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Fletcher K, Moran-Pryor A, Robert-Hendren D. Preliminary Clinical Outcomes of the Hello Sunday Morning Alcohol and Wellbeing Self-Assessment: Feasibility and Acceptability Study. JMIR Form Res 2023; 7:e48245. [PMID: 37874615 PMCID: PMC10630865 DOI: 10.2196/48245] [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: 04/17/2023] [Revised: 07/25/2023] [Accepted: 09/23/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Alcohol-related injuries and diseases are a leading cause of morbidity and mortality worldwide. Early intervention is essential given the chronic, relapsing nature of alcohol use disorders. There is significant potential for widely accessible web-based screening tools to help individuals determine where they stand in terms of alcohol use and provide support recommendations. Screening and brief interventions (SBIs) provide individuals with a stigma-free opportunity to learn and think about the potential risks of drinking and prompt help-seeking behavior by incorporating behavior change techniques. Furthermore, as excessive alcohol use and mental health problems often occur concurrently, SBIs for both conditions simultaneously can potentially address a critical gap in alcohol and mental health treatment. OBJECTIVE We investigated the feasibility, acceptability, and clinical outcomes of participants completing the Alcohol and Wellbeing Self-assessment (A&WS), a web-based SBI. METHODS The A&WS is freely available on the Hello Sunday Morning website as part of an uncontrolled observational prospective study. Feasibility was assessed based on the number of respondents who commenced and subsequently completed the A&WS. Acceptability was measured via participant feedback to determine overall satisfaction, perceived helpfulness, and likelihood of recommending the A&WS to others. Clinical outcomes were measured in two ways: (1) self-reported changes in alcohol consumption (Alcohol Use Disorders Identification Test score) or psychological distress (Kessler Psychological Distress Scale score) over time and (2) help seeking-both self-reported and immediate web-based help seeking. Preliminary baseline data collected for the first 9 months (March 2022 to December 2022) of the study were reported, including the 3-month follow-up outcomes. RESULTS A total of 17,628 participants commenced the A&WS, and of these, 14,419 (81.8%) completed it. Of those 14,419 who completed the A&WS, 1323 (9.18%) agreed to participate in the follow-up research. Acceptability was high, with 78.46% (1038/1323) reporting high satisfaction levels overall; 95.62% (1265/1323) found the A&WS easy to use and would recommend the tool to others. The 1-, 2-, and 3-month follow-ups were completed by 28.57% (378/1323), 21.09% (279/1323), and 17.61% (233/1323) of the participants, respectively. Significant reductions in the Alcohol Use Disorders Identification Test Consumption subscale (P<.001) and Kessler Psychological Distress Scale scores (P<.001) were observed over the 3-month follow-up period. CONCLUSIONS Our results suggest that the A&WS is a highly feasible and acceptable digital SBI that may support individuals in making changes to their alcohol consumption and improve their psychological well-being. In the absence of a control group, positive clinical outcomes cannot be attributed to the A&WS, which should now be subjected to a randomized controlled trial. This scalable, freely available tool has the potential to reach a large number of adults who might not otherwise access help while complementing the alcohol and mental health treatment ecosystem.
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Affiliation(s)
- Kathryn Fletcher
- Hello Sunday Morning, Sydney, Australia
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
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2
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Butow P, Shepherd HL, Cuddy J, Rankin N, Harris M, He S, Grimison P, Girgis A, Faris M, Shaw J. Staff perspectives on the feasibility of a clinical pathway for anxiety and depression in cancer care, and mid-implementation adaptations. BMC Health Serv Res 2022; 22:192. [PMID: 35164772 PMCID: PMC8842573 DOI: 10.1186/s12913-022-07532-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 12/14/2021] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Clinical pathways (CPs) are intended to standardise and improve care but do not always produce positive outcomes, possibly because they were not adapted to suit the specific context in which they were enacted. This qualitative study aimed to explore staff perspectives of implementation of a CP for routine screening, assessment, referral and management of anxiety and depression (the ADAPT CP) for patients with cancer, focussing on perceived feasibility of the CP and negotiated adaptations made during the implementation phase. METHODS The ADAPT CP was implemented in 12 urban and regional oncology services in Australia. Services were randomised to receive core versus enhanced implementation strategies. Core sites received support until implementation commencement and could access progress reports. Enhanced sites received proactive, ongoing support during the 12-month implementation. Purposively selected staff were interviewed prior to implementation (n = 88) and 6 months later, half-way through the implementation period (n = 89). Monthly meetings with lead multi-disciplinary teams at the eight enhanced sites were recorded. Data were thematically analysed. RESULTS Six overarching themes were identified: ADAPT is of high value; timing for introducing the CP and screening is difficult; online screening is challenging; a burden too much; no-one to refer patients to; and micro-logistics are key. While early screening was deemed desirable, diverse barriers meant this was complex, with adaptations made to time and screening location. Online screening prompted by email, seen as time-saving and efficient, also proved unsuccessful in some services, with adaptations made to in-clinic or phone screening, or repeated email reminders. Staff negative attitudes to ADAPT, time constraints, and perceived poor fit of ADAPT to work roles and flows, all impacted implementation, with key tasks often devolving to a few key individuals. Nevertheless, services remained committed to the ADAPT CP, and worked hard to create, review and adapt strategies to address challenges to optimise success. CONCLUSIONS This study demonstrates the interactive nature of health service change, with staff actively engaging with, forming views on, and problem-solving adaptations of the ADAPT CP to overcome barriers. Obtaining staff feedback is critical to ensure health service change is sustainable, meaningful and achieves its promise of improving patient outcomes. TRIAL REGISTRATION The study was registered prospectively with the ANZCTR on 22/3/2017. Trial ID ACTRN12617000411347.
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Affiliation(s)
- Phyllis Butow
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, NSW, 2006, Australia
| | - Heather L Shepherd
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, NSW, 2006, Australia.
| | - Jessica Cuddy
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, NSW, 2006, Australia
| | - Nicole Rankin
- The University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Marnie Harris
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, NSW, 2006, Australia
| | - Sharon He
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, NSW, 2006, Australia
| | | | - Afaf Girgis
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Kensington, Australia
| | - Mona Faris
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, NSW, 2006, Australia
| | - Joanne Shaw
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, NSW, 2006, Australia
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Frohlich JR, Rapinda KK, Schaub MP, Wenger A, Baumgartner C, Johnson EA, O'Connor RM, Vincent N, Blankers M, Ebert DD, Hadjistavropoulos HD, Mackenzie CS, Wardell JD, Augsburger M, Goldberg JO, Keough MT. Efficacy of a minimally guided internet treatment for alcohol misuse and emotional problems in young adults: Results of a randomized controlled trial. Addict Behav Rep 2021; 14:100390. [PMID: 34938848 PMCID: PMC8664864 DOI: 10.1016/j.abrep.2021.100390] [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: 05/31/2021] [Revised: 10/16/2021] [Accepted: 10/28/2021] [Indexed: 11/30/2022] Open
Abstract
Cognitive-behavioural therapy (CBT) and motivational interviewing (MI) can be readily adapted for brief, minimally guided, online interventions. Minimally guided online treatment is beneficial for hazardous drinking, mood difficulties, and quality of life in the short-term among young adults. Strategies designed to increase treatment engagement will likely mitigate the risk of attrition in future programs. Future versions of the Take Care of Me program are still needed to determine long-term effects and differential responses to treatment.
Many young adults struggle with comorbid alcohol misuse and emotional problems (i.e., depression and anxiety). However, there is currently a paucity of evidence-based, integrated, accessible treatment options for individuals with these comorbidities. The main goal of this study was to examine efficacy of a novel online, minimally guided, integrated program for comorbid alcohol misuse and emotional problems in young adults. Method: The study was an open-label two-arm RCT. Participants (N = 222, Mage = 24.6, 67.6% female) were randomized to one of two conditions: the Take Care of Me program (an 8-week, online integrated treatment condition consisting of 12 modules), or an online psychoeducational control condition. Intervention modules incorporated content based on principles of cognitive behavioral therapy and motivational interviewing. Participants completed assessment data at baseline, at the end of treatment (i.e., 8 weeks), and at follow-up (i.e., 24 weeks). Data were analyzed using generalized linear mixed models. Results: We observed that participants in the treatment condition showed larger reductions in depression, hazardous drinking, as well as increases in psychological quality of life and confidence at the end of treatment. We did not find group differences on total alcohol use at follow-up, but participants in the treatment group reduced their hazardous drinking and improved their quality of life at 24-week follow-up. Conclusions: Our study provides promising initial evidence for the first iteration of the comorbid alcohol misuse and emotional problems online program.
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Affiliation(s)
- Jona R Frohlich
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Karli K Rapinda
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Andreas Wenger
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Christian Baumgartner
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Edward A Johnson
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Roisin M O'Connor
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Norah Vincent
- Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Matthijs Blankers
- Arkin Mental Health Care, University of Amsterdam, Amsterdam, Netherlands.,Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands.,Academic Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, Netherlands
| | - David D Ebert
- Department of eMental Health, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Corey S Mackenzie
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Jeffrey D Wardell
- Department of Psychology, York University, Toronto, ON, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Mareike Augsburger
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Joel O Goldberg
- Department of Psychology, York University, Toronto, ON, Canada
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Goodmann DR, Daouk S, Sullivan M, Cabrera J, Liu NH, Barakat S, Muñoz RF, Leykin Y. Factor analysis of depression symptoms across five broad cultural groups. J Affect Disord 2021; 282:227-235. [PMID: 33418371 DOI: 10.1016/j.jad.2020.12.159] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 11/24/2020] [Accepted: 12/24/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Core symptoms of depression are likely universal, however cultural groups differ in their experience of the condition. The purpose of this study was to examine differences and similarities of depression symptom groupings between broad cultural groups. METHOD 6,982 adults took part in an online multilingual depression screening study, and completed an 18-item major depression screener. Participants were categorized into five broad cultural groups by language and country of residence: Spanish speakers from Latin America (n = 3,411); English speakers from Southeast Asia (n = 1,265); Russian speakers from the former Soviet bloc (n = 642); English speakers from English-speaking Western countries (n = 999); and Chinese speakers from China (n = 665). Principal components analysis with promax rotation was used. RESULTS Both similarities and noteworthy differences in symptom clustering between groups were observed. For instance, though suicide-related items formed a separate cluster for most cultures, for the Latin-American group, worthlessness loaded with suicidality. Changes in appetite and changes in weight tended to load on different factors (except for Chinese and Russian groups). Hypersomnia tended to load with psychomotor agitation, and core depression symptoms tended to load with physical symptoms (except for the Russian group). LIMITATIONS Depression was assessed by a self-report measure aligned to DSM-IV. CONCLUSION The analysis contributes to a nuanced understanding of depression manifestations of various cultures, which may inform culturally sensitive clinical practice.
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Affiliation(s)
- Danielle R Goodmann
- Palo Alto University, 1791 Arastradero Rd, Palo Alto, CA 94304, United States
| | - Sariah Daouk
- Palo Alto University, 1791 Arastradero Rd, Palo Alto, CA 94304, United States
| | - Megan Sullivan
- Palo Alto University, 1791 Arastradero Rd, Palo Alto, CA 94304, United States
| | | | | | | | - Ricardo F Muñoz
- Palo Alto University, 1791 Arastradero Rd, Palo Alto, CA 94304, United States; University of California, San Francisco
| | - Yan Leykin
- Palo Alto University, 1791 Arastradero Rd, Palo Alto, CA 94304, United States; University of California, San Francisco.
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Herrera L, Markle SL, Fukuda M, Aroca P, Villar A, Wang Y, Dominique G, Umoren O, Alegría M. Predictors of Research Assessment Completion in a Latino Sample with Dual Disorders. J Immigr Minor Health 2020; 22:1094-1100. [PMID: 32347414 DOI: 10.1007/s10903-020-01010-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Latinos are underrepresented in clinical trials, where they encounter challenges in participation and a lack of effective recruitment and retention strategies. For Latino migrants with mental health and substance use problems, these challenges are even greater. Analyzing results from a multicenter randomized clinical trial for Latino migrants with mental health and substance use problems in Boston, Massachusetts, USA as well as Madrid and Barcelona, Spain, we describe six retention strategies used to facilitate participant engagement in follow-up assessments, and report the sociodemographic, clinical, and educational factors associated with research assessment completion. Among 341 randomized participants, 77% completed the 12-month follow-up and 75% completed at least 3 of the 4 follow-up assessments. Having a high school diploma, being recruited at community centers versus other sites, and having a less severe mental health condition were significantly associated with completing more follow-up interviews. Rigorous and customized methods reflecting participant's individual context can bolster research assessment completion for diverse Latino populations with behavioral health concerns.
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Affiliation(s)
- Lizbeth Herrera
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA
| | - Sheri Lapatin Markle
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA
| | - Marie Fukuda
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA
| | - Paloma Aroca
- Department of Psychiatry, Instituto de Investigación Sanitaria, Fundación Jiménez Díaz, Madrid, Spain
| | - Ana Villar
- Department of Psychiatry, Hospital Universitari Vall D'Hebron, Barcelona, Spain
| | - Ye Wang
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA
| | - Georgina Dominique
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA
| | - Olivia Umoren
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA. .,Departments of Medicine and Psychiatry, Harvard Medical School, Boston, MA, USA.
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Hassem T, Laher S. A systematic review of online depression screening tools for use in the South African context. S Afr J Psychiatr 2019; 25:1373. [PMID: 31824743 PMCID: PMC6890541 DOI: 10.4102/sajpsychiatry.v25i0.1373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 06/21/2019] [Indexed: 11/01/2022] Open
Abstract
Background According to the World Health Organization, the alarming increase in rates of depression globally has become a serious concern. In 2010, the prevalence rate of depression in South Africa was 4.6%. Given the context of South Africa where the majority of the population have limited access to healthcare facilities and 59.3% of the population have access to the Internet, an online depression screening tool would have much to offer. Objective To determine whether online depression screening tools would be suitable for use in South Africa. Methods This study presents a systematic review of online depression screening tools to determine whether one would be suitable for use in South Africa. Articles were accessed from seven electronic databases from 1970 to 2018. All articles included in the review were critically appraised. Results A total of 17 articles met the inclusion criteria. From the results, there was only one screening tool available on an open access platform for use by the general population. The most common depression online screening tools were the Beck Depression Inventory-II (BDI-II), the Center for Epidemiology Studies Depression Scale (CES-D) and the Patient Health Questionnaire (PHQ-9). It was also evident that there were negligible differences in the psychometric properties of online versus paper versions of the online screening tools. Furthermore, there were very few studies that considered the African or South African population and no online screening tools for major depressive disorder (MDD) developed in these contexts. Conclusion There appears to be a need for a depression screening tool to be adapted for online usage in South Africa. It is recommended that the online screening tool should be adapted from the three commonly used online depression screening tools: PHQ-9, CES-D and BDI-II.
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Affiliation(s)
- Tasneem Hassem
- Department of Psychology, University of the Witwatersrand, Johannesburg, South Africa
| | - Sumaya Laher
- Department of Psychology, University of the Witwatersrand, Johannesburg, South Africa
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Hatch A, Hoffman JE, Ross R, Docherty JP. Expert Consensus Survey on Digital Health Tools for Patients With Serious Mental Illness: Optimizing for User Characteristics and User Support. JMIR Ment Health 2018; 5:e46. [PMID: 29895514 PMCID: PMC6019847 DOI: 10.2196/mental.9777] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/27/2018] [Accepted: 04/29/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Digital technology is increasingly being used to enhance health care in various areas of medicine. In the area of serious mental illness, it is important to understand the special characteristics of target users that may influence motivation and competence to use digital health tools, as well as the resources and training necessary for these patients to facilitate the use of this technology. OBJECTIVE The aim of this study was to conduct a quantitative expert consensus survey to identify key characteristics of target users (patients and health care professionals), barriers and facilitators for appropriate use, and resources needed to optimize the use of digital health tools in patients with serious mental illness. METHODS A panel of 40 experts in digital behavioral health who met the participation criteria completed a 19-question survey, rating predefined responses on a 9-point Likert scale. Consensus was determined using a chi-square test of score distributions across three ranges (1-3, 4-6, 7-9). Categorical ratings of first, second, or third line were designated based on the lowest category into which the CI of the mean ratings fell, with a boundary >6.5 for first line. Here, we report experts' responses to nine questions (265 options) that focused on (1) user characteristics that would promote or hinder the use of digital health tools, (2) potential benefits or motivators and barriers or unintended consequences of digital health tool use, and (3) support and training for patients and health care professionals. RESULTS Among patient characteristics most likely to promote use of digital health tools, experts endorsed interest in using state-of-the-art technology, availability of necessary resources, good occupational functioning, and perception of the tool as beneficial. Certain disease-associated signs and symptoms (eg, more severe symptoms, substance abuse problems, and a chaotic living situation) were considered likely to make it difficult for patients to use digital health tools. Enthusiasm among health care professionals for digital health tools and availability of staff and equipment to support their use were identified as variables to enable health care professionals to successfully incorporate digital health tools into their practices. The experts identified a number of potential benefits of and barriers to use of digital health tools by patients and health care professionals. Experts agreed that both health care professionals and patients would need to be trained in the use of these new technologies. CONCLUSIONS These results provide guidance to the mental health field on how to optimize the development and deployment of digital health tools for patients with serious mental illness.
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Affiliation(s)
- Ainslie Hatch
- Otsuka America Pharmaceutical, Inc, Princeton, NJ, United States
| | | | - Ruth Ross
- Ross Editorial, Port Townsend, WA, United States
| | - John P Docherty
- Otsuka America Pharmaceutical, Inc, Princeton, NJ, United States
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Choi I, Milne DN, Deady M, Calvo RA, Harvey SB, Glozier N. Impact of Mental Health Screening on Promoting Immediate Online Help-Seeking: Randomized Trial Comparing Normative Versus Humor-Driven Feedback. JMIR Ment Health 2018; 5:e26. [PMID: 29622528 PMCID: PMC5938694 DOI: 10.2196/mental.9480] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/14/2018] [Accepted: 02/19/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Given the widespread availability of mental health screening apps, providing personalized feedback may encourage people at high risk to seek help to manage their symptoms. While apps typically provide personal score feedback only, feedback types that are user-friendly and increase personal relevance may encourage further help-seeking. OBJECTIVE The aim of this study was to compare the effects of providing normative and humor-driven feedback on immediate online help-seeking, defined as clicking on a link to an external resource, and to explore demographic predictors that encourage help-seeking. METHODS An online sample of 549 adults were recruited using social media advertisements. Participants downloaded a smartphone app known as "Mindgauge" which allowed them to screen their mental wellbeing by completing standardized measures on Symptoms (Kessler 6-item Scale), Wellbeing (World Health Organization [Five] Wellbeing Index), and Resilience (Brief Resilience Scale). Participants were randomized to receive normative feedback that compared their scores to a reference group or humor-driven feedback that presented their scores in a relaxed manner. Those who scored in the moderate or poor ranges in any measure were encouraged to seek help by clicking on a link to an external online resource. RESULTS A total of 318 participants scored poorly on one or more measures and were provided with an external link after being randomized to receive normative or humor-driven feedback. There was no significant difference of feedback type on clicking on the external link across all measures. A larger proportion of participants from the Wellbeing measure (170/274, 62.0%) clicked on the links than the Resilience (47/179, 26.3%) or Symptoms (26/75, 34.7%) measures (χ2=60.35, P<.001). There were no significant demographic factors associated with help-seeking for the Resilience or Wellbeing measures. Participants with a previous episode of poor mental health were less likely than those without such history to click on the external link in the Symptoms measure (P=.003, odds ratio [OR] 0.83, 95% CI 0.02-0.44), and younger adults were less likely to click on the link compared to older adults across all measures (P=.005, OR 0.44, 95% CI 0.25-0.78). CONCLUSIONS This pilot study found that there was no difference between normative and humor-driven feedback on promoting immediate clicks to an external resource, suggesting no impact on online help-seeking. Limitations included: lack of personal score control group, limited measures of predictors and potential confounders, and the fact that other forms of professional help-seeking were not assessed. Further investigation into other predictors and factors that impact on help-seeking is needed. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12616000707460; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=370187 (Archived by WebCite at http://www.webcitation.org/6y8m8sVxr).
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Affiliation(s)
- Isabella Choi
- Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
| | - David N Milne
- Faculty of Engineering and Information Technologies, University of Technology Sydney, Sydney, Australia.,Wellbeing Technology Lab, School of Electrical and Information Engineering, The University of Sydney, Sydney, Australia
| | - Mark Deady
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Rafael A Calvo
- Wellbeing Technology Lab, School of Electrical and Information Engineering, The University of Sydney, Sydney, Australia
| | - Samuel B Harvey
- Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Nick Glozier
- Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
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Cronly J, Duff AJ, Riekert KA, Perry IJ, Fitzgerald AP, Horgan A, Lehane E, Howe B, Ni Chroinin M, Savage E. Online versus paper-based screening for depression and anxiety in adults with cystic fibrosis in Ireland: a cross-sectional exploratory study. BMJ Open 2018; 8:e019305. [PMID: 29358445 PMCID: PMC5781152 DOI: 10.1136/bmjopen-2017-019305] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To compare online and paper-based screening for depression and anxiety in adults with cystic fibrosis (CF). DESIGN AND SETTING Cross-sectional study in CF clinics in Ireland and through the Cystic Fibrosis Ireland online community. PARTICIPANTS 160 adult patients aged 18 or above were recruited. Of these, 147 were included in the analysis; 83 online and 64 paper-based. The remaining 13 were excluded because of incomplete data. MEASURES Depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). Data on pulmonary function (forced expiratory volume in 1 s %) and body mass index were self-reported based on clinical assessments. Sociodemographic data were collected. RESULTS Compared with the paper-based participants, the online participants were more likely to be female (61.7% vs 48.4%), older (mean 32.2 vs 28.2 years) and were more likely to be married (32.5% vs 15.6%), living with their spouse or partner (42.5% vs 22.6%) and working either full time (33.7% vs 15.9%) or part time (30.1%vs 17.5%). The prevalence rates of elevated anxiety and depression were not significantly different (P=0.71 and P=0.56). HADS anxiety and depression scores were not statistically different between online (P=0.83) and paper-based (P=0.92) participants based on Mann-Whitney U test. A significant negative correlation was found between depression and pulmonary function (r=-0.39, P=0.01) and anxiety and pulmonary function (r=-0.36, P=0.02). Based on Cronbach's alpha, there were no statistically significant differences between the online and paper-based participants on the internal consistency of the HADS anxiety (P=0.073) and depression (P=0.378) scales. CONCLUSIONS Our findings suggest that online and paper-based screening for depression and anxiety in adult patients with CF yield comparable findings on prevalence rates and scores, associations with health and internal consistency of subscales. This study highlights that online screening offers an alternative method to paper-based screening. Further research with a larger sample and assessment of measurement equivalence between online and paper based screening is needed to confirm our results.
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Affiliation(s)
- Jennifer Cronly
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - Alistair J Duff
- Department of Clinical Psychology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kristin A Riekert
- School of Medicine, John Hopkins University, Baltimore, Maryland, USA
| | - Ivan J Perry
- School of Epidemiology and Public Health, Western Gateway Building, University College Cork, Cork, Ireland
| | - Anthony P Fitzgerald
- School of Epidemiology and Public Health, Western Gateway Building, University College Cork, Cork, Ireland
- Department of Statistics, Western Gateway Building, University College Cork, Cork, Ireland
| | - Aine Horgan
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - Elaine Lehane
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - Barbara Howe
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | | | - Eileen Savage
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
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Rübsamen N, Akmatov MK, Castell S, Karch A, Mikolajczyk RT. Factors associated with attrition in a longitudinal online study: results from the HaBIDS panel. BMC Med Res Methodol 2017; 17:132. [PMID: 28859617 PMCID: PMC5580321 DOI: 10.1186/s12874-017-0408-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 08/21/2017] [Indexed: 11/10/2022] Open
Abstract
Background Knowing about predictors of attrition in a panel is important to initiate early measures against loss of participants. We investigated attrition in both early and late phase of an online panel with special focus on preferences regarding mode of participation. Methods We used data from the HaBIDS panel that was designed to investigate knowledge, attitudes, and practice regarding infections in the German general population. HaBIDS was divided into two phases: an initial phase when some participants could choose their preferred mode of participation (paper-and-pencil or online) and an extended phase when participants were asked to become members of an online panel that was not limited regarding its duration (i.e. participants initially preferring paper questionnaires switched to online participation). Using competing risks regression, we investigated two types of attrition (formal withdrawal and discontinuation without withdrawal) among online participants, separately for both phases. As potential predictors of attrition, we considered sociodemographic characteristics, physical and mental health as well as auxiliary information describing the survey process, and, in the extended phase, initial mode preference. Results In the initial phase, higher age and less frequent Internet usage predicted withdrawal, while younger age, higher stress levels, delay in returning the consent form, and need for receiving reminder emails predicted discontinuation. In the extended phase, only need for receiving reminder emails predicted discontinuation. Numbers of withdrawal in the extended phase were too small for analysis. Initial mode preference did not predict attrition in the extended phase. Besides age, there was no evidence of differential attrition by sociodemographic factors in any phase. Conclusions Predictors of attrition were similar in both phases of the panel, but they differed by type of attrition (withdrawal vs. discontinuation). Sociodemographic characteristics only played a minor role for both types of attrition. Need for receiving a reminder was the strongest predictor of discontinuation in any phase, but no predictor of withdrawal. We found predictors of attrition, which can be identified already in the early phase of a panel so that countermeasures (e.g. special incentives) can be taken. Electronic supplementary material The online version of this article (10.1186/s12874-017-0408-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicole Rübsamen
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Inhoffenstraße 7, 38124, Braunschweig, Germany.,PhD Programme "Epidemiology", Braunschweig-Hannover, Germany
| | - Manas K Akmatov
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Inhoffenstraße 7, 38124, Braunschweig, Germany.,AG "Biomarkers for Infectious Diseases", TWINCORE, Centre for Experimental and Clinical Infection Research, Feodor-Lynen-Str. 7, 30625, Hannover, Germany.,Centre for Individualized Infection Medicine, Hannover, Germany
| | - Stefanie Castell
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Inhoffenstraße 7, 38124, Braunschweig, Germany.,AG "Biomarkers for Infectious Diseases", TWINCORE, Centre for Experimental and Clinical Infection Research, Feodor-Lynen-Str. 7, 30625, Hannover, Germany
| | - André Karch
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Inhoffenstraße 7, 38124, Braunschweig, Germany.,PhD Programme "Epidemiology", Braunschweig-Hannover, Germany
| | - Rafael T Mikolajczyk
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Inhoffenstraße 7, 38124, Braunschweig, Germany. .,Hannover Medical School, Hannover, Germany. .,Institute for Medical Epidemiology, Biometry, and Informatics (IMEBI), Medical Faculty of the Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06110, Halle (Saale), Germany.
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11
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Norr AM, Gibby BA, Fuller KL, Portero AK, Schmidt NB. Online Dissemination of the Cognitive Anxiety Sensitivity Treatment (CAST) Using Craigslist: A Pilot Study. COGNITIVE THERAPY AND RESEARCH 2017. [DOI: 10.1007/s10608-017-9834-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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van Mierlo T, Hyatt D, Ching AT, Fournier R, Dembo RS. Behavioral Economics, Wearable Devices, and Cooperative Games: Results From a Population-Based Intervention to Increase Physical Activity. JMIR Serious Games 2016; 4:e1. [PMID: 26821955 PMCID: PMC4751337 DOI: 10.2196/games.5358] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 12/11/2015] [Accepted: 01/03/2016] [Indexed: 01/17/2023] Open
Abstract
Background Health care literature supports the development of accessible interventions that integrate behavioral economics, wearable devices, principles of evidence-based behavior change, and community support. However, there are limited real-world examples of large scale, population-based, member-driven reward platforms. Subsequently, a paucity of outcome data exists and health economic effects remain largely theoretical. To complicate matters, an emerging area of research is defining the role of Superusers, the small percentage of unusually engaged digital health participants who may influence other members. Objective The objective of this preliminary study is to analyze descriptive data from GOODcoins, a self-guided, free-to-consumer engagement and rewards platform incentivizing walking, running and cycling. Registered members accessed the GOODcoins platform through PCs, tablets or mobile devices, and had the opportunity to sync wearables to track activity. Following registration, members were encouraged to join gamified group challenges and compare their progress with that of others. As members met challenge targets, they were rewarded with GOODcoins, which could be redeemed for planet- or people-friendly products. Methods Outcome data were obtained from the GOODcoins custom SQL database. The reporting period was December 1, 2014 to May 1, 2015. Descriptive self-report data were analyzed using MySQL and MS Excel. Results The study period includes data from 1298 users who were connected to an exercise tracking device. Females consisted of 52.6% (n=683) of the study population, 33.7% (n=438) were between the ages of 20-29, and 24.8% (n=322) were between the ages of 30-39. 77.5% (n=1006) of connected and active members met daily-recommended physical activity guidelines of 30 minutes, with a total daily average activity of 107 minutes (95% CI 90, 124). Of all connected and active users, 96.1% (n=1248) listed walking as their primary activity. For members who exchanged GOODcoins, the mean balance was 4,000 (95% CI 3850, 4150) at time of redemption, and 50.4% (n=61) of exchanges were for fitness or outdoor products, while 4.1% (n=5) were for food-related items. Participants were most likely to complete challenges when rewards were between 201-300 GOODcoins. Conclusions The purpose of this study is to form a baseline for future research. Overall, results indicate that challenges and incentives may be effective for connected and active members, and may play a role in achieving daily-recommended activity guidelines. Registrants were typically younger, walking was the primary activity, and rewards were mainly exchanged for fitness or outdoor products. Remaining to be determined is whether members were already physically active at time of registration and are representative of healthy adherers, or were previously inactive and were incentivized to change their behavior. As challenges are gamified, there is an opportunity to investigate the role of superusers and healthy adherers, impacts on behavioral norms, and how cooperative games and incentives can be leveraged across stratified populations. Study limitations and future research agendas are discussed.
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13
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Batterham PJ, Calear AL, Sunderland M, Carragher N, Brewer JL. Online screening and feedback to increase help-seeking for mental health problems: population-based randomised controlled trial. BJPsych Open 2016; 2:67-73. [PMID: 27703756 PMCID: PMC4995576 DOI: 10.1192/bjpo.bp.115.001552] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 12/13/2015] [Accepted: 12/14/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Community-based screening for mental health problems may increase service use through feedback to individuals about their severity of symptoms and provision of contacts for appropriate services. AIMS The effect of symptom feedback on service use was assessed. Secondary outcomes included symptom change and study attrition. METHOD Using online recruitment, 2773 participants completed a comprehensive survey including screening for depression (n=1366) or social anxiety (n=1407). Across these two versions, approximately half (n=1342) of the participants were then randomly allocated to receive tailored feedback. Participants were reassessed after 3 months (Australian New Zealand Clinical Trials Registry ANZCTR12614000324617). RESULTS A negative effect of providing social anxiety feedback to individuals was observed, with significant reductions in professional service use. Greater attrition and lower intentions to seek help were also observed after feedback. CONCLUSIONS Online mental health screening with feedback is not effective for promoting professional service use. Alternative models of online screening require further investigation. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
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Affiliation(s)
| | - Alison L. Calear
- Alison L. Calear, BAppPsych (Hons), PhD, National Institute for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | | | - Natacha Carragher
- Natacha Carragher, BSc (Hons) Applied Psych, PhD, NHMRC Centre of Research Excellence in Mental Health and Substance Use, University of New South Wales, Sydney, Australia
| | - Jacqueline L. Brewer
- Jacqueline L. Brewer, BPsych (Hons), PhD, National Institute for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
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14
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Weßlau C, Cloos M, Höfling V, Steil R. Visual mental imagery and symptoms of depression - results from a large-scale web-based study. BMC Psychiatry 2015; 15:308. [PMID: 26631081 PMCID: PMC4668647 DOI: 10.1186/s12888-015-0689-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 11/24/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Mental imagery may influence the onset and maintenance of depression, but specific mechanisms have not yet been determined. METHODS Nine hundred twelve participants completed questionnaires on positive and negative mental images, as well as images of injury and death that lead to positive emotions ("ID-images"), and depressive symptomatology. The assessment was carried out online to reduce effects of social desirability. RESULTS Positive images were reported by 87 % of the sample, negative images by 77 %. ID-images were present in one-third of the sample. A connection with depression severity was found for the absence of positive mental images and the presence of negative images as well as ID-images. Higher depression scores were associated with more frequent and vivid negative images, greater imagery distress, and a higher proportion of negative relative to positive images. CONCLUSIONS Mental images are clearly related to depression. Future research should focus on ID-images and their connection to suicide-risk in depressed patients.
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Affiliation(s)
- Charlotte Weßlau
- Department of Clinical Psychology and Intervention, Institute of Psychology, Goethe University Frankfurt, P.O. Box 11 19 32-120, 60054, Frankfurt Main, Germany.
| | - Marie Cloos
- Department of Clinical Psychology and Intervention, Institute of Psychology, Goethe University Frankfurt, P.O. Box 11 19 32-120, 60054, Frankfurt Main, Germany.
| | - Volkmar Höfling
- Department of Clinical Psychology and Intervention, Institute of Psychology, Goethe University Frankfurt, P.O. Box 11 19 32-120, 60054, Frankfurt Main, Germany.
| | - Regina Steil
- Department of Clinical Psychology and Intervention, Institute of Psychology, Goethe University Frankfurt, P.O. Box 11 19 32-120, 60054, Frankfurt Main, Germany.
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Avis JLS, Holt NL, Maximova K, van Mierlo T, Fournier R, Padwal R, Cave AL, Martz P, Ball GDC. The Development and Refinement of an e-Health Screening, Brief Intervention, and Referral to Treatment for Parents to Prevent Childhood Obesity in Primary Care. Telemed J E Health 2015; 22:385-94. [PMID: 26451901 DOI: 10.1089/tmj.2015.0128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Nearly one-third of Canadian children can be categorized as overweight or obese. There is a growing interest in applying e-health approaches to prevent unhealthy weight gain in children, especially in settings that families access regularly. Our objective was to develop and refine an e-health screening, brief intervention, and referral to treatment (SBIRT) for parents to help prevent childhood obesity in primary care. MATERIALS AND METHODS Our SBIRT, titled the Resource Information Program for Parents on Lifestyle and Education (RIPPLE), was developed by our research team and an e-health intervention development company. RIPPLE was based on existing SBIRT models and contemporary literature on children's lifestyle behaviors. Refinements to RIPPLE were guided by feedback from five focus groups (6-10 participants per group) that documented perceptions of the SBIRT by participants (healthcare professionals [n = 20], parents [n = 10], and researchers and graduate trainees [n = 8]). Focus group commentaries were transcribed in real time using a court reporter. Data were analyzed thematically. RESULTS Participants viewed RIPPLE as a practical, well-designed, and novel tool to facilitate the prevention of childhood obesity in primary care. However, they also perceived that RIPPLE may elicit negative reactions from some parents and suggested improvements to specific elements (e.g., weight-related terms). CONCLUSIONS RIPPLE may enhance parents' awareness of children's weight status and motivation to change their children's lifestyle behaviors but should be improved prior to implementation. Findings from this research directly informed revisions to our SBIRT, which will undergo preliminary testing in a randomized controlled trial.
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Affiliation(s)
- Jillian L S Avis
- 1 Department of Pediatrics, University of Alberta , Edmonton, Alberta, Canada
| | - Nicholas L Holt
- 2 Faculty of Physical Education and Recreation, University of Alberta , Edmonton, Alberta, Canada
| | - Katerina Maximova
- 3 School of Public Health, University of Alberta , Edmonton, Alberta, Canada
| | - Trevor van Mierlo
- 4 Evolution Health Systems Inc., Toronto, Ontario, Canada .,5 Business School, University of Reading, Oxfordshire, United Kingdom
| | - Rachel Fournier
- 4 Evolution Health Systems Inc., Toronto, Ontario, Canada .,5 Business School, University of Reading, Oxfordshire, United Kingdom
| | - Raj Padwal
- 6 Department of Medicine, University of Alberta , Edmonton, Alberta, Canada
| | - Andrew L Cave
- 7 Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta , Edmonton, Alberta, Canada
| | - Patricia Martz
- 8 Public Health and Wellness Branch , Health Services Division, Ministry of Health, Government of Alberta, Edmonton, Alberta, Canada
| | - Geoff D C Ball
- 1 Department of Pediatrics, University of Alberta , Edmonton, Alberta, Canada .,9 Pediatric Centre for Weight and Health, Stollery Children's Hospital , Edmonton, Alberta, Canada
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16
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van Mierlo T, Fournier R, Ingham M. Targeting Medication Non-Adherence Behavior in Selected Autoimmune Diseases: A Systematic Approach to Digital Health Program Development. PLoS One 2015; 10:e0129364. [PMID: 26107637 PMCID: PMC4481109 DOI: 10.1371/journal.pone.0129364] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 05/07/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND 29 autoimmune diseases, including Rheumatoid Arthritis, gout, Crohn's Disease, and Systematic Lupus Erythematosus affect 7.6-9.4% of the population. While effective therapy is available, many patients do not follow treatment or use medications as directed. Digital health and Web 2.0 interventions have demonstrated much promise in increasing medication and treatment adherence, but to date many Internet tools have proven disappointing. In fact, most digital interventions continue to suffer from high attrition in patient populations, are burdensome for healthcare professionals, and have relatively short life spans. OBJECTIVE Digital health tools have traditionally centered on the transformation of existing interventions (such as diaries, trackers, stage-based or cognitive behavioral therapy programs, coupons, or symptom checklists) to electronic format. Advanced digital interventions have also incorporated attributes of Web 2.0 such as social networking, text messaging, and the use of video. Despite these efforts, there has not been little measurable impact in non-adherence for illnesses that require medical interventions, and research must look to other strategies or development methodologies. As a first step in investigating the feasibility of developing such a tool, the objective of the current study is to systematically rate factors of non-adherence that have been reported in past research studies. METHODS Grounded Theory, recognized as a rigorous method that facilitates the emergence of new themes through systematic analysis, data collection and coding, was used to analyze quantitative, qualitative and mixed method studies addressing the following autoimmune diseases: Rheumatoid Arthritis, gout, Crohn's Disease, Systematic Lupus Erythematosus, and inflammatory bowel disease. Studies were only included if they contained primary data addressing the relationship with non-adherence. RESULTS Out of the 27 studies, four non-modifiable and 11 modifiable risk factors were discovered. Over one third of articles identified the following risk factors as common contributors to medication non-adherence (percent of studies reporting): patients not understanding treatment (44%), side effects (41%), age (37%), dose regimen (33%), and perceived medication ineffectiveness (33%). An unanticipated finding that emerged was the need for risk stratification tools (81%) with patient-centric approaches (67%). CONCLUSIONS This study systematically identifies and categorizes medication non-adherence risk factors in select autoimmune diseases. Findings indicate that patients understanding of their disease and the role of medication are paramount. An unexpected finding was that the majority of research articles called for the creation of tailored, patient-centric interventions that dispel personal misconceptions about disease, pharmacotherapy, and how the body responds to treatment. To our knowledge, these interventions do not yet exist in digital format. Rather than adopting a systems level approach, digital health programs should focus on cohorts with heterogeneous needs, and develop tailored interventions based on individual non-adherence patterns.
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Affiliation(s)
- Trevor van Mierlo
- Evolution Health Systems Inc., 1266 Queen Street West, Suite 8, Toronto, Ontario, M6K 1L3, Canada
- Research Associate, Henley Business School, University of Reading, Greenlands, Henley-on-Thames, Oxfordshire, RG9 3AU, United Kingdom
| | - Rachel Fournier
- Evolution Health Systems Inc., 1266 Queen Street West, Suite 8, Toronto, Ontario, M6K 1L3, Canada
- Research Associate, Henley Business School, University of Reading, Greenlands, Henley-on-Thames, Oxfordshire, RG9 3AU, United Kingdom
| | - Michael Ingham
- Janssen Scientific Affairs LLC, 850 Ridgeview Dr., Horsham, Pennsylvania, 19044, United States of America
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