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Yeager CM, Benight CC. Engagement, Predictors, and Outcomes of a Trauma Recovery Digital Mental Health Intervention: Longitudinal Study. JMIR Ment Health 2022; 9:e35048. [PMID: 35499857 PMCID: PMC9112079 DOI: 10.2196/35048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/28/2022] [Accepted: 03/05/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Worldwide, exposure to potentially traumatic events is extremely common, and many individuals develop posttraumatic stress disorder (PTSD) along with other disorders. Unfortunately, considerable barriers to treatment exist. A promising approach to overcoming treatment barriers is a digital mental health intervention (DMHI). However, engagement with DMHIs is a concern, and theoretically based research in this area is sparse and often inconclusive. OBJECTIVE The focus of this study is on the complex issue of DMHI engagement. On the basis of the social cognitive theory framework, the conceptualization of engagement and a theoretically based model of predictors and outcomes were investigated using a DMHI for trauma recovery. METHODS A 6-week longitudinal study with a national sample of survivors of trauma was conducted to measure engagement, predictors of engagement, and mediational pathways to symptom reduction while using a trauma recovery DMHI (time 1: N=915; time 2: N=350; time 3: N=168; and time 4: N=101). RESULTS Confirmatory factor analysis of the engagement latent constructs of duration, frequency, interest, attention, and affect produced an acceptable model fit (χ22=8.3; P=.02; comparative fit index 0.973; root mean square error of approximation 0.059; 90% CI 0.022-0.103). Using the latent construct, the longitudinal theoretical model demonstrated adequate model fit (comparative fit index 0.929; root mean square error of approximation 0.052; 90% CI 0.040-0.064), indicating that engagement self-efficacy (β=.35; P<.001) and outcome expectations (β=.37; P<.001) were significant predictors of engagement (R2=39%). The overall indirect effect between engagement and PTSD symptom reduction was significant (β=-.065; P<.001; 90% CI -0.071 to -0.058). This relationship was serially mediated by both skill activation self-efficacy (β=.80; P<.001) and trauma coping self-efficacy (β=.40; P<.001), which predicted a reduction in PTSD symptoms (β=-.20; P=.02). CONCLUSIONS The results of this study may provide a solid foundation for formalizing the nascent science of engagement. Engagement conceptualization comprised general measures of attention, interest, affect, and use that could be applied to other applications. The longitudinal research model supported 2 theoretically based predictors of engagement: engagement self-efficacy and outcome expectancies. A total of 2 task-specific self-efficacies-skill activation and trauma coping-proved to be significant mediators between engagement and symptom reduction. Taken together, this model can be applied to other DMHIs to understand engagement, as well as predictors and mechanisms of action. Ultimately, this could help improve the design and development of engaging and effective trauma recovery DMHIs.
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Affiliation(s)
- Carolyn M Yeager
- Lyda Hill Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, United States
| | - Charles C Benight
- Lyda Hill Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, United States
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Van Rhoon L, McSharry J, Byrne M. Development and testing of a digital health acceptability model to explain the intention to use a digital diabetes prevention programme. Br J Health Psychol 2021; 27:716-740. [PMID: 34719099 DOI: 10.1111/bjhp.12569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/22/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Digitally-delivered diabetes prevention programmes (DPPs) may improve population health by reversing the escalating trend of type 2 diabetes (T2D) incidence. Understanding the factors which determine digital health acceptability is critical to developing effective interventions. This study aimed to develop and test a digital health acceptability model of the factors influencing the intention of adults living in Ireland to use a digital DPP. DESIGN A 61-item cross-sectional survey was issued online or in hard copy to a sample of adults. METHODS Participants viewed a brochure for a smartphone-based digital DPP. The FINDRISC assessed their risk of developing T2D, and Likert scale items assessed the personal health, social influence, eHealth literacy, and intervention factors of the model. Structural equation modelling was used to assess the relationships between these factors. RESULT Three-hundred-and-sixteen eligible participants (Mage = 36) completed the survey, 42% of which had a slightly elevated T2D risk or higher. Twelve direct factor relationships were statistically significant. Subjective norm had a moderate-to-large impact on T2D risk perceptions. Health status, perceived susceptibility to T2D, eHealth readiness, communicative eHealth literacy and image had significant impacts on use intentions through mediators of perceived ease of use and perceived usefulness. The model explained 65% of the variance in digital DPP use intentions. CONCLUSION Personal health beliefs, social influence, and eHealth literacy collectively influence a digital DPP's acceptability. These findings may inform the development of future digital DPPs and other digital health interventions. Future research should test the model with adults that have a higher T2D risk status.
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Affiliation(s)
- Luke Van Rhoon
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
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Knapova L, Klocek A, Elavsky S. The Role of Psychological Factors in Older Adults' Readiness to Use eHealth Technology: Cross-Sectional Questionnaire Study. J Med Internet Res 2020; 22:e14670. [PMID: 32348251 PMCID: PMC7290459 DOI: 10.2196/14670] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 12/17/2019] [Accepted: 02/09/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Information and communication technology (ICT) use among older adults has been on the rise in recent years. However, the predictors and mechanisms behind older adults' acceptance and use of ICT are not clear. OBJECTIVE This study aimed to systematically describe ICT usage among Czech older adults and to evaluate the factors influencing their ICT use and readiness to use digital technology to promote health (eHealth readiness). The primary focus was on psychological factors and the role of persons close to older adults. METHODS The research utilized cross-sectional survey data from a quota-based sample of Czech older adults (>50 years) and persons close to them further referred to as close persons (N=250 dyads). A structural equation modeling framework was used to evaluate relationships between psychological factors, ICT use, and eHealth readiness. RESULTS Czech older adults' use of ICT is low with the exception of cell phone usage (cell phone usage by 173/250, 69.2%; other devices used by 50/250, 20.0% of older adults or less). Apart from age (β=-.21; P<.001), eHealth readiness was predicted by ICT use (β=.65; P<.001). eHealth readiness was also indirectly affected by the need for cognitive closure (NFCC): individuals with a high need for closure perceived more barriers to ICT (β=.23; P=.01) and more reported barriers were linked to lower ICT usage (β=-.21; P=.001). The expected positive relationships between eHealth readiness of persons close to older adults and ICT use and eHealth readiness of older adults were not significant, but the total effect of eHealth readiness of persons close to older adults on eHealth readiness of older adults was positive and significant (β=.18; P=.01), indicating some level of influence of persons close to them on older adults' attitudes and behaviors. CONCLUSIONS This study provided the first systematic examination of Czech older adults' ICT usage and eHealth readiness. Novel predictors (NFCC and close persons' variables) were evaluated and yielded actionable results. More research is needed to clarify the role of persons close to older adults.
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Affiliation(s)
- Lenka Knapova
- Institute for Research on Children, Youth and Family, Masaryk University, Brno, Czech Republic.,Faculty of Informatics, Masaryk University, Brno, Czech Republic.,Faculty of Education, University of Ostrava, Ostrava, Czech Republic
| | - Adam Klocek
- Institute for Research on Children, Youth and Family, Masaryk University, Brno, Czech Republic.,Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Steriani Elavsky
- Institute for Research on Children, Youth and Family, Masaryk University, Brno, Czech Republic.,Faculty of Informatics, Masaryk University, Brno, Czech Republic.,Faculty of Education, University of Ostrava, Ostrava, Czech Republic
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GPs' perspectives on eHealth use in the Czech Republic: a cross-sectional mixed-design survey study. BJGP Open 2019; 3:bjgpopen19X101655. [PMID: 31344683 PMCID: PMC6970584 DOI: 10.3399/bjgpopen19x101655] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/10/2019] [Indexed: 12/01/2022] Open
Abstract
Background Digitalisation of health services is among the top priorities of the European Union (EU), yet take-up of eHealth tools is slower in some EU countries than others. Aim The aim of this study was to evaluate the use of information communication technology (ICT) and eHealth tools by Czech GPs, to elucidate their motivation and barriers to the adoption of eHealth technologies. Design & setting A cross-sectional, mixed-design survey study, administered online and conducted with GPs from seven randomly selected Czech regions. Of the invited 777 GPs, 196 participants responded (25% response rate) and 153 completed the survey. Method Quantitative (measured using, for example, the eHealth readiness scale) and qualitative (thematic analysis) methods were used. Results Hierarchical multilinear regression (controling for age, sex, and city size) showed that ICT usage in general practice was predicted by eHealth readiness. Among GPs with their own practice, age and practice size also predicted ICT use. Analysis of barriers specific to mobile health tools identified obstacles on the side of GPs (such as low perceived usefulness), patients (such as lack of interest), and contextual barriers (such as lack of time). Conclusion In addition to system-level change, educating Czech GPs about the benefits of eHealth tools for better patient–provider interaction and quality of care is necessary to facilitate eHealth adoption and usage in the Czech Republic.
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Jones M, Denisova A, Mitchell S, Owen T. Acceptability of a Plasticity-Focused Serious Game Intervention for Posttraumatic Stress Disorder: User Requirements Analysis. JMIR Serious Games 2019; 7:e11909. [PMID: 30990461 PMCID: PMC6488951 DOI: 10.2196/11909] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/01/2018] [Accepted: 12/09/2018] [Indexed: 01/20/2023] Open
Abstract
Background Trauma-focused cognitive behavioral therapy (TF-CBT) is a first-line treatment for posttraumatic stress disorder (PTSD). Despite a solid evidence base, TF-CBT response and attrition rates vary considerably. Plasticity-focused interventions, including the use of serious games, have the potential to improve TF-CBT response and treatment retention. Objective The aim of this study was to assess the acceptability of a mobile phone–delivered plasticity-focused serious game to improve response to TF-CBT for PTSD, and carry out a user requirements analysis should the development of a prototype be warranted. Methods We conducted 2 one-to-one interviews (n=2), one focus group involving service users who had received a diagnosis of PTSD (n=3) and one focus group involving psychological trauma service clinicians (n=4). Results We found that the concept of a plasticity-focused mobile phone intervention for PTSD is acceptable to patients and clinicians. Service users and clinicians both believed that the usage should be guided by a therapist, and both contributed useful inputs regarding the audiovisual aspects of the proposed serious game. It was accepted that the game would not be suitable for all patients and that clinicians would need to appropriately prescribe the usage of the game. Conclusions The findings highlight the acceptability of the proposed serious game and clarify the user requirements for such an intervention. It is the intention of the authors to carry out a user experience evaluation using a prototype serious game in a clinical population.
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Affiliation(s)
- Matthew Jones
- Health Services Research, Medical School, Swansea University, Swansea, United Kingdom
| | - Alena Denisova
- Department of Computer Science, College of Science, Swansea University, Swansea, United Kingdom
| | - Stephen Mitchell
- Department of Computer Science, College of Science, Swansea University, Swansea, United Kingdom
| | - Tom Owen
- Department of Computer Science, College of Science, Swansea University, Swansea, United Kingdom
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Paige SR, Stellefson M, Krieger JL, Anderson-Lewis C, Cheong J, Stopka C. Proposing a Transactional Model of eHealth Literacy: Concept Analysis. J Med Internet Res 2018; 20:e10175. [PMID: 30279155 PMCID: PMC6231800 DOI: 10.2196/10175] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/18/2018] [Accepted: 06/28/2018] [Indexed: 11/24/2022] Open
Abstract
Background Electronic health (eHealth) literacy was conceptualized in 2006 as the ability of internet users to locate, evaluate, and act upon web-based health information. Now, advances in eHealth technology have cultivated transactional opportunities for patients to access, share, and monitor health information. However, empirical evidence shows that existing models and measures of eHealth literacy have limited theoretical underpinnings that reflect the transactional capabilities of eHealth. This paper describes a conceptual model based on the Transactional Model of Communication (TMC), in which eHealth literacy is described as an intrapersonal skillset hypothesized as being dynamic; reciprocal; and shaped by social, relational, and cultural contexts. Objective The objective of our study was to systematically examine eHealth literacy definitions, models, and measures to propose a refined conceptual and operational definition based on the TMC. Methods Walker and Avant’s concept analysis method was used to guide the systematic review of eHealth literacy definitions (n=10), rating scales (n=6), models (n=4), and peer-reviewed model applications (n=16). Subsequent cluster analyses showed salient themes across definitions. Dimensions, antecedents, and consequences reflected in models and measures were extracted and deductively analyzed based on codes consistent with the TMC. Results Systematic review evidence revealed incongruity between operational eHealth literacy included in definitions compared with literacies included within models and measures. Theoretical underpinnings of eHealth literacy also remain dismal. Despite the transactional capabilities of eHealth, the role of “communication” in eHealth literacy remains underdeveloped and does not account for physical and cognitive processing abilities necessary for multiway transactions. Conclusions The Transactional Model of eHealth Literacy and a corresponding definition are proposed. In this novel model, eHealth literacy comprises a hierarchical intrapersonal skillset that mediates the reciprocal effect of contextual factors (ie, user oriented and task oriented) on patient engagement in health care. More specifically, the intrapersonal skillset counteracts the negative effect of “noise” (or impediments) produced by social and relational contexts. Cutting across health and technology literacies, the intrapersonal skillset of eHealth literacy is operationalized through four literacies that correspond with discrete operative skills: (1) functional (ie, locate and understand); (2) communicative (ie, exchange); (3) critical (ie, evaluate); and (4) translational (ie, apply).
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Affiliation(s)
- Samantha R Paige
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Gainesville, FL, United States.,Department of Health Education & Behavior, University of Florida, Gainesville, FL, United States
| | - Michael Stellefson
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, United States
| | - Janice L Krieger
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Gainesville, FL, United States
| | | | - JeeWon Cheong
- Department of Health Education & Behavior, University of Florida, Gainesville, FL, United States
| | - Christine Stopka
- Department of Health Education & Behavior, University of Florida, Gainesville, FL, United States
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Lucas GM, Rizzo A, Gratch J, Scherer S, Stratou G, Boberg J, Morency LP. Reporting Mental Health Symptoms: Breaking Down Barriers to Care with Virtual Human Interviewers. Front Robot AI 2017. [DOI: 10.3389/frobt.2017.00051] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Andrews SE, Runyon C, Aikens ML. The Math-Biology Values Instrument: Development of a Tool to Measure Life Science Majors' Task Values of Using Math in the Context of Biology. CBE LIFE SCIENCES EDUCATION 2017; 16:16/3/ar45. [PMID: 28747355 PMCID: PMC5589425 DOI: 10.1187/cbe.17-03-0043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/03/2017] [Accepted: 05/09/2017] [Indexed: 05/22/2023]
Abstract
In response to calls to improve the quantitative training of undergraduate biology students, there have been increased efforts to better integrate math into biology curricula. One challenge of such efforts is negative student attitudes toward math, which are thought to be particularly prevalent among biology students. According to theory, students' personal values toward using math in a biological context will influence their achievement and behavioral outcomes, but a validated instrument is needed to determine this empirically. We developed the Math-Biology Values Instrument (MBVI), an 11-item college-level self--report instrument grounded in expectancy-value theory, to measure life science students' interest in using math to understand biology, the perceived usefulness of math to their life science career, and the cost of using math in biology courses. We used a process that integrates multiple forms of validity evidence to show that scores from the MBVI can be used as a valid measure of a student's value of math in the context of biology. The MBVI can be used by instructors and researchers to help identify instructional strategies that influence math-biology values and understand how math-biology values are related to students' achievement and decisions to pursue more advanced quantitative-based courses.
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Affiliation(s)
- Sarah E Andrews
- Department of Biological Sciences, University of New Hampshire, Durham, NH 03824
| | - Christopher Runyon
- Educational Psychology Department, University of Texas at Austin, Austin, TX 78712
| | - Melissa L Aikens
- Department of Biological Sciences, University of New Hampshire, Durham, NH 03824
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