexed: 02/06/2023] Open
Abstract
Background Long-term weight maintenance after weight loss is challenging, and innovative solutions are required. Digital technologies can support behavior change and, therefore, have the potential to be an effective tool for weight loss maintenance. However, to create meaningful and effective digital behavior change interventions that support end user values and needs, a combination of persuasive system design (PSD) principles and behavior change techniques (BCTs) might be needed. Objective This study aimed to investigate how an evidence-informed digital behavior change intervention can be designed and developed by combining PSD principles and BCTs into design features to support end user values and needs for long-term weight loss maintenance. Methods This study presents a concept for how PSD principles and BCTs can be translated into design features by combining design thinking and Agile methods to develop and deliver an evidence-informed digital behavior change intervention aimed at supporting weight maintenance. Overall, 45 stakeholders participated in the systematic and iterative development process comprising co-design workshops, prototyping, Agile development, and usability testing. This included prospective end users (n=17, 38%; ie, people with obesity who had lost ≥8% of their weight), health care providers (n=9, 20%), healthy volunteers (n=4, 9%), a service designer (n=1, 2%), and stakeholders from the multidisciplinary research and development team (n=14, 31%; ie, software developers; digital designers; and eHealth, behavior change, and obesity experts). Stakeholder input on how to operationalize the design features and optimize the technology was examined through formative evaluation and qualitative analyses using rapid and in-depth analysis approaches. Results A total of 17 design features combining PSD principles and BCTs were identified as important to support end user values and needs based on stakeholder input during the design and development of eCHANGE, a digital intervention to support long-term weight loss maintenance. The design features were combined into 4 main intervention components: Week Plan, My Overview, Knowledge and Skills, and Virtual Coach and Smart Feedback System. To support a healthy lifestyle and continued behavior change to maintain weight, PSD principles such as tailoring, personalization, self-monitoring, reminders, rewards, rehearsal, praise, and suggestions were combined and implemented into the design features together with BCTs from the clusters of goals and planning, feedback and monitoring, social support, repetition and substitution, shaping knowledge, natural consequences, associations, antecedents, identity, and self-belief. Conclusions Combining and implementing PSD principles and BCTs in digital interventions aimed at supporting sustainable behavior change may contribute to the design of engaging and motivating interventions in line with end user values and needs. As such, the design and development of the eCHANGE intervention can provide valuable input for future design and tailoring of evidence-informed digital interventions, even beyond digital interventions in support of health behavior change and long-term weight loss maintenance. Trial Registration ClinicalTrials.gov NCT04537988; https://clinicaltrials.gov/ct2/show/NCT04537988
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Affiliation(s)
- Rikke Aune Asbjørnsen
- Center for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
- Research and Innovation Department, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Jøran Hjelmesæth
- Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Jobke Wentzel
- Center for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
- Research Group IT Innovations in Health Care, Windesheim University of Applied Sciences, Zwolle, Netherlands
| | - Marianne Ollivier
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Matthew M Clark
- Department of Psychiatry & Psychology, College of Medicine & Science, Mayo Clinic, Rochester, MN, United States
| | - Julia E W C van Gemert-Pijnen
- Center for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
- University of Waterloo, Waterloo, ON, Canada
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Department of Psychiatry & Psychology, College of Medicine & Science, Mayo Clinic, Rochester, MN, United States
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Keller KJM, Mehrle Elliott D, Britt-Rankin J. Adults' Reaction to Public Health Messaging: Recall, Media Type, and Behavior Change Motivation. JOURNAL OF PREVENTION (2022) 2022; 43:125-141. [PMID: 35286556 DOI: 10.1007/s10935-021-00661-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/11/2021] [Indexed: 06/14/2023]
Abstract
This paper focuses on effective messaging practices identified in data collected after 10 years of implementing a gain-framed messaging campaign encouraging healthier behaviors in middle-aged and older adults. In Study 1, we measured message recall and intended health behaviors in an intercept survey of 733 adults. Binary logistic regression indicated that women were more likely than men to report intent to change behavior. Recalling messages from billboards or fliers was associated with a lower likelihood of intended behavior change, and media type was associated with intended behavior for those who saw the message online (reducing screen time) or on television (increasing physical activity and ceasing smoking). Study 2 focused on adult generational differences in response to the campaign and types of media used to access information. Data from an intercept survey of 604 clients at agencies serving low-income adults were segmented into three age groups: under 35, ages 35-54, and ages 55+. Recall and reaction to campaign materials differed by age group, and the influence of life stage factors and health costs varied across age groups. Television and newspapers were most frequently reported by the oldest group, and social media and online news/blogs were most frequently chosen by the youngest group. Campaign response of adults older than age 35 aligned with goals of improving health behaviors. Together, these studies indicate that diffuse messaging strategies may raise overall awareness, and targeted strategies may be more influential in motivating behavior change. Influential factors and media should be differentially leveraged to target different age cohorts of adults.
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Affiliation(s)
- Kimberly J M Keller
- Department of Health Sciences, University of Missouri, Columbia, MO, USA.
- University of Missouri Extension, Columbia, MO, USA.
| | | | - Jo Britt-Rankin
- Department of Health Sciences, University of Missouri, Columbia, MO, USA
- University of Missouri Extension, Columbia, MO, USA
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Kip H, Keizer J, da Silva MC, Beerlage-de Jong N, Köhle N, Kelders SM. Methods for Human-Centered eHealth Development: Narrative Scoping Review. J Med Internet Res 2022; 24:e31858. [PMID: 35084359 PMCID: PMC8832261 DOI: 10.2196/31858] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/29/2021] [Accepted: 11/15/2021] [Indexed: 12/16/2022] Open
Abstract
Background Thorough holistic development of eHealth can contribute to a good fit among the technology, its users, and the context. However, despite the availability of frameworks, not much is known about specific research activities for different aims, phases, and settings. This results in researchers having to reinvent the wheel. Consequently, there is a need to synthesize existing knowledge on research activities for participatory eHealth development processes. Objective The 3 main goals of this review are to create an overview of the development strategies used in studies based on the CeHRes (Center for eHealth Research) Roadmap, create an overview of the goals for which these methods can be used, and provide insight into the lessons learned about these methods. Methods We included eHealth development studies that were based on the phases and/or principles of the CeHRes Roadmap. This framework was selected because of its focus on participatory, iterative eHealth design in context and to limit the scope of this review. Data were extracted about the type of strategy used, rationale for using the strategy, research questions, and reported information on lessons learned. The most frequently mentioned lessons learned were summarized using a narrative, inductive approach. Results In the included 160 papers, a distinction was made between overarching development methods (n=10) and products (n=7). Methods are used to gather new data, whereas products can be used to synthesize previously collected data and support the collection of new data. The identified methods were focus groups, interviews, questionnaires, usability tests, literature studies, desk research, log data analyses, card sorting, Delphi studies, and experience sampling. The identified products were prototypes, requirements, stakeholder maps, values, behavior change strategies, personas, and business models. Examples of how these methods and products were applied in the development process and information about lessons learned were provided. Conclusions This study shows that there is a plethora of methods and products that can be used at different points in the development process and in different settings. To do justice to the complexity of eHealth development, it seems that multiple strategies should be combined. In addition, we found no evidence for an optimal single step-by-step approach to develop eHealth. Rather, researchers need to select the most suitable research methods for their research objectives, the context in which data are collected, and the characteristics of the participants. This study serves as a first step toward creating a toolkit to support researchers in applying the CeHRes Roadmap to practice. In this way, they can shape the most suitable and efficient eHealth development process.
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Affiliation(s)
- Hanneke Kip
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,Department of Research, Transfore, Deventer, Netherlands
| | - Julia Keizer
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Marcia C da Silva
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Nienke Beerlage-de Jong
- Department of Health Technology & Services Research, University of Twente, Enschede, Netherlands
| | - Nadine Köhle
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Saskia M Kelders
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
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21
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Social Mobile Approaches to Reducing Weight (SMART) 2.0: protocol of a randomized controlled trial among young adults in university settings. Trials 2022; 23:7. [PMID: 34980208 PMCID: PMC8721474 DOI: 10.1186/s13063-021-05938-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Excess weight gain in young adulthood is associated with future weight gain and increased risk of chronic disease. Although multimodal, technology-based weight-loss interventions have the potential to promote weight loss among young adults, many interventions have limited personalization, and few have been deployed and evaluated for longer than a year. We aim to assess the effects of a highly personalized, 2-year intervention that uses popular mobile and social technologies to promote weight loss among young adults. Methods The Social Mobile Approaches to Reducing Weight (SMART) 2.0 Study is a 24-month parallel-group randomized controlled trial that will include 642 overweight or obese participants, aged 18–35 years, from universities and community colleges in San Diego, CA. All participants receive a wearable activity tracker, connected scale, and corresponding app. Participants randomized to one intervention group receive evidence-based information about weight loss and behavior change techniques via personalized daily text messaging (i.e., SMS/MMS), posts on social media platforms, and online groups. Participants in a second intervention group receive the aforementioned elements in addition to brief, technology-mediated health coaching. Participants in the control group receive a wearable activity tracker, connected scale, and corresponding app alone. The primary outcome is objectively measured weight in kilograms over 24 months. Secondary outcomes include anthropometric measurements; physiological measures; physical activity, diet, sleep, and psychosocial measures; and engagement with intervention modalities. Outcomes are assessed at baseline and 6, 12, 18, and 24 months. Differences between the randomized groups will be analyzed using a mixed model of repeated measures and will be based on the intent-to-treat principle. Discussion We hypothesize that both SMART 2.0 intervention groups will significantly improve weight loss compared to the control group, and the group receiving health coaching will experience the greatest improvement. We further hypothesize that differences in secondary outcomes will favor the intervention groups. There is a critical need to advance understanding of the effectiveness of multimodal, technology-based weight-loss interventions that have the potential for long-term effects and widespread dissemination among young adults. Our findings should inform the implementation of low-cost and scalable interventions for weight loss and risk-reducing health behaviors. Trial registration ClinicalTrials.govNCT03907462. Registered on April 9, 2019
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22
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Goldstein SP, Zhang F, Klasnja P, Hoover A, Wing RR, Thomas JG. Optimizing a Just-in-Time Adaptive Intervention to Improve Dietary Adherence in Behavioral Obesity Treatment: Protocol for a Microrandomized Trial. JMIR Res Protoc 2021; 10:e33568. [PMID: 34874892 PMCID: PMC8691411 DOI: 10.2196/33568] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Behavioral obesity treatment (BOT) is a gold standard approach to weight loss and reduces the risk of cardiovascular disease. However, frequent lapses from the recommended diet stymie weight loss and prevent individuals from actualizing the health benefits of BOT. There is a need for innovative treatment solutions to improve adherence to the prescribed diet in BOT. OBJECTIVE The aim of this study is to optimize a smartphone-based just-in-time adaptive intervention (JITAI) that uses daily surveys to assess triggers for dietary lapses and deliver interventions when the risk of lapse is high. A microrandomized trial design will evaluate the efficacy of any interventions (ie, theory-driven or a generic alert to risk) on the proximal outcome of lapses during BOT, compare the effects of theory-driven interventions with generic risk alerts on the proximal outcome of lapse, and examine contextual moderators of interventions. METHODS Adults with overweight or obesity and cardiovascular disease risk (n=159) will participate in a 6-month web-based BOT while using the JITAI to prevent dietary lapses. Each time the JITAI detects elevated lapse risk, the participant will be randomized to no intervention, a generic risk alert, or 1 of 4 theory-driven interventions (ie, enhanced education, building self-efficacy, fostering motivation, and improving self-regulation). The primary outcome will be the occurrence of lapse in the 2.5 hours following randomization. Contextual moderators of intervention efficacy will also be explored (eg, location and time of day). The data will inform an optimized JITAI that selects the theory-driven approach most likely to prevent lapses in a given moment. RESULTS The recruitment for the microrandomized trial began on April 19, 2021, and is ongoing. CONCLUSIONS This study will optimize a JITAI for dietary lapses so that it empirically tailors the provision of evidence-based intervention to the individual and context. The finalized JITAI will be evaluated for efficacy in a future randomized controlled trial of distal health outcomes (eg, weight loss). TRIAL REGISTRATION ClinicalTrials.gov NCT04784585; http://clinicaltrials.gov/ct2/show/NCT04784585. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/33568.
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Affiliation(s)
- Stephanie P Goldstein
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - Fengqing Zhang
- Department of Psychology, Drexel University, Philadelphia, PA, United States
| | - Predrag Klasnja
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Adam Hoover
- Holcombe Department of Electrical and Computer Engineering, Clemson University, Clemson, SC, United States
| | - Rena R Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - John Graham Thomas
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
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Airola E. Learning and Use of eHealth Among Older Adults Living at Home in Rural and Nonrural Settings: Systematic Review. J Med Internet Res 2021; 23:e23804. [PMID: 34860664 PMCID: PMC8686468 DOI: 10.2196/23804] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/23/2020] [Accepted: 10/14/2021] [Indexed: 02/06/2023] Open
Abstract
Background Care policies emphasize deinstitutionalization and aging in place in response to demographic changes. Different eHealth technologies are one way to achieve this aim. However, there is a need to better understand older adults’ needs for eHealth services, and thus, these health solutions require further exploration. Objective The purpose of this systematic literature review is to appraise, synthesize, and summarize the literature on older adults’ (aged ≥60 years) eHealth learning and use in real home settings, particularly in rural and remote areas, with a focus on the social and cultural context. Methods A systematic search was conducted in January 2020 using 4 academic databases. The studies by means of qualitative thematic analysis to identify the barriers, enablers, and support practices involved in the domestication process were examined. In addition, we identified the various meanings attached to eHealth technologies for older adults living in rural and remote areas. Results In total, 31 empirical studies published between 2010 and 2020 were included in this review. A total of 17 articles included participants from rural and remote areas. The most regularly reported barriers related to older adults’ learning to use and use of eHealth were health-related difficulties, such as cognitive impairment or impaired hearing. The most reported enabler was the support provided for older adults in learning and use of eHealth. Support mainly comprised older adults’ own digital competences, which were distributed with their social network. It was found that eHealth technology is needed for rural and remote areas to facilitate access and reduce logistical barriers to health care services. Conclusions The literature review provided information and practical implications for designers, health care providers, and policy makers. On the basis of these findings, eHealth technologies should be easy to use, and adequate support should be provided to older adults for use.
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Affiliation(s)
- Ella Airola
- Media Education Hub, Faculty of Education, University of Lapland, Rovaniemi, Finland
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Morton E, Nicholas J, Lapadat L, O'Brien HL, Barnes SJ, Poh C, Michalak EE. Use of smartphone apps in bipolar disorder: An international web-based survey of feature preferences and privacy concerns. J Affect Disord 2021; 295:1102-1109. [PMID: 34706421 DOI: 10.1016/j.jad.2021.08.132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/29/2021] [Accepted: 08/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Smartphone apps have potential for delivering interventions and supporting self-management in bipolar disorder (BD), however clinical trials of mental health apps have high dropout rates and low sustained use in real-world contexts. To support the development of app-based interventions, we explored use of and attitudes towards apps amongst people with BD, specifically concerns about privacy and preferences for various app features. METHODS An international web-based survey was used to investigate concerns about privacy and the perceived importance of various app features among people with BD. Quantitative findings were summarised using descriptive statistics. Qualitative content analysis was used to investigate free-text responses. RESULTS A total of 919 people completed the survey; 97.5% reported using smartphone apps in general. Concerns regarding data security were prevalent. Commonly prioritised mHealth features included content quality/accuracy, ease and flexibility of use, cost, and data security. The ability to share data with others, rewards for use, inter-app connectivity, and peer support were endorsed as important by fewer than half of respondents. Qualitative findings suggested that sustained app use could be supported by novel and positive content, customisation, meaningful use of data, interactivity, and perceived real-world benefits. CONCLUSIONS The findings of the present study offer important design considerations for the development and evaluation of future app-based interventions for BD. Importantly, some features that have previously been suggested as clinically beneficial or likely to support engagement were perceived ambivalently, emphasising the need for in-depth consultation with potential end users during app development.
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Affiliation(s)
- Emma Morton
- Department of Psychiatry, University of British Columbia, 420-5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada
| | - Jennifer Nicholas
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, University of Melbourne, VIC, Australia
| | - Laura Lapadat
- Department of Psychiatry, University of British Columbia, 420-5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada
| | - Heather L O'Brien
- School of Information, University of British Columbia, Vancouver, BC, Canada
| | - Steven J Barnes
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Caden Poh
- Department of Psychiatry, University of British Columbia, 420-5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia, 420-5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada.
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Chatterjee A, Prinz A, Gerdes M, Martinez S. Digital Interventions on Healthy Lifestyle Management: Systematic Review. J Med Internet Res 2021; 23:e26931. [PMID: 34787575 PMCID: PMC8663673 DOI: 10.2196/26931] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/07/2021] [Accepted: 08/10/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Digital interventions have tremendous potential to improve well-being and health care conveyance by improving adequacy, proficiency, availability, and personalization. They have gained acknowledgment in interventions for the management of a healthy lifestyle. Therefore, we are reviewing existing conceptual frameworks, digital intervention approaches, and associated methods to identify the impact of digital intervention on adopting a healthier lifestyle. OBJECTIVE This study aims to evaluate the impact of digital interventions on weight management in maintaining a healthy lifestyle (eg, regular physical activity, healthy habits, and proper dietary patterns). METHODS We conducted a systematic literature review to search the scientific databases (Nature, SpringerLink, Elsevier, IEEE Xplore, and PubMed) that included digital interventions on healthy lifestyle, focusing on preventing obesity and being overweight as a prime objective. Peer-reviewed articles published between 2015 and 2020 were included. We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and a framework for an evidence-based systematic review. Furthermore, we improved the review process by adopting the Rayyan tool and the Scale for the Assessment of Narrative Review Articles. RESULTS Our initial searches identified 780 potential studies through electronic and manual searches; however, 107 articles in the final stage were cited following the specified inclusion and exclusion criteria. The identified methods for a successful digital intervention to promote a healthy lifestyle are self-monitoring, self-motivation, goal setting, personalized feedback, participant engagement, psychological empowerment, persuasion, digital literacy, efficacy, and credibility. In this study, we identified existing conceptual frameworks for digital interventions, different approaches to provide digital interventions, associated methods, and execution challenges and their impact on the promotion of healthy lifestyle management. CONCLUSIONS This systematic literature review selected intervention principles (rules), theories, design features, ways to determine efficient interventions, and weaknesses in healthy lifestyle management from established digital intervention approaches. The results help us understand how digital interventions influence lifestyle management and overcome the existing shortcomings. It serves as a basis for further research with a focus on designing, developing, testing, and evaluating the generation of personalized lifestyle recommendations as a part of digital health interventions.
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Affiliation(s)
- Ayan Chatterjee
- Department for Information and Communication Technologies, Centre for e-Health, University of Agder, Grimstad, Norway
| | - Andreas Prinz
- Department for Information and Communication Technologies, Centre for e-Health, University of Agder, Grimstad, Norway
| | - Martin Gerdes
- Department for Information and Communication Technologies, Centre for e-Health, University of Agder, Grimstad, Norway
| | - Santiago Martinez
- Department of Health and Nursing Science, Centre for e-Health, University of Agder, Grimstad, Norway
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Health-related consequences of the type and utilization rates of electronic devices by college students. BMC Public Health 2021; 21:1970. [PMID: 34724921 PMCID: PMC8559143 DOI: 10.1186/s12889-021-11975-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 10/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background College students are leading an evolution of device use both in the type of device and the frequency of use. They have transitioned from desktop stations to laptops, tablets, and especially smartphones and use them throughout the day and into the night. Methods Using a 35-min online survey, we sought to understand how technology daily usage patterns, device types, and postures affect pain and discomfort to understand how knowledge of that pain might help students avoid it. Data were analyzed from 515 students (69.5% male) who completed an internet-delivered survey (81.3% response rate). Results Participants ranked smartphones as their most frequently used technology (64.0%), followed by laptops and tablets (both 53.2%), and desktop computers (46.4%). Time spent using smartphones averaged over 4.4 h per day. When using their devices, students were more likely to adopt non-traditional workplace postures as they used these devices primarily on the couch or at a chair with no desk. Conclusion Recent trends in wireless academic access points along with the portability of small handheld devices, have made smartphones the most common link to educational materials despite having the least favorable control and display scenario from an ergonomic perspective. Further, the potential impact of transitions in work environments due to COVID-19 may further exacerbate ergonomic issues among millions highlighting the need for such work to be carried out.
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Woodford J, Karlsson M, Hagström J, Hägg Sylvén Y, Norbäck K, Grönqvist H, von Essen L. Conducting Digital Health Care Research: Document Analysis of Challenges Experienced During Intervention Development and Feasibility Study Setup of an Internet-Administered Intervention for Parents of Children Treated for Cancer. JMIR Form Res 2021; 5:e26266. [PMID: 34433524 PMCID: PMC8538021 DOI: 10.2196/26266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/16/2021] [Accepted: 05/02/2021] [Indexed: 11/19/2022] Open
Abstract
Background The design and conduct of research to develop, test, and evaluate complex health care interventions is challenging. Although the existing literature describes key challenges associated with the design and conduct of definitive (evaluation) trials, there is a lack of information concerning specific challenges associated with the intervention development phase and setup of feasibility studies. In particular, the literature is scarce concerning the challenges associated with conducting digital health care research, such as research on internet-administered interventions and research using digital features to support the execution of study procedures (eg, recruitment, consent, retention, and data collection and management). This study is conducted in the context of the intervention development and feasibility study setup phases of an internet-administered, guided, low-intensity cognitive behavioral therapy–based intervention for parents of children previously treated for cancer. Objective The aim of this study is to explore the challenges experienced during the development phase of the internet-administered intervention and digital features to support the execution of the study procedures and a feasibility study setup. Methods To explore the key challenges experienced, we conducted a document analysis of written records from all study meetings held by the research team (meeting minutes) between June 7, 2018, and January 10, 2020, guided by a thematic analysis approach. Furthermore, discussion groups with members of the research team were held to develop a more detailed understanding of the key challenges experienced. Methods and results are reported in accordance with the relevant items from the Standards for Reporting Qualitative Research checklist. Results Six main themes were identified: decision-making and communication, expertise, external constraints, flexibility, planning and scheduling, and technical constraints. Conclusions Significant challenges were experienced during the intervention development and setup phases of the feasibility study. Implications are discussed to inform future design, conduct, and planning of internet-administered intervention development and feasibility studies, especially within the context of digital health care research.
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Affiliation(s)
- Joanne Woodford
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Mathilda Karlsson
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Josefin Hagström
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ylva Hägg Sylvén
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Kajsa Norbäck
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Helena Grönqvist
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Chevance G, Perski O, Hekler EB. Innovative methods for observing and changing complex health behaviors: four propositions. Transl Behav Med 2021; 11:676-685. [PMID: 32421196 PMCID: PMC7963282 DOI: 10.1093/tbm/ibaa026] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Precision health initiatives aim to progressively move from traditional, group-level approaches to health diagnostics and treatments toward ones that are individualized, contextualized, and timely. This article aims to provide an overview of key methods and approaches that can help facilitate this transition in the health behavior change domain. This article is a narrative review of the methods used to observe and change complex health behaviors. On the basis of the available literature, we argue that health behavior change researchers should progressively transition from (i) low- to high-resolution behavioral assessments, (ii) group-only to group- and individual-level statistical inference, (iii) narrative theoretical models to dynamic computational models, and (iv) static to adaptive and continuous tuning interventions. Rather than providing an exhaustive and technical presentation of each method and approach, this article articulates why and how researchers interested in health behavior change can apply these innovative methods. Practical examples contributing to these efforts are presented. If successfully adopted and implemented, the four propositions in this article have the potential to greatly improve our public health and behavior change practices in the near future.
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Affiliation(s)
- Guillaume Chevance
- Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, USA.,Exercise and Physical Activity Resource Center, University of California, San Diego, La Jolla, CA, USA.,Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Olga Perski
- Department of Behavioural Science and Health, University College London, Torrington Place, London, UK
| | - Eric B Hekler
- Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, USA.,Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
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"I Want a Program That Looks at My Whole Life." A Focus Group Study on the Ideal Components for an mHealth Weight Management Program for African American Women. J Acad Nutr Diet 2021; 122:139-148. [PMID: 34351276 DOI: 10.1016/j.jand.2021.06.310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The high rate of obesity, ownership of smartphones, and online search for nutrition and dieting information among African American women (AAW) provide a unique opportunity to develop cost-effective, accessible, and acceptable mHealth weight management programs for them. Furthermore, they should participate in the development and evaluation of these programs. OBJECTIVE To explore ideal components of a culturally relevant mHealth weight management program for AAW and to examine how these components may vary by age group. DESIGN Twelve focus group triads were conducted with AAW in north central Florida. The framework method was used to manage, organize, synthesize, and analyze data themes by age groups: 18 to 29 (young), 30 to 50 (middle age), and 51+ (older). PARTICIPANTS/SETTING Thirty-six smartphone owners who expressed a desire to lose weight were recruited through several community partnerships. RESULTS Based on body mass index (BMI), young women were classified as overweight (BMI 26.23 ± 6.7), middle-aged women as obese (BMI30.72 ± 8.31), and older women as obese (BMI 31.03 ± 5.67). Most searched online for dieting information within the past 12 months. Five overarching themes for designing mHealth weight management programs were identified: (1) holistic program that goes beyond dieting; (2) social media integration for support and sense of community; (3) self-monitoring app; (4) two-way text messaging; and (5) programs of varying lengths and meaningful incentives. CONCLUSION AAW were receptive to mHealth weight management programs, which may be appealing during and after the COVID-19 pandemic. Holistic programs of 4 to 6 weeks that addressed stress eating, had a social media component, and included a few educational texts per week may be appealing to AAW.
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Ford KL, Portz JD, Zhou S, Gornail S, Moore SL, Zhang X, Bull S. Benefits, Facilitators, and Recommendations for Digital Health Academic-Industry Collaboration: A Mini Review. Front Digit Health 2021; 3:616278. [PMID: 34713094 PMCID: PMC8521882 DOI: 10.3389/fdgth.2021.616278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 02/24/2021] [Indexed: 12/23/2022] Open
Abstract
Digital health remains a growing and challenging niche in public health practice. Academic-industry collaboration (AIC) offers a mechanism to bring disparate sectors together to alleviate digital health challenges of engagement, reach, sustainability, dissemination, evaluation, and equity. Despite the ongoing endorsements for AIC in digital health, limited understanding exists of successful AIC exists. Most published research highlights the barriers of collaboration rather than efficacy, leaving collaborators asking: What are the benefits and facilitators of AIC and do they apply in digital health? As an initial effort to fill the gap in the literature, the purpose of this mini review outlines the benefits and facilitators from previous AIC and offers recommendations specific to digital health.
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Affiliation(s)
- Kelsey L. Ford
- Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
| | - Jennifer D. Portz
- Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
| | - Shuo Zhou
- Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
| | - Starlynne Gornail
- Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
| | - Susan L. Moore
- Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
| | - Xuhong Zhang
- Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
| | - Sheana Bull
- Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
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Zieschank K, Day J, Ireland MJ, March S. Co-design and qualitative validation of animated assessment item content for a child-reported digital distress screener. Internet Interv 2021; 24:100381. [PMID: 33777706 PMCID: PMC7985717 DOI: 10.1016/j.invent.2021.100381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 02/12/2021] [Accepted: 02/22/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The Interactive Child Distress Screener (ICDS) is a novel, digital screening tool that is currently under development and aims to broadly assess self-reported emotional and behavioural distress in children aged five to 11 years. This study implemented a generative participatory codesign and iterative refinement process to qualitatively validate the content of 30 animated assessment items developed for the ICDS by assessing their acceptability and accuracy from the child's perspective. METHODS The participants (N = 62) were five to 11-year-old children. Individual interviews were conducted with each child to determine acceptability and validity of animated items and facilitate the co-design refinement process of the animated assessment items. RESULTS Twenty-two out of 30 (73%) items met ≥80% satisfaction and accuracy consensus in their original format, six items (20%) required one round of refinement before meeting consensus, and two items (7%) required two rounds of refinements. Combined acceptability of animated items was high, ranging from 4.1 to 5 out of 5 across all items. CONCLUSION Participants were able to accurately identify and understand socio-emotional and behavioural constructs when depicted as animated items. Acceptability was high, even in first iterations when accuracy of understanding required refinement. This study highlighted the importance and benefits of iterative participatory design methodology in ensuring assessment items developed for children are understood, accepted and likely to be effective in obtaining accurate self-report.
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Affiliation(s)
- Kirsty Zieschank
- School of Psychology and Counselling and Centre for Health Research, University of Southern Queensland, Springfield Campus, PO Box 4196, Springfield Central, Queensland 4300, Australia
| | - Jamin Day
- Family Action Centre, The University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Michael J Ireland
- School of Psychology and Counselling and Centre for Health Research, University of Southern Queensland, Springfield Campus, PO Box 4196, Springfield Central, Queensland 4300, Australia
| | - Sonja March
- School of Psychology and Counselling and Centre for Health Research, University of Southern Queensland, Springfield Campus, PO Box 4196, Springfield Central, Queensland 4300, Australia
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Kepper M, Walsh-Bailey C, Staiano A, Fowler LA, Gacad A, Blackwood A, Fowler SA, Kelley M. Health Information Technology Use Among Healthcare Providers Treating Children and Adolescents With Obesity: a Systematic Review. CURR EPIDEMIOL REP 2021. [DOI: 10.1007/s40471-021-00262-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Greene K, Choi HJ, Glenn SD, Ray AE, Hecht ML. The Role of Engagement in Effective, Digital Prevention Interventions: the Function of Engagement in the REAL Media Substance Use Prevention Curriculum. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 22:247-258. [PMID: 33140287 PMCID: PMC7855866 DOI: 10.1007/s11121-020-01181-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
Prevention curricula rely on audience engagement to effectively communicate their messages. However, to date, measurement of engagement has primarily focused on self-report that is often an indicator of liking or satisfaction. Emerging technologies for intervention delivery hold promise not only for additional engagement indicators but also for dissemination outside of traditional vehicles such as classroom delivery. The present study, grounded in the theory of active involvement (Greene 2013), explores the role of engagement (as measured by self-report, program analytics, and observation) with short-term substance use prevention outcomes such as self-efficacy to counter-argue and descriptive and injunctive norms. The study tracks 4-H youth (N = 310) engaged with a media literacy focused e-learning substance prevention curriculum, REAL media. Results indicate that self-reports of engagement predicted self-efficacy to counter-argue, but a program-analytic indicator of dosage predicted lower injunctive and descriptive norms, all at 3 months. The observational indicator was correlated with self-efficacy to counter-argue but not significant in the predictive models. The implications and directions for future research regarding how engagement is measured in prevention and included in studying program effects are discussed. Clinical trial: NCT03157700, May 2017.
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Affiliation(s)
| | | | - Shannon D Glenn
- Rutgers University, New Brunswick, NJ, USA
- REAL Prevention LLC, Clifton, NJ, USA
| | - Anne E Ray
- University of Kentucky, Lexington, KY, USA
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Sobolev M, Vitale R, Wen H, Kizer J, Leeman R, Pollak JP, Baumel A, Vadhan NP, Estrin D, Muench F. The Digital Marshmallow Test (DMT) Diagnostic and Monitoring Mobile Health App for Impulsive Behavior: Development and Validation Study. JMIR Mhealth Uhealth 2021; 9:e25018. [PMID: 33480854 PMCID: PMC7837672 DOI: 10.2196/25018] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/29/2020] [Accepted: 12/07/2020] [Indexed: 12/26/2022] Open
Abstract
Background The classic Marshmallow Test, where children were offered a choice between one small but immediate reward (eg, one marshmallow) or a larger reward (eg, two marshmallows) if they waited for a period of time, instigated a wealth of research on the relationships among impulsive responding, self-regulation, and clinical and life outcomes. Impulsivity is a hallmark feature of self-regulation failures that lead to poor health decisions and outcomes, making understanding and treating impulsivity one of the most important constructs to tackle in building a culture of health. Despite a large literature base, impulsivity measurement remains difficult due to the multidimensional nature of the construct and limited methods of assessment in daily life. Mobile devices and the rise of mobile health (mHealth) have changed our ability to assess and intervene with individuals remotely, providing an avenue for ambulatory diagnostic testing and interventions. Longitudinal studies with mobile devices can further help to understand impulsive behaviors and variation in state impulsivity in daily life. Objective The aim of this study was to develop and validate an impulsivity mHealth diagnostics and monitoring app called Digital Marshmallow Test (DMT) using both the Apple and Android platforms for widespread dissemination to researchers, clinicians, and the general public. Methods The DMT app was developed using Apple’s ResearchKit (iOS) and Android’s ResearchStack open source frameworks for developing health research study apps. The DMT app consists of three main modules: self-report, ecological momentary assessment, and active behavioral and cognitive tasks. We conducted a study with a 21-day assessment period (N=116 participants) to validate the novel measures of the DMT app. Results We used a semantic differential scale to develop self-report trait and momentary state measures of impulsivity as part of the DMT app. We identified three state factors (inefficient, thrill seeking, and intentional) that correlated highly with established measures of impulsivity. We further leveraged momentary semantic differential questions to examine intraindividual variability, the effect of daily life, and the contextual effect of mood on state impulsivity and daily impulsive behaviors. Our results indicated validation of the self-report sematic differential and related results, and of the mobile behavioral tasks, including the Balloon Analogue Risk Task and Go-No-Go task, with relatively low validity of the mobile Delay Discounting task. We discuss the design implications of these results to mHealth research. Conclusions This study demonstrates the potential for assessing different facets of trait and state impulsivity during everyday life and in clinical settings using the DMT mobile app. The DMT app can be further used to enhance our understanding of the individual facets that underlie impulsive behaviors, as well as providing a promising avenue for digital interventions. Trial Registration ClinicalTrials.gov NCT03006653; https://www.clinicaltrials.gov/ct2/show/NCT03006653
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Affiliation(s)
- Michael Sobolev
- Cornell Tech, Cornell University, New York City, NY, United States.,Feinstein Institute for Medical Research, Northwell Health, Great Neck, NY, United States
| | - Rachel Vitale
- The Partnership to End Addiction, New York, NY, United States
| | - Hongyi Wen
- Cornell Tech, Cornell University, New York City, NY, United States
| | - James Kizer
- Cornell Tech, Cornell University, New York City, NY, United States
| | - Robert Leeman
- College of Health and Human Performance, Department of Health Education and Behavior, University of Florida, Gainsville, FL, United States
| | - J P Pollak
- Cornell Tech, Cornell University, New York City, NY, United States
| | | | - Nehal P Vadhan
- Feinstein Institute for Medical Research, Northwell Health, Great Neck, NY, United States
| | - Deborah Estrin
- Cornell Tech, Cornell University, New York City, NY, United States
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Ford KL, Leiferman J, Sobral B, Bennett JK, Moore SL, Bull S. "It depends:" a qualitative study on digital health academic-industry collaboration. Mhealth 2021; 7:57. [PMID: 34805388 PMCID: PMC8572752 DOI: 10.21037/mhealth-20-140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/07/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Academic-industry collaborations (AICs) are endorsed to alleviate challenges in digital health, but partnership experiences remain understudied. The qualitative study's objective investigated collaboration experiences between academic institutions and digital health companies. METHODS A phenomenology methodology captured experiences of AICs, eliciting perspectives from academic researchers and industry affiliates (e.g., leadership, company investigators). Semi-structured interviews probed eligible collaborators about their experiences in digital health. Analysts coded and organized data into significant statements reaching thematic saturation. RESULTS Participants (N=20) were interviewed from 6 academic institutions and 14 unique industry partners. Seven themes emerged: (I) Collaboration evolves with time, relationships, funding, and evidence; (II) Collaboration demands strong relationships and interpersonal dynamics; (III) Operational processes vary across collaborations; (IV) Collaboration climate and context matters; (V) Shared expectations lead to a better understanding of success; (VI) Overcoming challenges with recommendations; (VII) Collaboration may help navigate the global pandemic. CONCLUSIONS Digital health academic industry collaboration demands strong relationships, requiring flexible mechanisms of collaboration and cultural fit. Diverse models of collaboration exist and remain dependent on contextual factors. While no collaboration conquers all challenges in digital health, AICs may serve as a facilitator for improved digital health products, thus advancing science, promoting public health, and benefiting the economy.
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Affiliation(s)
- Kelsey L. Ford
- Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Jenn Leiferman
- Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Bruno Sobral
- Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- Colorado State University, Fort Collins, CO, USA
| | - John K. Bennett
- University of Colorado Denver, Denver, CO, USA
- University of Colorado Boulder, Boulder, CO, USA
| | - Susan L. Moore
- Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Sheana Bull
- Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- University of Colorado Denver, Denver, CO, USA
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Cummins N, Schuller BW. Five Crucial Challenges in Digital Health. Front Digit Health 2020; 2:536203. [PMID: 34713029 PMCID: PMC8521883 DOI: 10.3389/fdgth.2020.536203] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/04/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Nicholas Cummins
- Chair of Embedded Intelligence for Health Care and Wellbeing, University of Augsburg, Augsburg, Germany
- The Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Björn W. Schuller
- Chair of Embedded Intelligence for Health Care and Wellbeing, University of Augsburg, Augsburg, Germany
- Department of Computing, Imperial College London, London, United Kingdom
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Bul K, Holliday N, Magee P, Wark P. From development to exploitation of digital health solutions: lessons learnt through multidisciplinary research and consultancy. JOURNAL OF ENABLING TECHNOLOGIES 2020. [DOI: 10.1108/jet-09-2020-0035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This viewpoint paper provides an overview of lessons learnt throughout the whole cycle of development to exploitation of digital solutions in health and wellbeing settings. This paper aims to address learnings that can be applied to all digital health technologies, including assistive technologies, apps, wearables, medical devices and serious games.
Design/methodology/approach
Based on the knowledge and experiences of working within a multidisciplinary team, the authors discuss lessons learnt through research and consultancy projects in digital health and translate these into pragmatic suggestions and recommendations.
Findings
Firstly, the importance of collaborating and co-creating with multidisciplinary stakeholders and end users throughout the whole project lifecycle is emphasised. Secondly, digital health solutions are not a means to an end, nor a panacea; decisions should be evidence-based and needs-driven. Thirdly, whenever possible, research designs and tools need to be more adaptive and personalised. Fourthly, the use of a mixed-method system approach and continuous evaluation throughout the project’s lifecycle is recommended to build up the evidence base. Fifthly, to ensure successful exploitation and implementation, a business case and timely bottom-up approach is recommended. Finally, to prevent research waste, it is our shared responsibility to collaborate with existing consortia and create an awareness of existing solutions and approaches.
Originality/value
In conclusion, collaborating in the field of digital health offered insights into how to be more purposeful and effective in development, evaluation and exploitation of digital health solutions. Moving this diverse and dynamic field forward is challenging but will contribute to greater long-term impact on society.
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Nelson LA, Williamson SE, Nigg A, Martinez W. Implementation of Technology-Delivered Diabetes Self-care Interventions in Clinical Care: a Narrative Review. Curr Diab Rep 2020; 20:71. [PMID: 33206241 PMCID: PMC8188808 DOI: 10.1007/s11892-020-01356-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE OF REVIEW Evidence is growing for the positive effects of technology-delivered diabetes self-care interventions on behavioral and clinical outcomes. However, our understanding of how to effectively implement these interventions into routine clinical practice is limited. This article provides an overview of the methods and results of studies examining the implementation of technology-delivered diabetes self-care interventions into clinical care. We focus specifically on patient-facing behavioral interventions delivered with technology (e.g., text messaging, apps, websites). RECENT FINDINGS Eleven articles were included in the review. Most studies (n = 9) examined barriers and facilitators to implementation, while about half (n = 5) integrated the intervention into clinical care and evaluated implementation and/or effectiveness. Only six studies applied a theory or framework. The most common determinants of implementation were time constraints for clinic staff, familiarity with technology, knowledge of the intervention, and perceived value. We found substantial variation in implementation outcomes, including which were reported, how they were assessed, and the results. In the four studies that evaluated effectiveness, hemoglobin A1c improved. Successful implementation of technology-delivered interventions has the potential to transform healthcare delivery and improve diabetes health on a population level. Promising strategies to address common determinants of implementation include appointing a clinic champion, developing staff training and educational materials, and adapting intervention processes to the clinic context. Future research should evaluate these implementation strategies to understand when and how they impact outcomes. Frameworks such as Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) can help ensure outcomes are systematically reported and allow for comparison across studies.
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Affiliation(s)
- Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA.
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA.
| | - Sarah E Williamson
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | - Audriana Nigg
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | - William Martinez
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
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Kip H, Wentzel J, Kelders SM. Shaping Blended Care: Adapting an Instrument to Support Therapists in Using eMental Health. JMIR Ment Health 2020; 7:e24245. [PMID: 33185559 PMCID: PMC7695535 DOI: 10.2196/24245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/05/2020] [Accepted: 10/05/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Although eMental health interventions, especially when delivered in a blended way, have great potential to improve the quality and efficiency of mental health care, their use in practice lags behind expectations. The Fit for Blended Care (FfBC) instrument was developed to support therapists and clients in shaping blended care in a way that optimally fits their needs. However, this existing version cannot be directly applied to specific branches of mental health care as it is too broad and generic. OBJECTIVE The goal of this study is to adapt the existing FfBC instrument to fit a specific, complex setting-forensic mental health care-by means of participatory development with therapists. METHODS The participatory process was divided into 4 phases and was executed by a project team consisting of 1 manager, 3-5 therapists, and 1 researcher. In phase 1, general requirements for the adaptation of the existing instrument were discussed in 2 focus groups with the project team. In phase 2, patient-related factors that influence the use of an existing web-based intervention were elicited through semistructured interviews with all 18 therapists working at an outpatient clinic. In phase 3, multiple focus groups with the project teams were held to create the first version of the adapted FfBC instrument. In phase 4, a digital prototype of the instrument was used with 8 patients, and the experiences of the 4 therapists were discussed in a focus group. RESULTS In phase 1, it became clear that the therapists' main requirement was to develop a much shorter instrument with a few items, in which the content was specifically tailored to the characteristics of forensic psychiatric outpatients. The interviews showed a broad range of patient-related factors, of which 5 were used in the instrument: motivation for blended treatment; writing about thoughts, feelings, and behavior; conscientiousness; psychosocial problems; and social support. In addition, a part of the instrument was focused on the practical necessary preconditions that patients should fill by themselves before the treatment was developed. The use of the web-based prototype of the instrument in treatment resulted in overall positive experiences with the content; however, therapists indicated that the items should be formulated in a more patient-centered way to encourage their involvement in discussing the factors. CONCLUSIONS The participatory, iterative process of this study resulted in an adapted version of the FfBC instrument that fits the specific forensic context and supports shared decision making. In general, the adaptiveness of the instrument is important: its content and implementation should fit the type of care, the organization, and eHealth intervention. To adapt the instrument to other contexts, the guidelines described in this paper can be followed.
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Affiliation(s)
- Hanneke Kip
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands.,Department of Research, Transfore, Deventer, Netherlands
| | - Jobke Wentzel
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands.,Research Group IT Innovations in Health Care, Windesheim University of Applied Sciences, Zwolle, Netherlands
| | - Saskia M Kelders
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands.,Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
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Hekler E, Tiro JA, Hunter CM, Nebeker C. Precision Health: The Role of the Social and Behavioral Sciences in Advancing the Vision. Ann Behav Med 2020; 54:805-826. [PMID: 32338719 PMCID: PMC7646154 DOI: 10.1093/abm/kaaa018] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In 2015, Collins and Varmus articulated a vision for precision medicine emphasizing molecular characterization of illness to identify actionable biomarkers to support individualized treatment. Researchers have argued for a broader conceptualization, precision health. Precision health is an ambitious conceptualization of health, which includes dynamic linkages between research and practice as well as medicine, population health, and public health. The goal is a unified approach to match a full range of promotion, prevention, diagnostic, and treatment interventions to fundamental and actionable determinants of health; to not just address symptoms, but to directly target genetic, biological, environmental, and social and behavioral determinants of health. PURPOSE The purpose of this paper is to elucidate the role of social and behavioral sciences within precision health. MAIN BODY Recent technologies, research frameworks, and methods are enabling new approaches to measure, intervene, and conduct social and behavioral science research. These approaches support three opportunities in precision health that the social and behavioral sciences could colead including: (a) developing interventions that continuously "tune" to each person's evolving needs; (b) enhancing and accelerating links between research and practice; and (c) studying mechanisms of change in real-world contexts. There are three challenges for precision health: (a) methods of knowledge organization and curation; (b) ethical conduct of research; and (c) equitable implementation of precision health. CONCLUSIONS Precision health requires active coleadership from social and behavioral scientists. Prior work and evidence firmly demonstrate why the social and behavioral sciences should colead with regard to three opportunity and three challenge areas.
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Affiliation(s)
- Eric Hekler
- Department of Family Medicine and Public Health, School of Medicine, UC San Diego, La Jolla, CA, USA
- Center for Wireless and Population Health Systems, Qualcomm Institute, UC San Diego, La Jolla, CA, USA
- Design Lab, UC San Diego, La Jolla, CA, USA
| | - Jasmin A Tiro
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Christine M Hunter
- Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD, USA
| | - Camille Nebeker
- Department of Family Medicine and Public Health, School of Medicine, UC San Diego, La Jolla, CA, USA
- Center for Wireless and Population Health Systems, Qualcomm Institute, UC San Diego, La Jolla, CA, USA
- Design Lab, UC San Diego, La Jolla, CA, USA
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Vilardaga R, Rizo J, Ries RK, Kientz JA, Ziedonis DM, Hernandez K, McClernon FJ. Formative, multimethod case studies of learn to quit, an acceptance and commitment therapy smoking cessation app designed for people with serious mental illness. Transl Behav Med 2020; 9:1076-1086. [PMID: 30445507 DOI: 10.1093/tbm/iby097] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Despite public health efforts, individuals with serious mental illness (SMI) still have very high rates of tobacco smoking. Innovative approaches to reach this population are needed. These series of case studies aimed to descriptively evaluate the usability, user experience (UX), and user engagement (UE) of Learn to Quit (LTQ), an acceptance and commitment therapy smoking cessation app designed for people with SMI, and to compare it with an app designed for the general population, NCI (National Cancer Institute) QuitGuide (QG). Both apps were combined with nicotine replacement therapy and technical coaching. Inspired by the ORBIT model, we implemented two case studies with crossover AB interventions, two B-phase training designs, and three bi-phasic AB single-case designs with Start-Point and Order randomization (A = QG, B = LTQ). Study outcomes were measured using the System Usability Scale, UX interviews, and background analytics. LTQ's usability levels were above the standard cutoff and on average higher than QG. UX outcomes suggested the relative benefits of LTQ's visual design, gamification and simple design structure. LTQ's overall UE was high; the app was opened for an average of 14 min per day (vs. QG: 7 min). However, users showed low levels of UE with each of the app's tracking feature. Measures of psychiatric functioning suggested the safety of LTQ in people with SMI. LTQ appears to be a usable and engaging smoking cessation app in people with SMI. An optimized version of LTQ should be tested in a Phase II study.
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Affiliation(s)
- Roger Vilardaga
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Javier Rizo
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Richard K Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Julie A Kientz
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Douglas M Ziedonis
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Kayla Hernandez
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Francis J McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
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Brigden A, Anderson E, Linney C, Morris R, Parslow R, Serafimova T, Smith L, Briggs E, Loades M, Crawley E. Digital Behavior Change Interventions for Younger Children With Chronic Health Conditions: Systematic Review. J Med Internet Res 2020; 22:e16924. [PMID: 32735227 PMCID: PMC7428934 DOI: 10.2196/16924] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/30/2020] [Accepted: 05/20/2020] [Indexed: 12/14/2022] Open
Abstract
Background The prevalence of chronic health conditions in childhood is increasing, and behavioral interventions can support the management of these conditions. Compared with face-to-face treatment, the use of digital interventions may be more cost-effective, appealing, and accessible, but there has been inadequate attention to their use with younger populations (children aged 5-12 years). Objective This systematic review aims to (1) identify effective digital interventions, (2) report the characteristics of promising interventions, and (3) describe the user’s experience of the digital intervention. Methods A total of 4 databases were searched (Excerpta Medica Database [EMBASE], PsycINFO, Medical Literature Analysis and Retrieval System Online [MEDLINE], and the Cochrane Library) between January 2014 and January 2019. The inclusion criteria for studies were as follows: (1) children aged between 5 and 12 years, (2) interventions for behavior change, (3) randomized controlled trials, (4) digital interventions, and (5) chronic health conditions. Two researchers independently double reviewed papers to assess eligibility, extract data, and assess quality. Results Searches run in the databases identified 2643 papers. We identified 17 eligible interventions. The most promising interventions (having a beneficial effect and low risk of bias) were 3 targeting overweight or obesity, using exergaming or social media, and 2 for anxiety, using web-based cognitive behavioral therapy (CBT). Characteristics of promising interventions included gaming features, therapist support, and parental involvement. Most were purely behavioral interventions (rather than CBT or third wave), typically using the behavior change techniques (BCTs) feedback and monitoring, shaping knowledge, repetition and substitution, and reward. Three papers included qualitative data on the user’s experience. We developed the following themes: parental involvement, connection with a health professional is important for engagement, technological affordances and barriers, and child-centered design. Conclusions Of the 17 eligible interventions, digital interventions for anxiety and overweight or obesity had the greatest promise. Using qualitative methods during digital intervention development and evaluation may lead to more meaningful, usable, feasible, and engaging interventions, especially for this underresearched younger population. The following characteristics could be considered when developing digital interventions for younger children: involvement of parents, gaming features, additional therapist support, behavioral (rather than cognitive) approaches, and particular BCTs (feedback and monitoring, shaping knowledge, repetition and substitution, and reward). This review suggests a model for improving the conceptualization and reporting of behavioral interventions involving children and parents.
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Affiliation(s)
- Amberly Brigden
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Emma Anderson
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Catherine Linney
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Richard Morris
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Roxanne Parslow
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Teona Serafimova
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Lucie Smith
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Emily Briggs
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Maria Loades
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,Department of Psychology, University of Bath, Bath, United Kingdom
| | - Esther Crawley
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Arevian AC, O'Hora J, Rosser J, Mango JD, Miklowitz DJ, Wells KB. Patient and Provider Cocreation of Mobile Texting Apps to Support Behavioral Health: Usability Study. JMIR Mhealth Uhealth 2020; 8:e12655. [PMID: 32723714 PMCID: PMC7424494 DOI: 10.2196/12655] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 08/05/2019] [Accepted: 03/29/2020] [Indexed: 11/23/2022] Open
Abstract
Background Mobile technologies hold potential for improving the quality of care and engagement of patients. However, there are considerable challenges in ensuring that technologies are relevant, useful, and engaging. While end users such as patients and providers are increasingly involved in the design of health technologies, there are limited examples of their involvement in directly creating technologies for their personal use. Objective We aim to evaluate the feasibility and acceptability of patients and providers creating mobile texting apps to support treatment goals. Methods In an 11-month usability study, we enrolled 4 providers and 28 patients in an intensive outpatient program for obsessive-compulsive disorder. Patients and providers created their own mobile texting apps using a visual app development platform. A subsample of 10 patients and 4 providers completed a usability measure. Results Participants created a total of 360 unique mobile text messages (1787 total messages sent). There were 4 types of messages identified, including personalized reminders, clinical exposures, interactive prompts, and encouraging/informational messages. A total of 9 out of 10 (90%) patients agreed that the messages were relevant to their recovery, and 8 out of 10 (80%) agreed that the messages were effective at helping complete treatment plans. Conclusions Enabling patients and providers to cocreate apps for their own use by using a visual application platform is feasible and holds potential for increasing the relevance, sustainability, and effectiveness of digital health technologies.
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Affiliation(s)
- Armen C Arevian
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States
| | - Jennifer O'Hora
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States
| | - James Rosser
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States
| | - Joseph D Mango
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States
| | - David J Miklowitz
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States
| | - Kenneth B Wells
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States
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Ainsworth B, Bruton A, Thomas M, Yardley L. One year later: Highlighting the challenges and opportunities in disseminating a breathing-retraining digital behaviour change intervention. Digit Health 2020; 6:2055207620936441. [PMID: 32728474 PMCID: PMC7364807 DOI: 10.1177/2055207620936441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/01/2020] [Indexed: 11/26/2022] Open
Abstract
Digital behaviour change interventions can provide effective and cost-effective treatments for a range of health conditions. However, after rigorous evaluation, there still remain challenges to disseminating and implementing evidence-based interventions that can hinder their effectiveness ‘in the real world’. We conducted a large-scale randomised controlled trial of self-guided breathing retraining, which we then disseminated freely as a digital intervention. Here we share our experience of this process after one year, highlighting the opportunities that digital health interventions can offer alongside the challenges that must be addressed in order to harness their effectiveness. Whilst such treatments can support many individuals at extremely low cost, careful dissemination strategies should be proactively planned in order to ensure such opportunities are maximised and interventions remain up to date in a fast-moving digital landscape.
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Affiliation(s)
- Ben Ainsworth
- Department of Psychology, University of Bath, UK.,NIHR Biomedical Research Centre, Faculty of Medicine, University of Southampton, UK
| | - Anne Bruton
- School of Health Sciences, University of Southampton, UK
| | - Mike Thomas
- Primary Care and Population Sciences, University of Southampton, UK
| | - Lucy Yardley
- School of Psychological Science, University of Bristol, UK.,School of Psychology, University of Southampton, UK
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van Heerden A, Leppanen J, Rotheram-Borus MJ, Worthman CM, Kohrt BA, Skeen S, Giese S, Hughes R, Bohmer L, Tomlinson M. Emerging Opportunities Provided by Technology to Advance Research in Child Health Globally. Glob Pediatr Health 2020; 7:2333794X20917570. [PMID: 32523976 PMCID: PMC7235657 DOI: 10.1177/2333794x20917570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/04/2020] [Accepted: 03/06/2020] [Indexed: 11/15/2022] Open
Abstract
Current approaches to longitudinal assessment of children's developmental and psychological well-being, as mandated in the United Nations Sustainable Development Goals, are expensive and time consuming. Substantive understanding of global progress toward these goals will require a suite of new robust, cost-effective research tools designed to assess key developmental processes in diverse settings. While first steps have been taken toward this end through efforts such as the National Institutes of Health's Toolbox, experience-near approaches including naturalistic observation have remained too costly and time consuming to scale to the population level. This perspective presents 4 emerging technologies with high potential for advancing the field of child health and development research, namely (1) affective computing, (2) ubiquitous computing, (3) eye tracking, and (4) machine learning. By drawing attention of scientists, policy makers, investors/funders, and the media to the applications and potential risks of these emerging opportunities, we hope to inspire a fresh wave of innovation and new solutions to the global challenges faced by children and their families.
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Affiliation(s)
- Alastair van Heerden
- Human Sciences Research Council, Pietermaritzburg, South Africa.,University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | | | - Sarah Skeen
- Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | | | - Rob Hughes
- The Children's Investment Fund Foundation, London, UK
| | - Lisa Bohmer
- Conrad N. Hilton Foundation, Westlake Village, CA, USA
| | - Mark Tomlinson
- Stellenbosch University, Stellenbosch, Western Cape, South Africa
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46
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Cliffe B, Croker A, Denne M, Stallard P. Clinicians' use of and attitudes towards technology to provide and support interventions in child and adolescent mental health services. Child Adolesc Ment Health 2020; 25:95-101. [PMID: 32307835 DOI: 10.1111/camh.12362] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 11/14/2019] [Accepted: 11/14/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Technology can increase child and adolescent mental health service (CAMHS) capacity by supporting and delivering interventions, yet it has not been widely adopted by CAMHS child mental health professionals. Uptake can either be facilitated or obstructed by child mental health professionals' attitudes, which remain largely unknown. METHOD One hundred fifty-four CAMHS child mental health professionals completed a questionnaire about their use of, and attitudes towards, using technology with children and adolescents. RESULTS Child mental health professionals perceived themselves as generally competent at using technology, especially younger child mental health professionals, and perceived it to be helpful in their clinical work. A number of benefits of its use were identified such as accessibility, convenience and appeal, and it was primarily perceived as a preventative/psychoeducational tool rather than a replacement for face-to-face therapy. Older technologies (helplines and websites) were most frequently used, whereas newer technologies (computer games) were rarely used. Child mental health professionals were unsure what resources were available and whether technology is safe, private or reliable. CONCLUSIONS Despite positive attitudes towards technology, newer technologies were rarely used by child mental health professionals. An overall lack of knowledge about resources along with concerns about safety and reliability may account for the slow uptake of technology within CAMHS. These issues need addressing to maximise implementation, perhaps through training or workshops.
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Affiliation(s)
| | - Abigail Croker
- Child and Family Service, Temple House Practice, Keynsham, UK
| | - Megan Denne
- Child and Family Service, Temple House Practice, Keynsham, UK
| | - Paul Stallard
- Department for Health, University of Bath, Bath, UK.,Child and Family Service, Temple House Practice, Keynsham, UK
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Shaffer KM, Tigershtrom A, Badr H, Benvengo S, Hernandez M, Ritterband LM. Dyadic Psychosocial eHealth Interventions: Systematic Scoping Review. J Med Internet Res 2020; 22:e15509. [PMID: 32130143 PMCID: PMC7081137 DOI: 10.2196/15509] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/08/2019] [Accepted: 12/19/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Dyadic psychosocial interventions have been found beneficial both for people coping with mental or physical health conditions as well as their family members and friends who provide them with support. Delivering these interventions via electronic health (eHealth) may help increase their scalability. OBJECTIVE This scoping review aimed to provide the first comprehensive overview of dyadic eHealth interventions for individuals of all ages affected by mental or physical illness and their family members or friends who support them. The goal was to understand how dyadic eHealth interventions have been used and to highlight areas of research needed to advance dyadic eHealth intervention development and dissemination. METHODS A comprehensive electronic literature search of PubMed, EMBASE, Cochrane, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO was conducted for articles published in the English language through March 2019. Eligible records described a psychosocial eHealth intervention that intervened with both care recipients and their support person. RESULTS A total of 7113 records were reviewed of which 101 met eligibility criteria. There were 52 unique dyadic eHealth interventions identified, which were tested across 73 different trials. Of the unique interventions, 33 were conducted among dyads of children and their supporting parent, 1 was conducted with an adolescent-young adult care recipient population, and the remaining 18 were conducted among adult dyads. Interventions targeting pediatric dyads most commonly addressed a mental health condition (n=10); interventions targeting adult dyads most commonly addressed cancer (n=9). More than three-fourths of interventions (n=40) required some human support from research staff or clinicians. Most studies (n=64) specified one or more primary outcomes for care recipients, whereas less than one-fourth (n=22) specified primary outcomes for support persons. Where specified, primary outcomes were most commonly self-reported psychosocial or health factors for both care recipients (n=43) and support persons (n=18). Results of the dyadic eHealth intervention tended to be positive for care recipients, but evidence of effects for support persons was limited because of few studies specifying primary outcomes for supporters. Trials of dyadic eHealth interventions were most commonly randomized controlled trials (RCTs; n=44), and RCTs most commonly compared the dyadic eHealth intervention to usual care alone (n=22). CONCLUSIONS This first comprehensive review of dyadic eHealth interventions demonstrates that there is substantial, diverse, and growing literature supporting this interventional approach. However, several significant gaps were identified. Few studies were designed to evaluate the unique effects of dyadic interventions relative to individual interventions. There was also limited assessment and reporting of outcomes for support persons, and there were no interventions meeting our eligibility criteria specifically targeting the needs of older adult dyads. Findings highlight areas of research opportunities for developing dyadic eHealth interventions for novel populations and for increasing access to dyadic care.
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Affiliation(s)
- Kelly M Shaffer
- Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, VA, United States
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | - Hoda Badr
- Baylor College of Medicine, Houston, TX, United States
| | | | - Marisol Hernandez
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
- CUNY School of Medicine/City College of New York, New York, NY, United States
| | - Lee M Ritterband
- Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, VA, United States
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Digital interventions for adolescent and young adult cancer survivors. Curr Opin Support Palliat Care 2020; 14:51-59. [DOI: 10.1097/spc.0000000000000480] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Damen I, Brombacher H, Lallemand C, Brankaert R, Brombacher A, van Wesemael P, Vos S. A Scoping Review of Digital Tools to Reduce Sedentary Behavior or Increase Physical Activity in Knowledge Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020499. [PMID: 31941096 PMCID: PMC7014464 DOI: 10.3390/ijerph17020499] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/13/2019] [Accepted: 01/07/2020] [Indexed: 12/02/2022]
Abstract
Background: There is increasing interest in the role that technology can play in improving the vitality of knowledge workers. A promising and widely adopted strategy to attain this goal is to reduce sedentary behavior (SB) and increase physical activity (PA). In this paper, we review the state-of-the-art SB and PA interventions using technology in the office environment. By scoping the existing landscape, we identified current gaps and underexplored possibilities. We discuss opportunities for future development and research on SB and PA interventions using technology. Methods: A systematic search was conducted in the Association for Computing Machinery digital library, the interdisciplinary library Scopus, and the Institute of Electrical and Electronics Engineers Xplore Digital Library to locate peer-reviewed scientific articles detailing SB and PA technology interventions in office environments between 2009 and 2019. Results: The initial search identified 1130 articles, of which 45 studies were included in the analysis. Our scoping review focused on the technologies supporting the interventions, which were coded using a grounded approach. Conclusion: Our findings showed that current SB and PA interventions using technology provide limited possibilities for physically active ways of working as opposed to the common strategy of prompting breaks. Interventions are also often offered as additional systems or services, rather than integrated into existing office infrastructures. With this work, we have mapped different types of interventions and provide an increased understanding of the opportunities for future multidisciplinary development and research of technologies to address sedentary behavior and physical activity in the office context.
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Affiliation(s)
- Ida Damen
- Department of Industrial Design, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands; (H.B.); (C.L.); (R.B.); (A.B.)
- Correspondence: (I.D.); (S.V.)
| | - Hans Brombacher
- Department of Industrial Design, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands; (H.B.); (C.L.); (R.B.); (A.B.)
| | - Carine Lallemand
- Department of Industrial Design, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands; (H.B.); (C.L.); (R.B.); (A.B.)
- HCI Research Group, University of Luxembourg, 4365 Esch-sur-Alzette, Luxembourg
| | - Rens Brankaert
- Department of Industrial Design, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands; (H.B.); (C.L.); (R.B.); (A.B.)
- School for Allied Health Professions, Fontys University of Applied Sciences, 5600 AH Eindhoven, The Netherlands
| | - Aarnout Brombacher
- Department of Industrial Design, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands; (H.B.); (C.L.); (R.B.); (A.B.)
| | - Pieter van Wesemael
- Department of the Built Environment, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands;
| | - Steven Vos
- Department of Industrial Design, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands; (H.B.); (C.L.); (R.B.); (A.B.)
- School of Sport Studies, Fontys University of Applied Sciences, 5644 HZ Eindhoven, The Netherlands
- Correspondence: (I.D.); (S.V.)
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Abstract
Mobile technology is increasingly being used to enhance health and wellness, including in the assessment and treatment of psychiatric disorders. Such applications have been referred to collectively as mHealth, and this article provides a comprehensive review and clinical perspective of research regarding mHealth in late-life mood and anxiety disorders. The novel data collection offered by mHealth has contributed to a broader understanding of psychopathology, to an increased diversity of psychological interventions, and to novel methods of assessment that may ultimately provide individually adaptive mental health care for this population. Older adults face challenges (e.g., transportation, mobility) that limit their ability to receive medical and mental health care services, and mHealth may improve the capacity to reach this population. Although several mobile interventions exist for health-related issues in older adults (e.g., balance, diabetes, medication management), mHealth targeting psychiatric disorders is limited and most often focuses on problems related to dementia, cognitive dysfunction, and memory loss. Given that depression and anxiety are two of the most common mental health concerns among this population, mHealth has strong potential for broad public health interventions that may improve effectiveness of mental health care via individualized assessments and treatments.
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