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Lo B, Teferi B, Wong HW, Abi-Jaoude A, Chopra J, Charow R, Zhang M, Shi J, Johnson A, Levinson A, Cleverley K, Henderson J, Voineskos A, Wiljer D. Enhancing the value of digital health tools for mental health help-seeking in Canadian transitional aged youth during the pandemic: Qualitative study. Int J Med Inform 2024; 182:105299. [PMID: 38061186 DOI: 10.1016/j.ijmedinf.2023.105299] [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: 06/06/2023] [Revised: 11/03/2023] [Accepted: 11/14/2023] [Indexed: 01/07/2024]
Abstract
While the COVID-19 pandemic has greatly exacerbated the mental health challenges of transition-aged youth (TAY) between 17 and 29 years old, it has also led to the rapid adoption of digital tools for mental health help-seeking and treatment. However, to date, there has been limited work focusing on how this shift has impacted perceptions, needs and challenges of this population in using digital tools. The current study aims to understand their perspectives on mental health help-seeking during the pandemic and emerging issues related to digital tools (e.g., digital health equity, inclusivity). A total of 16 TAY were invited from three post-secondary institutions in the Greater Toronto Area. A total of two streams of focus groups were held and participants were invited to share their perceptions, needs and experiences. Five main themes were identified: 1) Helpfulness of a centralized resource encompassing a variety of diverse mental health supports help-seeking; 2) The impact of the shift to online mental health support on the use of informal supports; 3) Digital tool affordability and availability; 4) Importance of inclusivity for digital tools; and 5) Need for additional support for mental health seeking and digital tool navigation. Future work should examine how these needs can be addressed through new and existing digital mental health help-seeking tools for TAY.
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Affiliation(s)
- Brian Lo
- Office of Education, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario M5T 3M7, Canada; Information Management Group, Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, Ontario M6J 1H4, Canada.
| | - Bemnet Teferi
- Office of Education, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada; Dalla Lana School of Public Health, 155 College St, Toronto, Ontario M5T 3M7, Canada.
| | - Howard W Wong
- Office of Education, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada.
| | - Alexxa Abi-Jaoude
- Office of Education, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada.
| | - Jasmine Chopra
- Office of Education, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada.
| | - Rebecca Charow
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario M5T 3M7, Canada; UHN Digital, University Health Network, 190 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
| | - Melody Zhang
- UHN Digital, University Health Network, 190 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
| | - Jenny Shi
- Office of Education, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada.
| | - Andrew Johnson
- Office of Education, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada.
| | - Andrea Levinson
- Health and Wellness, University of Toronto, 700 Bay Street, Toronto, ON M5G 1Z6, Canada; Department of Psychiatry, Temerty Faculty of Medicine, 1 King's College Cir, Toronto, Ontario M5S 1A8, Canada.
| | - Kristin Cleverley
- Department of Psychiatry, Temerty Faculty of Medicine, 1 King's College Cir, Toronto, Ontario M5S 1A8, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St, Toronto, Ontario M5T 3M7, Canada; Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, Ontario M6J 1H4, Canada.
| | - Jo Henderson
- Department of Psychiatry, Temerty Faculty of Medicine, 1 King's College Cir, Toronto, Ontario M5S 1A8, Canada; Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, Ontario M6J 1H4, Canada.
| | - Aristotle Voineskos
- Department of Psychiatry, Temerty Faculty of Medicine, 1 King's College Cir, Toronto, Ontario M5S 1A8, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, Ontario, M6J 1H4, Canada.
| | - David Wiljer
- Office of Education, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario M5T 3M7, Canada; Department of Psychiatry, Temerty Faculty of Medicine, 1 King's College Cir, Toronto, Ontario M5S 1A8, Canada; UHN Digital, University Health Network, 190 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
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Nahas C, Gandit M, Quillion-Dupré L, Monfort E. How to engage patients in computerized cognitive training: a cognitive rehabilitation expert's perspective. Disabil Rehabil Assist Technol 2023:1-13. [PMID: 37994038 DOI: 10.1080/17483107.2023.2284879] [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: 05/31/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE The relationship between a patient and their therapist plays a crucial role in patient engagement. While Computerized Cognitive Training (CCT) may assist in preserving cognitive skills in cases of aging, dementia or acquired brain injuries, its effectiveness has not been definitively proven. Improving user engagement, acceptance, and software usability could aid in addressing this issue. The present study aims to identify potential obstacles and facilitators by examining the perspectives of rehabilitation professionals on the current usage of CCT software. METHODS Semi-structured interviews were conducted with 16 rehabilitation professionals, familiar with a CCT software. The data were transcribed and followed by an independent iterative thematic analysis. RESULTS Two major themes were identified: (1) facilitating factors and (2) difficulties related to use. The main obstacles were difficulties related to the computerized nature of the exercises, technology use, understanding the software and general learning difficulties. The main facilitators were the ecological and novel nature of the exercises, and the adaptability of the difficulty levels. CONCLUSION The complexity of the CCT presents challenges for its usage by rehabilitation professionals, which in turn can impede patient utilization as well. To address this issue and promote sustainable use of the software, providing instruction delivery to facilitate learning and understanding of the CCT is essential. Additionally, creating a standardized foundation that therapists can refer to for guidance may also aid in optimizing the software's usage. It is recommended to utilize a model for CCT acceptability and acceptance in developing these solutions to enhance patient engagement.
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Affiliation(s)
- Christelle Nahas
- TIMC Laboratory, Universite Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, Grenoble, France
- LIP/PC2S, EA 4145, Universite Grenoble Alpes, Grenoble, France
- COVIRTUA Healthcare, Colomiers, France
| | - Marc Gandit
- LIP/PC2S, EA 4145, Universite Grenoble Alpes, Grenoble, France
| | | | - Emmanuel Monfort
- TIMC Laboratory, Universite Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, Grenoble, France
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Prochaska JJ, Wang Y, Bowdring MA, Chieng A, Chaudhary NP, Ramo DE. Acceptability and Utility of a Smartphone App to Support Adolescent Mental Health (BeMe): Program Evaluation Study. JMIR Mhealth Uhealth 2023; 11:e47183. [PMID: 37639293 PMCID: PMC10495844 DOI: 10.2196/47183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/26/2023] [Accepted: 08/03/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Adolescents face unprecedented mental health challenges, and technology has the opportunity to facilitate access and support digitally connected generations. The combination of digital tools and live human connection may hold particular promise for resonating with and flexibly supporting young people's mental health. OBJECTIVE This study aimed to describe the BeMe app-based platform to support adolescents' mental health and well-being and to examine app engagement, usability, and satisfaction. METHODS Adolescents in the United States, aged 13 to 20 years, were recruited via the web and enrolled between September 1 and October 31, 2022. App engagement, feature use, clinical functioning, and satisfaction with BeMe were examined for 30 days. BeMe provides content based on cognitive behavioral therapy, dialectical behavior therapy, motivational interviewing, and positive psychology; interactive activities; live text-based coaching; links to clinical services; and crisis support tools (digital and live). RESULTS The average age of the sample (N=13,421) was 15.04 (SD 1.7) years, and 56.72% (7612/13,421) identified with she/her pronouns. For the subsample that completed the in-app assessments, the mean scores indicated concern for depression (8-item Patient Health Questionnaire mean 15.68/20, SD 5.9; n=239), anxiety (7-item Generalized Anxiety Disorder Questionnaire mean 13.37/17, SD 5.0; n=791), and poor well-being (World Health Organization-Five Well-being Index mean 30.15/100, SD 16.1; n=1923). Overall, the adolescents engaged with BeMe for an average of 2.38 (SD 2.7) days in 7.94 (SD 24.1) sessions and completed 11.26 (SD 19.8) activities. Most adolescents engaged with BeMe's content (12,270/13,421, 91.42%), mood ratings (13,094/13,421, 97.56%), and interactive skills (10,098/13,421, 75.24%), and almost one-fifth of the adolescents engaged with coaching (2539/13,421, 18.92%), clinical resources (2411/13,421, 17.96%), and crisis support resources (2499/13,421, 18.62%). Overall app engagement (total activities) was highest among female and gender-neutral adolescents compared with male adolescents (all P<.001) and was highest among younger adolescents (aged 13-14 years) compared with all other ages (all P<.001). Satisfaction ratings were generally high for content (eg, 158/176, 89.8% rated as helpful and 1044/1139, 91.66% improved coping self-efficacy), activities (5362/8468, 63.32% helpful and 4408/6072, 72.6% useful in coping with big feelings), and coaching (747/894, 83.6% helpful and 747/894, 83.6% improved coping self-efficacy). Engagement (total activities completed) predicted the likelihood of app satisfaction (P<.001). CONCLUSIONS Many adolescents downloaded the BeMe app and completed multiple sessions and activities. Engagement with BeMe was higher among female and younger adolescents. Ratings of BeMe's content, activities, and coaching were very positive for cognitive precursors aimed at reducing depression and anxiety and improving well-being. The findings will inform future app development to promote more sustained engagement, and future evaluations will assess the effects of BeMe on changes in mental health outcomes.
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Affiliation(s)
- Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Palo Alto, CA, United States
| | - Yixin Wang
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Palo Alto, CA, United States
| | - Molly A Bowdring
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Palo Alto, CA, United States
| | - Amy Chieng
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Palo Alto, CA, United States
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Denison-Day JL, Muir S, Newell C, Appleton KM. The Role of Aesthetics in Intentions to Use Digital Health Interventions. PLOS DIGITAL HEALTH 2023; 2:e0000274. [PMID: 37347727 DOI: 10.1371/journal.pdig.0000274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/16/2023] [Indexed: 06/24/2023]
Abstract
Digital interventions are increasingly recognised as cost-effective treatment solutions for a number of health concerns, but adoption and use of these interventions can be low, affecting outcomes. This research sought to identify how individual aesthetic facets and perceived trust may influence perceptions toward and intentions to use an online health intervention by building on the Technology Acceptance Model, where perceived attractiveness, perceived usefulness, perceived ease of use and perceived enjoyment are thought to predict behavioural intentions towards a website. An online questionnaire study assessed perceptions of nine stimuli varying in four aesthetic facets (simplicity, diversity, colour & craftsmanship), utilising a quasi-experimental within-subjects design with a repetition among three different groups: individuals from the general population who were shown stimuli referring to general health (GP-H) (N = 257); individuals experiencing an eating disorder and shown stimuli referring to eating disorders (ED-ED) (N = 109); and individuals from the general population who were shown stimuli referring to eating disorders (GP-ED) (N = 235). Linear mixed models demonstrated that perceptions of simplicity and craftsmanship significantly influenced perceptions of usefulness, ease of use, enjoyment and trust, which in turn influenced behavioural intentions. This study demonstrates that developing the TAM model to add a further construct of perceived trust could be beneficial for digital health intervention developers. In this study, simplicity and craftsmanship were identified as the aesthetic facets with the greatest impact on user perceptions of digital health interventions.
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Affiliation(s)
- James L Denison-Day
- Department of Psychology, University of Southampton, Hampshire, United Kingdom
| | - Sarah Muir
- Department of Psychology, University of Southampton, Hampshire, United Kingdom
| | - Ciaran Newell
- Dorset Healthcare University NHS Foundation Trust, Poole, United Kingdom
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Balcombe L, De Leo D. The Potential Impact of Adjunct Digital Tools and Technology to Help Distressed and Suicidal Men: An Integrative Review. Front Psychol 2022; 12:796371. [PMID: 35058855 PMCID: PMC8765720 DOI: 10.3389/fpsyg.2021.796371] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/09/2021] [Indexed: 12/12/2022] Open
Abstract
Suicidal men feel the need to be self-reliant and that they cannot find another way out of relationship or socioeconomic issues. Suicide prevention is of crucial importance worldwide. The much higher rate of suicide in men engenders action. The prelude is a subjective experience that can be very isolating and severely distressing. Men may not realize a change in their thinking and behaviors, which makes it more difficult to seek and get help, thereby interrupting a "downward spiral". Stoicism often prevents men from admitting to their personal struggle. The lack of "quality" connections and "non-tailored" therapies has led to a high number of men "walking out" on traditional clinical approaches. But there are complicated relationships in motivations and formative behaviors of suicide with regards to emotional state, psychiatric disorders, interpersonal life events and suicidal behavior method selection. Middle-aged and older men have alternated as the most at-risk of suicide. There is no one solution that applies to all men, but digital tools may be of assistance (e.g., video conferences, social networks, telephone calls, and emails). Digital interventions require higher levels of effectiveness for distress and suicidality but self-guided approaches may be the most suitable for men especially where linked with an integrated online suicide prevention platform (e.g., quick response with online chats, phone calls, and emails). Furthermore, technology-enabled models of care offer promise to advance appropriate linking to mental health services through better and faster understanding of the specific needs of individuals (e.g., socio-cultural) and the type and level of suicidality experienced. Long-term evidence for suicidality and its evaluation may benefit from progressing human computer-interaction and providing impetus for an eminent integrated digital platform.
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Affiliation(s)
- Luke Balcombe
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
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Oti O, Pitt I. Online mental health interventions designed for students in higher education: A user-centered perspective. Internet Interv 2021; 26:100468. [PMID: 34703772 PMCID: PMC8524143 DOI: 10.1016/j.invent.2021.100468] [Citation(s) in RCA: 7] [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: 08/04/2021] [Revised: 09/24/2021] [Accepted: 10/05/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Digital mental health interventions have been posited as a way of reducing the burden on mental health services in higher education institutions. However, low adherence and high attrition rates present a challenge that limits the effectiveness of these interventions. User-centered design has been proposed as a suitable approach in improving the adherence of users to these interventions. OBJECTIVE The objective of this scoping review was to examine digital mental health interventions that have been designed specifically for students in higher education. It aimed to summarize the published literature on digital mental health interventions which take a user-centered approach in developing interventions for students in higher education. METHODS A scoping review of peer-reviewed research papers from the following electronic databases was conducted: Embase, ACM digital library, Web of Science, IEEE Explore, SCOPUS, EBSCO Host (including APA PyscInfo, CINAHL PLUS, APA PsycArticles, Medline), PubMed and Google Scholar. Databases were searched from inception until 13 Jan and 14 Jan 2021. Of the 755 articles that were identified, 57 articles were selected for full review. 34 articles were excluded for not matching the inclusion criteria. RESULTS 23 studies were included in this review. The included interventions targeted various areas of mental health including depression, anxiety, overall wellbeing, and mental health awareness. The interventions were commonly delivered through mobile apps, web-based apps, and desktop apps. In addition, we explore design methodologies applied in the development of the interventions: we note significant stakeholder engagement in the studies, the inclusion of multiple stakeholder types (students, health care professionals, university staff, and young people in the general population), and limited use of design frameworks. Finally, in exploring user engagement, attrition rates and user acceptance, we find that most of the studies have not progressed enough (i.e., at pilot/prototype stages of development) to determine the impact of design methodologies on the success of these interventions. CONCLUSION Our review revealed a need for further research on the impact of user-centered design practices on the success of digital mental health interventions in this population. Further, we provide recommendations that researchers/designers in this field of research should take into consideration when designing online mental health interventions for students in higher education. Some of the recommendations include: add personalization; improve user interfaces; take adequate steps to ensure anonymity/privacy/security; include peer engagement; and include access to mental health professionals.
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