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Copland RR, Hanke S, Rogers A, Mpaltadoros L, Lazarou I, Zeltsi A, Nikolopoulos S, MacDonald TM, Mackenzie IS. The Digital Platform and Its Emerging Role in Decentralized Clinical Trials. J Med Internet Res 2024; 26:e47882. [PMID: 39226549 DOI: 10.2196/47882] [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: 04/06/2023] [Revised: 10/11/2023] [Accepted: 07/09/2024] [Indexed: 09/05/2024] Open
Abstract
Decentralized clinical trials (DCTs) are becoming increasingly popular. Digital clinical trial platforms are software environments where users complete designated clinical trial tasks, providing investigators and trial participants with efficient tools to support trial activities and streamline trial processes. In particular, digital platforms with a modular architecture lend themselves to DCTs, where individual trial activities can correspond to specific platform modules. While design features can allow users to customize their platform experience, the real strengths of digital platforms for DCTs are enabling centralized data capture and remote monitoring of trial participants and in using digital technologies to streamline workflows and improve trial management. When selecting a platform for use in a DCT, sponsors and investigators must consider the specific trial requirements. All digital platforms are limited in their functionality and technical capabilities. Integrating additional functional modules into a central platform may solve these challenges, but few commercial platforms are open to integrating third-party components. The lack of common data standardization protocols for clinical trials will likely limit the development of one-size-fits-all digital platforms for DCTs. This viewpoint summarizes the current role of digital platforms in supporting decentralized trial activities, including a discussion of the potential benefits and challenges of digital platforms for investigators and participants. We will highlight the role of the digital platform in the development of DCTs and emphasize where existing technology is functionally limiting. Finally, we will discuss the concept of the ideal fully integrated and unified DCT and the obstacles developers must address before it can be realized.
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Affiliation(s)
- Rachel R Copland
- MEMO Research, School of Medicine, University of Dundee, Dundee, United Kingdom
| | | | - Amy Rogers
- MEMO Research, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Lampros Mpaltadoros
- Information Technologies Institute, Centre for Research & Technology Hellas, Thessaloniki, Greece
| | - Ioulietta Lazarou
- Information Technologies Institute, Centre for Research & Technology Hellas, Thessaloniki, Greece
| | - Alexandra Zeltsi
- Information Technologies Institute, Centre for Research & Technology Hellas, Thessaloniki, Greece
| | - Spiros Nikolopoulos
- Information Technologies Institute, Centre for Research & Technology Hellas, Thessaloniki, Greece
| | - Thomas M MacDonald
- MEMO Research, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Isla S Mackenzie
- MEMO Research, School of Medicine, University of Dundee, Dundee, United Kingdom
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Alhammad N, Alajlani M, Abd-Alrazaq A, Epiphaniou G, Arvanitis T. Patients' Perspectives on the Data Confidentiality, Privacy, and Security of mHealth Apps: Systematic Review. J Med Internet Res 2024; 26:e50715. [PMID: 38820572 PMCID: PMC11179037 DOI: 10.2196/50715] [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: 07/10/2023] [Revised: 09/03/2023] [Accepted: 01/25/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Mobile health (mHealth) apps have the potential to enhance health care service delivery. However, concerns regarding patients' confidentiality, privacy, and security consistently affect the adoption of mHealth apps. Despite this, no review has comprehensively summarized the findings of studies on this subject matter. OBJECTIVE This systematic review aims to investigate patients' perspectives and awareness of the confidentiality, privacy, and security of the data collected through mHealth apps. METHODS Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive literature search was conducted in 3 electronic databases: PubMed, Ovid, and ScienceDirect. All the retrieved articles were screened according to specific inclusion criteria to select relevant articles published between 2014 and 2022. RESULTS A total of 33 articles exploring mHealth patients' perspectives and awareness of data privacy, security, and confidentiality issues and the associated factors were included in this systematic review. Thematic analyses of the retrieved data led to the synthesis of 4 themes: concerns about data privacy, confidentiality, and security; awareness; facilitators and enablers; and associated factors. Patients showed discordant and concordant perspectives regarding data privacy, security, and confidentiality, as well as suggesting approaches to improve the use of mHealth apps (facilitators), such as protection of personal data, ensuring that health status or medical conditions are not mentioned, brief training or education on data security, and assuring data confidentiality and privacy. Similarly, awareness of the subject matter differed across the studies, suggesting the need to improve patients' awareness of data security and privacy. Older patients, those with a history of experiencing data breaches, and those belonging to the higher-income class were more likely to raise concerns about the data security and privacy of mHealth apps. These concerns were not frequent among patients with higher satisfaction levels and those who perceived the data type to be less sensitive. CONCLUSIONS Patients expressed diverse views on mHealth apps' privacy, security, and confidentiality, with some of the issues raised affecting technology use. These findings may assist mHealth app developers and other stakeholders in improving patients' awareness and adjusting current privacy and security features in mHealth apps to enhance their adoption and use. TRIAL REGISTRATION PROSPERO CRD42023456658; https://tinyurl.com/ytnjtmca.
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Affiliation(s)
- Nasser Alhammad
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, United Kingdom
- Health Informatics, Saudi Electronic University, Jeddah, Saudi Arabia
| | - Mohannad Alajlani
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, United Kingdom
| | - Alaa Abd-Alrazaq
- AI Center for Precision Health, Weill Cornell Medicine, Doha, Qatar
| | - Gregory Epiphaniou
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, United Kingdom
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de Azevedo Cardoso T, Kochhar S, Torous J, Morton E. Digital Tools to Facilitate the Detection and Treatment of Bipolar Disorder: Key Developments and Future Directions. JMIR Ment Health 2024; 11:e58631. [PMID: 38557724 PMCID: PMC11019420 DOI: 10.2196/58631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 03/25/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
Bipolar disorder (BD) impacts over 40 million people around the world, often manifesting in early adulthood and substantially impacting the quality of life and functioning of individuals. Although early interventions are associated with a better prognosis, the early detection of BD is challenging given the high degree of similarity with other psychiatric conditions, including major depressive disorder, which corroborates the high rates of misdiagnosis. Further, BD has a chronic, relapsing course, and the majority of patients will go on to experience mood relapses despite pharmacological treatment. Digital technologies present promising results to augment early detection of symptoms and enhance BD treatment. In this editorial, we will discuss current findings on the use of digital technologies in the field of BD, while debating the challenges associated with their implementation in clinical practice and the future directions.
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Affiliation(s)
- Taiane de Azevedo Cardoso
- The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia
- JMIR Publications, Toronto, ON, Canada
| | | | - John Torous
- Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Emma Morton
- School of Psychological Sciences, Monash University, Clayton, Australia
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Kark SM, Worthington MA, Christie RH, Masino AJ. Opportunities for digital health technology: identifying unmet needs for bipolar misdiagnosis and depression care management. Front Digit Health 2023; 5:1221754. [PMID: 37771820 PMCID: PMC10523347 DOI: 10.3389/fdgth.2023.1221754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/22/2023] [Indexed: 09/30/2023] Open
Abstract
Introduction Digital health technologies (DHTs) driven by artificial intelligence applications, particularly those including predictive models derived with machine learning methods, have garnered substantial attention and financial investment in recent years. Yet, there is little evidence of widespread adoption and scant proof of gains in patient health outcomes. One factor of this paradox is the disconnect between DHT developers and digital health ecosystem stakeholders, which can result in developing technologies that are highly sophisticated but clinically irrelevant. Here, we aimed to uncover challenges faced by psychiatrists treating patients with major depressive disorder (MDD). Specifically, we focused on challenges psychiatrists raised about bipolar disorder (BD) misdiagnosis. Methods We conducted semi-structured interviews with 10 United States-based psychiatrists. We applied text and thematic analysis to the resulting interview transcripts. Results Three main themes emerged: (1) BD is often misdiagnosed, (2) information crucial to evaluating BD is often occluded from clinical observation, and (3) BD misdiagnosis has important treatment implications. Discussion Using upstream stakeholder engagement methods, we were able to identify a narrow, unforeseen, and clinically relevant problem. We propose an organizing framework for development of digital tools based upon clinician-identified unmet need.
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Affiliation(s)
| | | | | | - Aaron J. Masino
- AiCure, New York, NY, United States
- Department of Biostatistics, Epidemiology, and Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Heydarian S, Shakiba A, Rostam Niakan Kalhori S. The Minimum Feature Set for Designing Mobile Apps to Support Bipolar Disorder-Affected Patients: Proposal of Essential Functions and Requirements. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2023; 7:254-276. [PMID: 37377634 PMCID: PMC10290972 DOI: 10.1007/s41666-023-00134-5] [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: 07/23/2021] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 06/29/2023]
Abstract
Research conducted on mobile apps providing mental health services has concluded that patients with mental disorders tend to use such apps to maintain mental health balance technology may help manage and monitor issues like bipolar disorder (BP). This study was conducted in four steps to identify the features of designing a mobile application for BP-affected patients including (1) a literature search, (2) analyzing existing mobile apps to examine their efficiency, (3) interviewing patients affected with BP to discover their needs, and 4) exploring the points of view of experts using a dynamic narrative survey. Literature search and mobile app analysis resulted in 45 features, which were later reduced to 30 after the experts were surveyed about the project. The features included the following: mood monitoring, sleep schedule, energy level evaluation, irritability, speech level, communication, sexual activity, self-confidence level, suicidal thoughts, guilt, concentration level, aggressiveness, anxiety, appetite, smoking or drug abuse, blood pressure, the patient's weight and the side effects of medication, reminders, mood data scales, diagrams or charts of the collected data, referring the collected data to a psychologist, educational information, sending feedbacks to patients using the application, and standard tests for mood assessment. The first phase of analysis should consider an expert and patient view survey, mood and medication tracking, as well as communication with other people in the same situation are the most features to be considered. The present study has identified the necessity of apps intended to manage and monitor bipolar patients to maximize efficiency and minimize relapse and side effects.
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Affiliation(s)
- Saeedeh Heydarian
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Floor 3, No. 17, Fare-Danesh Alley, Tehran, Iran
| | - Alia Shakiba
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Sharareh Rostam Niakan Kalhori
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Floor 3, No. 17, Fare-Danesh Alley, Tehran, Iran
- Peter L. Reichertz Institute for Medical Informatics, TU Braunschweig and Hannover Medical School, 38106 Brunswick, Germany
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Gordon-Smith K, Saunders KEA, Morton T, Savage J, South M, Geddes J, Craddock N, Jones I, Jones L. User perspectives on long-term remote active electronic self-monitoring of mood symptoms in bipolar spectrum disorders. J Affect Disord 2023; 324:325-333. [PMID: 36584706 DOI: 10.1016/j.jad.2022.12.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND User feedback is crucial in the development of electronic self-monitoring tools for bipolar spectrum disorders (BSD). Previous studies have examined user experiences in small samples self-monitoring over relatively short time periods. We aimed to explore the experiences of a large sample of individuals with BSD engaged in long-term remote active electronic self-monitoring. METHODS An online survey, containing closed and open questions, was sent to participants with BSD enrolled on the Bipolar Disorder Research Network (BDRN) True Colours mood-monitoring system. Questions related to experiences of using True Colours, including viewing mood graphs, and sharing data with healthcare professionals (HCPs) and/or family/friends. RESULTS Response rate was 62.7 % (n = 362). 88.4 % reported finding using True Colours helpful. Commonly reported benefits were having a visual record of mood changes, patterns/triggers and identifying early warning signs. Limitations included questions not being comprehensive or revealing anything new. One third had shared their graphs, with 89.9 % finding it helpful to share with HCPs and 78.7 % helpful to share with family/friends. Perceived benefits included aiding communication and limitations included lack of interest/understanding from others. LIMITATIONS Responder bias may be present. Findings may not be generalisable to all research cohorts. CONCLUSIONS The majority of participants valued long-term self-monitoring. Personalisation and ease of use were important. A potential challenge is continued use when mood is long-term stable, highlighting the need for measures to be sensitive to small changes. Sharing self-monitoring data with HCPs may enhance communication of the lived experience of those with BSD. Future research should examine HCPs' perspectives.
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Affiliation(s)
| | - Kate E A Saunders
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | | | | | - Matthew South
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - John Geddes
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Nick Craddock
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK
| | - Ian Jones
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK
| | - Lisa Jones
- Psychological Medicine, University of Worcester, UK.
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Morton E, Nicholas J, Yang L, Lapadat L, Barnes SJ, Provencher MD, Depp C, Chan M, Kulur R, Michalak EE. Evaluating the quality, safety, and functionality of commonly used smartphone apps for bipolar disorder mood and sleep self-management. Int J Bipolar Disord 2022; 10:10. [PMID: 35368207 PMCID: PMC8977125 DOI: 10.1186/s40345-022-00256-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 02/01/2022] [Indexed: 12/03/2022] Open
Abstract
Background Individuals with bipolar disorder (BD) are increasingly turning to smartphone applications (apps) for health information and self-management support. While reviews have raised concerns regarding the effectiveness and safety of publicly available apps for BD, apps surveyed may not reflect what individuals with BD are using. The present study had two aims: first, to characterize the use of health apps to support mood and sleep amongst people with BD, and second, to evaluate the quality, safety and functionality of the most commonly used self-management apps. Methods A web-based survey was conducted to explore which apps people with BD reported using to support self-management of mood and sleep. The characteristics of the most commonly nominated apps were described using a standardized framework, including their privacy policy, clinical foundations, and functionality. Results Respondents (n = 919) were 77.9% female with a mean age of 36.9 years. 41.6% of participants (n = 382) reported using a self-management app to support mood or sleep. 110 unique apps were nominated in relation to mood, and 104 unique apps nominated in relation to sleep; however, most apps were only mentioned once. The nine most frequently nominated apps related to mood and sleep were subject to further evaluation. All reviewed apps offered a privacy policy, however user control over data was limited and the complexity of privacy policies was high. Only one app was developed for BD populations. Half of reviewed apps had published peer-reviewed evidence to support their claims of efficacy, but little research was specific to BD. Conclusion Findings illustrate the potential of smartphone apps to increase the reach of psychosocial interventions amongst people with BD. Apps were largely created by commercial developers and designed for the general population, highlighting a gap in the development and dissemination of evidence-informed apps for BD. There may be risks in using generic health apps for BD self-management; clinicians should enquire about patients’ app use to foster conversations about their particular benefits and limitations. Supplementary Information The online version contains supplementary material available at 10.1186/s40345-022-00256-6.
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Michalak EE, Barnes SJ, Morton E, O'Brien HL, Murray G, Hole R, Meyer D. Supporting Self-Management and Quality of Life in Bipolar Disorder with the PolarUs App (Alpha): Protocol for a Mixed-Methods Study (Preprint). JMIR Res Protoc 2022; 11:e36213. [PMID: 35925666 PMCID: PMC9389375 DOI: 10.2196/36213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/13/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Steven J Barnes
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Emma Morton
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Heather L O'Brien
- School of Information, University of British Columbia, Vancouver, BC, Canada
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Melbourne, BC, Canada
| | - Rachelle Hole
- Canadian Institute for Inclusion and Citizenship, University of British Columbia, Kelowna, BC, Canada
| | - Denny Meyer
- Centre for Mental Health, Swinburne University of Technology, Melbourne, BC, Canada
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Ryan KA, Smith SN, Yocum AK, Carley I, Liebrecht C, Navis B, Vest E, Bertram H, McInnis MG, Kilbourne AM. The Life Goals Self-Management Mobile App for Bipolar Disorder: Consumer Feasibility, Usability, and Acceptability Study. JMIR Form Res 2021; 5:e32450. [PMID: 34898452 PMCID: PMC8713087 DOI: 10.2196/32450] [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: 07/30/2021] [Revised: 09/08/2021] [Accepted: 11/05/2021] [Indexed: 12/12/2022] Open
Abstract
Background Life Goals is an evidence-based self-management intervention that assists individuals with bipolar disorder (BD) by aligning BD symptom coping strategies with their personal goals. The intervention can be availed via in-person and telephonic sessions, and it has been recently developed as an individualized, customizable mobile app. Objective We examined the feasibility, usability, and acceptability of the Life Goals self-management app among individuals diagnosed with BD who used the app for up to 6 months. Methods A total of 28 individuals with BD used the Life Goals app on their personal smartphone for 6 months. They completed key clinical outcome measurements of functioning, disability, and psychiatric symptoms at baseline, 3 months, and 6 months, in addition to a poststudy survey about usability and satisfaction. Results Participants used the app for a median of 25 times (IQR 13-65.75), and for a longer time during the first 3 months of the study. The modules on depression and anxiety were the most frequently used, accounting for 35% and 22% of total usage, respectively. Overall, the study participants found the app useful (15/25, 60%) and easy to use (18/25, 72%), and they reported that the screen displayed the material adequately (22/25, 88%). However, less than half of the participants found the app helpful in managing their health (10/25, 40%) or in making progress on their wellness goals (9/25, 36%). Clinical outcomes showed a trend for improvements in mental and physical health and mania-related well-being. Conclusions The Life Goals app showed feasibility of use among individuals with BD. Higher user engagement was observed in the initial 3 months with users interested more frequently in the mood modules than other wellness modules. Participants reported acceptability with the ease of app use and satisfaction with the app user interface, but the app showed low success in encouraging self-management within this small sample. The Life Goals app is a mobile health technology that can provide individuals with serious mental illness with more flexible access to evidence-based treatments.
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Affiliation(s)
- Kelly A Ryan
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Shawna N Smith
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Anastasia K Yocum
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Isabel Carley
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Celeste Liebrecht
- VA Ann Arbor Healthcare System, United States Department of Veterans Affairs, Ann Arbor, MI, United States.,Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, United States
| | - Bethany Navis
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Erica Vest
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Holli Bertram
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Melvin G McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Amy M Kilbourne
- VA Ann Arbor Healthcare System, United States Department of Veterans Affairs, Ann Arbor, MI, United States.,Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, United States
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