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Miao Y, Luo Y, Zhao Y, Liu M, Wang H, Wu Y. Effectiveness of eHealth Interventions in Improving Medication Adherence Among Patients With Cardiovascular Disease: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e58013. [PMID: 39008845 PMCID: PMC11287104 DOI: 10.2196/58013] [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: 03/03/2024] [Revised: 04/02/2024] [Accepted: 05/30/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Nonadherence to medication among patients with cardiovascular diseases undermines the desired therapeutic outcomes. eHealth interventions emerge as promising strategies to effectively tackle this issue. OBJECTIVE The aim of this study was to conduct a network meta-analysis (NMA) to compare and rank the efficacy of various eHealth interventions in improving medication adherence among patients with cardiovascular diseases (CVDs). METHODS A systematic search strategy was conducted in PubMed, Embase, Web of Science, Cochrane, China National Knowledge Infrastructure Library (CNKI), China Science and Technology Journal Database (Weipu), and WanFang databases to search for randomized controlled trials (RCTs) published from their inception on January 15, 2024. We carried out a frequentist NMA to compare the efficacy of various eHealth interventions. The quality of the literature was assessed using the risk of bias tool from the Cochrane Handbook (version 2.0), and extracted data were analyzed using Stata16.0 (StataCorp LLC) and RevMan5.4 software (Cochrane Collaboration). The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. RESULTS A total of 21 RCTs involving 3904 patients were enrolled. The NMA revealed that combined interventions (standardized mean difference [SMD] 0.89, 95% CI 0.22-1.57), telephone support (SMD 0.68, 95% CI 0.02-1.33), telemonitoring interventions (SMD 0.70, 95% CI 0.02-1.39), and mobile phone app interventions (SMD 0.65, 95% CI 0.01-1.30) were statistically superior to usual care. However, SMS compared to usual care showed no statistical difference. Notably, the combined intervention, with a surface under the cumulative ranking curve of 79.3%, appeared to be the most effective option for patients with CVDs. Regarding systolic blood pressure and diastolic blood pressure outcomes, the combined intervention also had the highest probability of being the best intervention. CONCLUSIONS The research indicates that the combined intervention (SMS text messaging and telephone support) has the greatest likelihood of being the most effective eHealth intervention to improve medication adherence in patients with CVDs, followed by telemonitoring, telephone support, and app interventions. The results of these network meta-analyses can provide crucial evidence-based support for health care providers to enhance patients' medication adherence. Given the differences in the design and implementation of eHealth interventions, further large-scale, well-designed multicenter trials are needed. TRIAL REGISTRATION INPLASY 2023120063; https://inplasy.com/inplasy-2023-12-0063/.
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Affiliation(s)
- Yiqun Miao
- School of Nursing, Capital Medical University, Beijing, China
| | - Yuan Luo
- School of Nursing, Capital Medical University, Beijing, China
| | - Yuhan Zhao
- School of Nursing, Capital Medical University, Beijing, China
| | - Mingxuan Liu
- School of Nursing, Capital Medical University, Beijing, China
| | - Huiying Wang
- School of Nursing, Capital Medical University, Beijing, China
| | - Ying Wu
- School of Nursing, Capital Medical University, Beijing, China
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Schmidt SA. Teletherapy Used to Breakdown Access Barriers. Telemed J E Health 2024; 30:1491-1494. [PMID: 38190285 DOI: 10.1089/tmj.2023.0612] [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] [Indexed: 01/10/2024] Open
Abstract
The studies presented in this literature review reveal the numerous ways that teletherapy can be used to treat patients with mental health issues. The literature includes six research articles from published scientific journals that span from 2005 to 2020. The three types of telehealth therapy reviewed include mobile telehealth, telephone, and video technology. The six research articles focus on the ways that telehealth can reach communities of lower socioeconomic status (SES) and those suffering from access barriers. The benefits of teletherapy include cost savings, time efficiency, easier access, and a reduction in recidivism. Challenges include access barriers, financial difficulties, anxiety, and fear of stigmatization. Limitations of the studies presented include a lack of accessibility to internet and technology, privacy issues, and insurance coverage. Overall, results show that teletherapy provides an affordable, accessible alternative to traditional in-person mental health therapy, especially in reaching lower SES groups, Veterans, and patients with access restrictions.
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Affiliation(s)
- Sarah A Schmidt
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, New York, USA
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Rogers CB, Webb JB, Bauert L, Carelock J. Feasibility and Acceptability of a Guided Self-Help, Text-Messaging Intervention to Promote Positive Body Image of Emerging Adult Women. Front Glob Womens Health 2022; 3:849836. [PMID: 35572213 PMCID: PMC9099092 DOI: 10.3389/fgwh.2022.849836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/11/2022] [Indexed: 11/15/2022] Open
Abstract
The predominant approach of existing eating disorder prevention programs targets risk factors for development; furthermore, burgeoning evidence suggests that promotion of protective factors against eating disorders (e.g., positive body image) is also a worthy avenue for prevention efforts. The present study considered existing literature gaps in the design of an 8-week guided self-help intervention meant to address the risk for disordered eating through the improvement of positive body image and enhancement of current adaptive functioning. The intervention incorporated elements of weight-inclusive health promotion (e.g., Health at Every Size; HAES) alongside positive psychology and third-wave behavioral interventions [e.g., self-compassion, mindful eating, Acceptance and Commitment Therapy (ACT)] to promote engagement in mindful-self-care. This mixed-methods study evaluated the feasibility and acceptability of the text-messaging based intervention in a diverse sample of cisgender college women (N = 30; 30% Black; 30% bisexual) at risk for disordered eating. Results indicated a high level of engagement and satisfaction with the intervention. Proof of concept was preliminarily supported by the observed significant changes in variables of interest (i.e., body appreciation, positive embodiment, mindful self-care, intuitive eating, self-compassion, disordered eating, and body image dissatisfaction) across the intervention. Overall, results of this study suggest that the use of a guided self-help program based in technology which seeks to reduce risk factors for disordered eating while also supporting adaptive functioning may be indicated for emerging adult women. This article will discuss how the present study provides the groundwork for continued development of innovative and remotely accessible interventions which promote positive body image.
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Affiliation(s)
- Courtney B. Rogers
- Cherokee Health Systems, Knoxville, TN, United States
- *Correspondence: Courtney B. Rogers
| | - Jennifer B. Webb
- Health Psychology PhD Program, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Lia Bauert
- Health Psychology PhD Program, University of North Carolina at Charlotte, Charlotte, NC, United States
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Shalaby R, Spurvey P, Knox M, Rathwell R, Vuong W, Surood S, Urichuk L, Snaterse M, Greenshaw AJ, Li XM, Agyapong VIO. Clinical Outcomes in Routine Evaluation Measures for Patients Discharged from Acute Psychiatric Care: Four-Arm Peer and Text Messaging Support Controlled Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073798. [PMID: 35409483 PMCID: PMC8997547 DOI: 10.3390/ijerph19073798] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 12/10/2022]
Abstract
Background: Peer support workers (PSW) and text messaging services (TxM) are supportive health services that are frequently examined in the field of mental health. Both interventions have positive outcomes, with TxM demonstrating clinical and economic effectiveness and PSW showing its utility within the recovery-oriented model. Objective: To evaluate the effectiveness of PSW and TxM in reducing psychological distress of recently discharged patients receiving psychiatric care. Methods: This is a prospective, rater-blinded, pilot-controlled observational study consisting of 181 patients discharged from acute psychiatric care. Patients were randomized into one of four conditions: daily supportive text messages only, peer support only, peer support plus daily text messages, or treatment as usual. Clinical Outcomes in Routine Evaluation—Outcome Measure (CORE-OM), a standardized measure of mental distress, was administered at four time points: baseline, six weeks, three months, and six months. MANCOVA was used to assess the impact of the interventions on participants’ scores on four CORE-OM subscales across the three follow-up time points. Recovery, clinical change, and reliable change in CORE-OM all-item analysis were examined across the four groups, and the prevalence of risk symptoms was measured. Results: A total of 63 patients completed assessments at each time point. The interaction between PSW and TxM was predictive of differences in scores on the CORE-OM functioning subscale with a medium effect size (F1,63 = 4.19; p = 0.045; ηp2 = 0.07). The PSW + TxM group consistently achieved higher rates of recovery and clinical and reliable improvement compared to the other study groups. Additionally, the text message group and the PSW + TxM group significantly reduced the prevalence of risk of self/other harm symptoms after six months of intervention, with 27.59% (χ2(1) = 4.42, p = 0.04) and 50% (χ2(1) = 9.03, p < 0.01) prevalence reduction, respectively. Conclusions: The combination of peer support and supportive text messaging is an impactful intervention with positive clinical outcomes for acute care patients. Adding the two interventions into routine psychiatric care for patients after discharge is highly recommended.
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Affiliation(s)
- Reham Shalaby
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (R.S.); (A.J.G.); (X.-M.L.)
| | - Pamela Spurvey
- Alberta Health Services Addiction and Mental Health, Edmonton, AB T5J 3E4, Canada; (P.S.); (M.K.); (R.R.); (W.V.); (S.S.); (L.U.); (M.S.)
| | - Michelle Knox
- Alberta Health Services Addiction and Mental Health, Edmonton, AB T5J 3E4, Canada; (P.S.); (M.K.); (R.R.); (W.V.); (S.S.); (L.U.); (M.S.)
| | - Rebecca Rathwell
- Alberta Health Services Addiction and Mental Health, Edmonton, AB T5J 3E4, Canada; (P.S.); (M.K.); (R.R.); (W.V.); (S.S.); (L.U.); (M.S.)
| | - Wesley Vuong
- Alberta Health Services Addiction and Mental Health, Edmonton, AB T5J 3E4, Canada; (P.S.); (M.K.); (R.R.); (W.V.); (S.S.); (L.U.); (M.S.)
| | - Shireen Surood
- Alberta Health Services Addiction and Mental Health, Edmonton, AB T5J 3E4, Canada; (P.S.); (M.K.); (R.R.); (W.V.); (S.S.); (L.U.); (M.S.)
| | - Liana Urichuk
- Alberta Health Services Addiction and Mental Health, Edmonton, AB T5J 3E4, Canada; (P.S.); (M.K.); (R.R.); (W.V.); (S.S.); (L.U.); (M.S.)
| | - Mark Snaterse
- Alberta Health Services Addiction and Mental Health, Edmonton, AB T5J 3E4, Canada; (P.S.); (M.K.); (R.R.); (W.V.); (S.S.); (L.U.); (M.S.)
| | - Andrew J. Greenshaw
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (R.S.); (A.J.G.); (X.-M.L.)
| | - Xin-Min Li
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (R.S.); (A.J.G.); (X.-M.L.)
| | - Vincent I. O. Agyapong
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (R.S.); (A.J.G.); (X.-M.L.)
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
- Correspondence:
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Raue PJ, Fridling N, Song J, Hull TD, Alexopoulos GS, Arean PA. Message-based psychotherapy for older adults: A cohort comparison study. Front Psychiatry 2022; 13:951354. [PMID: 36090371 PMCID: PMC9453249 DOI: 10.3389/fpsyt.2022.951354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Digital Mental Health Interventions (DMHI) can diminish inequities in mental health care provision. As DMHIs increase in popularity, however, older adults may be unintentionally excluded due to barriers such as lack of awareness, internet access, digital tools, technological socialization and education, physiological accessibility, and communication technology infrastructure. The aim of this study was to examine longitudinal treatment engagement patterns and 15-week clinical outcomes of depressed and anxious older adults compared to a matched cohort of younger adults seeking treatment from a large asynchronous telemedicine provider. METHODS The 2,470 older adults (55+ years) and a matched cohort of younger adults (26-35 years) diagnosed with depression or anxiety were treated by licensed therapists via messaging 5 days a week. Patterns of treatment engagement on the platform were compared across groups by examining total number of days in treatment, days actively messaging on the platform, and average words and messages per week sent by patients over the entire period they remained in treatment. Symptoms were assessed every 3 weeks using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7), and changes were compared across age groups over 15 weeks. RESULTS Older patients attended more days in treatment than younger patients, but there were no differences in number of days actively messaging on the platform, number of messages per week, or word count per week. The two age groups did not differ in their final anxiety or depressive symptoms when controlling for total number of weeks attended. Patients in the younger age group experienced a quicker rate of reduction than older adults in their anxiety, but not depressive symptoms. CONCLUSIONS Among individuals willing to initiate care through a DMHI, older adults had overall similar engagement as younger adults and they showed similar improvement in symptoms of depression and anxiety. Given the advantages of message-based care for aiding a mental health workforce in serving larger numbers of individuals in need and the expected growth of the aging population, these findings could help healthcare systems in evaluating a variety of treatment options and delivery media for meeting the healthcare needs of the future.
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Affiliation(s)
- Patrick J Raue
- Department of Psychiatry & Behavioral Sciences, University of Washington Medical Center, Seattle, WA, United States
| | | | - Jiyoung Song
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | | | - George S Alexopoulos
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY, United States
| | - Patricia A Arean
- Department of Psychiatry & Behavioral Sciences, University of Washington Medical Center, Seattle, WA, United States
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Challenges and opportunities in the provision of mental health care services during the COVID-19 pandemic and beyond. LESSONS FROM COVID-19 2022. [PMCID: PMC9347459 DOI: 10.1016/b978-0-323-99878-9.00008-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The provision of services to people with mental health problems and their families has been substantially affected by the COVID-19 pandemic. Often face-to-face clinical work had to be replaced with telehealth, in line with COVID-19 regulations of social distancing. Currently, different types of online services have been implemented to meet the mental health needs of the population. This change from face-to-face to online service provision has been disruptive to many South Africans and at times resulted in people not being able to access these services. Aim: This chapter aims to describe specifically the use of online psychological service delivery pre-COVID-19 and during the lockdown. Method: We conducted a literature review exploring the delivery of psychological services through online channels pre-COVID-19 and during the lockdown. We highlight lessons learned and opportunities for psychological service provision beyond the pandemic. Conclusion: We conclude that online service platforms can increase access to psychological services and identify strategies that can be adopted to strengthen service provision.
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Ramos G, Aguilera A, Montoya A, Lau A, Wen CY, Cruz Torres V, Chavira D. App-Based Mindfulness Meditation for People of Color Who Experience Race-Related Stress: Protocol for a Randomized Controlled Trial (Preprint). JMIR Res Protoc 2021; 11:e35196. [PMID: 35436228 PMCID: PMC9052031 DOI: 10.2196/35196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/08/2022] [Accepted: 03/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background People of color (POC) who experience race-related stress are at risk of developing mental health problems, including high levels of stress, anxiety, and depression. Mindfulness meditation may be especially well suited to help POC cope, given its emphasis on gaining awareness and acceptance of emotions associated with discriminatory treatment. However, mindfulness meditation rarely reaches POC, and digital approaches could reduce this treatment gap by addressing traditional barriers to care. Objective This study will test the effectiveness of a self-directed app-based mindfulness meditation program among POC who experience elevated levels of race-related stress. Implementation outcomes such as treatment acceptability, adherence, and satisfaction will be examined. Methods Participants (n=80) will be recruited online by posting recruitment materials on social media and sending emails to relevant groups. In-person recruitment will consist of posting flyers in communities with significant POC representation. Eligible participants will be block randomized to either the intervention group (n=40) that will complete a self-directed 4-week mindfulness meditation program or a wait-list control condition (n=40) that will receive access to the app after study completion. All participants will complete measures at baseline, midtreatment, and posttreatment. Primary outcomes include changes in stress, anxiety, and depression, and secondary outcomes constitute changes in mindfulness, self-compassion, rumination, emotion suppression, and experiential avoidance. Exploratory analyses will examine whether changes in the secondary outcomes mediate changes in primary outcomes. Finally, treatment acceptability, adherence, and satisfaction will be examined descriptively. Results Recruitment began in October 2021. Data will be analyzed using multilevel modeling, a statistical methodology that accounts for the dependence among repeated observations. Considering attrition issues in self-directed digital interventions and their potential effects on statistical significance and treatment effect sizes, we will examine data using both intention-to-treat and per-protocol analyses. Conclusions To our knowledge, this will be the first study to provide data on the effectiveness of a self-directed app-based mindfulness meditation program for POC recruited based on elevated race-related stress, a high-risk population. Similarly, meaningful clinical targets for POC affected by stressors related to race will be examined. Findings will provide important information regarding whether this type of intervention is an acceptable treatment among these marginalized groups. Trial Registration ClinicalTrials.gov NCT05027113; https://clinicaltrials.gov/ct2/show/NCT05027113 International Registered Report Identifier (IRRID) DERR1-10.2196/35196
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Affiliation(s)
- Giovanni Ramos
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Adrian Aguilera
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Amanda Montoya
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Anna Lau
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Chu Yin Wen
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Denise Chavira
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
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Arean P, Hull D, Pullmann MD, Heagerty PJ. Protocol for a sequential, multiple assignment, randomised trial to test the effectiveness of message-based psychotherapy for depression compared with telepsychotherapy. BMJ Open 2021; 11:e046958. [PMID: 34728440 PMCID: PMC8565526 DOI: 10.1136/bmjopen-2020-046958] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Digital mental health tools have become popular alternatives to traditional psychotherapy. One emerging form of digital mental health is message-based care, the use of text messages or asynchronous voice or video messaging to provide psychotherapy. There has been no research into whether this is an effective method of psychotherapy as a stand-alone treatment or in combination with traditional psychotherapy. METHODS AND ANALYSIS This is a sequential, multiple assignment randomised trial to compare message-based care, videoconference-psychotherapy and a combination of the two treatments in 1000 depressed adults. Participants will be recruited through Talkspace, a digital mental health company, and randomised to receive 6 weeks of either message-based care only or videoconference-psychotherapy only. At 6 weeks, participants will be evaluated for their response to treatment. Those with a 50% or more response to treatment will continue with their assigned condition. Those who do not respond will be randomised to either monthly videoconference-psychotherapy or weekly videoconference-psychotherapy plus message-based care. Primary outcomes will be depression and social functioning. We will also explore moderators of treatment outcome. ETHICS AND DISSEMINATION The study received ethics approval from the University of Washington Institutional Review Board. Results of this study will be presented in peer-reviewed journals and at professional conferences. TRIAL REGISTRATION NUMBER NCT04513080; Pre-results.
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Affiliation(s)
- Patricia Arean
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Derrick Hull
- Research and Development, Talkspace Network LLC, New York City, New York, USA
| | - Michael D Pullmann
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Patrick J Heagerty
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
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Improving social functioning in people with schizophrenia-spectrum disorders via mobile experimental interventions: Results from the CLIMB pilot trial. SCHIZOPHRENIA RESEARCH-COGNITION 2021; 26:100211. [PMID: 34381699 PMCID: PMC8340304 DOI: 10.1016/j.scog.2021.100211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/15/2021] [Accepted: 07/21/2021] [Indexed: 12/02/2022]
Abstract
Background Patients with Schizophrenia Spectrum Disorders (SSD) demonstrate poor social functioning. While group-based approaches show long-term improvements, access to treatments is limited. Digital platforms hold promise to overcome barriers to treatment delivery and improve outcomes. Objective In a parallel arm, double-blind RCT, we tested CLIMB, a clinician-assisted, adjunct to treatment that includes computerized social cognition training (SCT), ecological momentary assessments (EMAs), group tele-therapy, and moderated messaging. CLIMB was compared to an active control that includes computerized general cognitive training (GCT), unstructured support groups, and unmoderated messaging. Methods The primary outcome was social functioning. Secondary outcomes were negative symptoms and quality of life (QoL). Given the sample size, Propensity Score Models were used to ensure balanced baseline covariates. Mixed-effects models examined change over time. Results 24 participants completed the study (12 per arm). No significant between-group differences emerged in engagement. CLIMB participants engaged in a median of 8 sessions (IQR = 2), 2.8 h of SCT (IQR = 7.5), and 2710 EMAs; control participants engaged in a median of 9 sessions (IQR = 3) and 2.2 h of GCT (IQR = 7.9). As a group, participants showed significant improvements in social functioning (p = .046), with no between-group differences. Intent-to-treat analyses indicated greater improvements in QoL (p = .025) for the active control. Conclusions Delivering group-based mobile interventions to individuals with SSD is feasible. EMAs allow clinicians to maintain inter-session engagement, build participant self-awareness, and tailor treatment delivery. In this treatment model, whether SCT or GCT is more effective remains unclear. Further research will evaluate group-based mobile interventions to improve outcomes in SSD.
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Armstrong CC, Odukoya EJ, Sundaramurthy K, Darrow SM. Youth and Provider Perspectives on Behavior-Tracking Mobile Apps: Qualitative Analysis. JMIR Ment Health 2021; 8:e24482. [PMID: 33885364 PMCID: PMC8103306 DOI: 10.2196/24482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/26/2021] [Accepted: 02/22/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Mobile health apps stand as one possible means of improving evidence-based mental health interventions for youth. However, a better understanding of youth and provider perspectives is necessary to support widespread implementation. OBJECTIVE The objective of this research was to explore both youth and provider perspectives on using mobile apps to enhance evidence-based clinical care, with an emphasis on gathering perspectives on behavior-tracking apps. METHODS Inductive qualitative analysis was conducted on data obtained from semistructured interviews held with 10 youths who received psychotherapy and 12 mental health care providers who conducted therapy with youths aged 13-26 years. Interviews were independently coded by multiple coders and consensus meetings were held to establish reliability. RESULTS During the interviews, the youths and providers broadly agreed on the benefits of behavior tracking and believed that tracking via app could be more enjoyable and accessible. Providers and youths also shared similar concerns that negative emotions and user burden could limit app usage. Participants also suggested potential app features that, if implemented, would help meet the clinical needs of providers and support long-term use among youth. Such features included having a pleasant user interface, reminders for clients, and graphical output of data to clients and providers. CONCLUSIONS Youths and providers explained that the integration of mobile health into psychotherapy has the potential to make treatment, particularly behavior tracking, easy and more accessible. However, both groups had concerns about the increased burden that could be placed on the clients and providers.
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Affiliation(s)
- Courtney C Armstrong
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Erica J Odukoya
- University of Michigan Medical School, Ann Arbor, MI, United States.,Department of Psychiartry, University of California, San Francisco, San Francisco, CA, United States
| | - Keerthi Sundaramurthy
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Sabrina M Darrow
- Department of Psychiartry, University of California, San Francisco, San Francisco, CA, United States
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Mishna F, Sanders JE, Daciuk J, Milne E, Fantus S, Bogo M, Fang L, Greenblatt A, Rosen P, Khoury-Kassabri M, Lefevre M. #socialwork: An International Study Examining Social Workers’ Use of Information and Communication Technology. BRITISH JOURNAL OF SOCIAL WORK 2021. [PMCID: PMC8083293 DOI: 10.1093/bjsw/bcab066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Information and Communication Technologies (ICTs) permeated social work practice before coronavirus disease 2019 (COVID-19). In addition to ICT-based formal services (e.g. e-counselling), social workers used ICTs informally as an adjunct to face-to-face practice. Building on our previous research, our cross-sectional online survey examined social workers’ informal use of ICTs in four countries: Canada, the USA, Israel and the UK. The survey was administered through Qualtrics software among social workers across Canada (n = 2,609), the USA (n = 1,225), Israel (n = 386) and the UK (n = 134), and analysed using IBM SPSS Statistics version 26. The findings substantiate the ubiquitous use of informal ICTs in social work practice, as an adjunct to face-to-face treatment, across the four countries. Given the current, unprecedented context of COVID-19, we discuss the meaning of our findings related to access, ethical considerations (e.g. professional boundaries) and supervision in the context of restricted face-to-face practice. We discuss the implications for social work practice, education and research, and conclude that in the COVID-19 context, there is an even greater need for research, clinical discussion, supervision and policy on informal ICT use in social work practice.
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Affiliation(s)
- Faye Mishna
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada M5WS 1V4
- Correspondence to Faye Mishna, Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario, Canada M5S 1V4. E-mail:
| | - Jane E Sanders
- School of Social Work/King's University College at Western University, London, Ontario, Canada N6A 2M3
| | - Joanne Daciuk
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada M5WS 1V4
| | - Elizabeth Milne
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada M5WS 1V4
| | - Sophia Fantus
- School of Social Work, University of Texas at Arlington, Arlington, TX 76019, USA
| | - Marion Bogo
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada M5WS 1V4
| | - Lin Fang
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada M5WS 1V4
| | - Andrea Greenblatt
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada M5WS 1V4
| | - Penny Rosen
- American Association for Psychoanalysis in Clinical Social Work, New York, NY 10025-6540, USA
| | - Mona Khoury-Kassabri
- School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem 91905, Israel
| | - Michelle Lefevre
- Department of Social Work and Social Care, University of Sussex, Brighton BN1 9RH, UK
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12
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Bunnell BE, Nemeth LS, Lenert LA, Kazantzis N, Deblinger E, Higgins KA, Ruggiero KJ. Barriers Associated with the Implementation of Homework in Youth Mental Health Treatment and Potential Mobile Health Solutions. COGNITIVE THERAPY AND RESEARCH 2021; 45:272-286. [PMID: 34108776 PMCID: PMC8183976 DOI: 10.1007/s10608-020-10090-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Homework, or between-session practice of skills learned during therapy, is integral to effective youth mental health TREATMENTS. However, homework is often under-utilized by providers and patients due to many barriers, which might be mitigated via mHealth solutions. METHODS Semi-structured qualitative interviews were conducted with nationally certified trainers in Trauma Focused Cognitive Behavioral Therapy (TF-CBT; n=21) and youth TF-CBT patients ages 8-17 (n=15) and their caregivers (n=12) to examine barriers to the successful implementation of homework in youth mental health treatment and potential mHealth solutions to those barriers. RESULTS The results indicated that many providers struggle to consistently develop, assign, and assess homework exercises with their patients. Patients are often difficult to engage and either avoid or have difficulty remembering to practice exercises, especially given their busy/chaotic home lives. Trainers and families had positive views and useful suggestions for mHealth solutions to these barriers in terms of functionality (e.g., reminders, tracking, pre-made homework exercises, rewards) and user interface (e.g., easy navigation, clear instructions, engaging activities). CONCLUSIONS This study adds to the literature on homework barriers and potential mHealth solutions to those barriers, which is largely based on recommendations from experts in the field. The results aligned well with this literature, providing additional support for existing recommendations, particularly as they relate to treatment with youth and caregivers.
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Affiliation(s)
- Brian E. Bunnell
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
- Biomedical Informatics Center, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Lynne S. Nemeth
- Department of Nursing, College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Leslie A. Lenert
- Biomedical Informatics Center, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Nikolaos Kazantzis
- Cognitive Behavior Therapy Research Unit and School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Esther Deblinger
- Child Abuse Research Education & Service (CARES) Institute, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Kristen A. Higgins
- Biomedical Informatics Center, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Kenneth J. Ruggiero
- Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina, Charleston, SC, USA
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13
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Burgess ER, Walter N, Ball-Rokeach SJ, Murphy ST. Communication Hotspots: How Infrastructure Shapes People's Health. HEALTH COMMUNICATION 2021; 36:361-371. [PMID: 31760807 DOI: 10.1080/10410236.2019.1692490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Informed by communication infrastructure theory (CIT) and the social capital approach to health, this study focused on the role played by communication hotspots: physical places in a community (e.g., parks, churches, or restaurants) where health information is shared between network actors. By analyzing survey data that included information about communication infrastructure, frequency of health conversations, as well as the size and diversity of respondents' social networks, this study illustrates how communication hotspots may reduce perceived barriers to healthcare among Latinas in the greater Los Angeles area (N = 780). The results suggest that communication hotspots can influence people's health by facilitating information-sharing activities. In addition, communication hotspots may reduce perceived barriers to healthcare by bringing together diverse network actors. We conclude by considering future health interventions and policy planning to leverage and enhance community members' interactions at communication hotspots.
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Affiliation(s)
| | | | - Sandra J Ball-Rokeach
- Annenberg School for Communication and Journalism, University of Southern California
| | - Sheila T Murphy
- Annenberg School for Communication and Journalism, University of Southern California
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14
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Mental Health Outreach via Supportive Text Messages during the COVID-19 Pandemic: Improved Mental Health and Reduced Suicidal Ideation after Six Weeks in Subscribers of Text4Hope Compared to a Control Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042157. [PMID: 33672120 PMCID: PMC7927101 DOI: 10.3390/ijerph18042157] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 01/17/2023]
Abstract
Background: In March 2020, Alberta Health Services launched Text4Hope, a free mental health text-message service. The service aimed to alleviate pandemic-associated stress, generalized anxiety disorder (GAD), major depressive disorder (MDD), and suicidal propensity. The effectiveness of Text4Hope was evaluated by comparing psychiatric parameters between two subscriber groups. Methods: A comparative cross-sectional study with two arms: Text4Hope subscribers who received daily texts for six weeks, the intervention group (IG); and new Text4Hope subscribers who were yet to receive messages, the control group (CG). Logistic regression models were used in the analysis. Results: Participants in the IG had lower prevalence rates for moderate/high stress (78.8% vs. 88.0%), likely GAD (31.4% vs. 46.5%), and likely MDD (36.8% vs. 52.1%), respectively, compared to respondents in the CG. After controlling for demographic variables, the IG remained less likely to self-report symptoms of moderate/high stress (OR = 0.56; 95% CI = 0.41–0.75), likely GAD (OR = 0.55; 95% CI = 0.44–0.68), and likely MDD (OR = 0.50; 95% CI = 0.47–0.73). The mean Composite Mental Health score, the sum of mean scores on the PSS, GAD-7, and PHQ-9 was 20.9% higher in the CG. Conclusions: Text4Hope is an effective population-level intervention that helps reduce stress, anxiety, depression, and suicidal thoughts during the COVID-19 pandemic. Similar texting services should be implemented during global crises.
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Torabizadeh C, Rousta S, Gholamzadeh S, Kojouri J, Jamali K, Parvizi MM. Efficacy of education delivery through multimedia and text messaging on the psychological parameters of patients scheduled for coronary angiography: a single-blind randomized controlled clinical trial. BMC Cardiovasc Disord 2021; 21:3. [PMID: 33397300 PMCID: PMC7784265 DOI: 10.1186/s12872-020-01820-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 12/10/2020] [Indexed: 11/10/2022] Open
Abstract
Background Angiography is a highly effective invasive method for diagnosing coronary artery diseases but can lead to certain psychological problems such as stress, anxiety, and depression. This study aimed to compare the effects of education delivery through multimedia DVD content or text messaging in comparison with conventional printed pamphlets on the psychological parameters of patients scheduled for angiography. Methods This study was a randomized controlled clinical trial. We used the convenience sampling method to select 120 patients who met the inclusion criteria among individuals who were scheduled for elective coronary angiography.
The patients were randomly divided into three groups through the block randomization method. The necessary educational tips for before, during, and after the angiography procedure were delivered to the patients in interventional group 1 (n = 40) and interventional group 2 (n = 40) through text messages and a multimedia DVD, respectively. The control group received routine hospital education through pamphlets besides the opportunity for verbal discussions with nurses. All educational content was delivered to the patients four days before the scheduled day of angiography. The DASS-21 questionnaire, consisting of the three domains of stress, anxiety, and depression, was used to collect the data. The questionnaire was administered at the time of delivering the educational content as the pretest evaluation and 30 min after the angiography procedure as the posttest evaluation. SPSS software, version 18, was used for statistical analysis. Results There was no significant difference among the three groups of patients in terms of pretest DASS-21 scores. Conversely, the mean posttest scores in all DASS-21 domains were significantly lower among the patients receiving education via the multimedia DVD or text messaging in comparison with the control group (P < 0.001). However, there were no statistically significant differences between the mean scores in all domains between the participants in the DVD and text messaging groups. Conclusion It seems that both DVDs and text messaging are more effective than conventional pamphlets in controlling the anxiety, stress, and stress of patients scheduled for elective coronary artery angiography. Iranian Registry of Clinical Trials: IRCT registration number: IRCT2015030121283N1, Registration date: 2015-10-05, 1394/07/13
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Affiliation(s)
- Camellia Torabizadeh
- School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Rousta
- School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sakineh Gholamzadeh
- School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Javad Kojouri
- Education Development Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kavoos Jamali
- Kowsar Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Mahdi Parvizi
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. .,Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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16
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Noble JM, Vuong W, Surood S, Urichuk L, Greenshaw AJ, Agyapong VIO. Text4Support Mobile-Based Programming for Individuals Accessing Addictions and Mental Health Services-Retroactive Program Analysis at Baseline, 12 Weeks, and 6 Months. Front Psychiatry 2021; 12:640795. [PMID: 34122173 PMCID: PMC8192801 DOI: 10.3389/fpsyt.2021.640795] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 04/28/2021] [Indexed: 12/15/2022] Open
Abstract
Objective: Where traditional approaches fall short, widely accessible and accepted, yet under leveraged, digital technologies such as text messaging present novel opportunities to solve a range of health care solutions. The following provides a preliminary analysis of the Text4Support program, a text-messaging intervention using the principles of cognitive behavioral therapy, which seeks to support the health and well-being of individuals seeking support for addiction or mental health concerns. The goal of this study was to assess whether the Text4Support program improved the perceived overall mental well-being of participants. Methods: The evaluation analyzes survey responses of individuals who were enrolled in the Text4Support program beginning in July 2019, who had completed the 6-months program by May 2020. Participants were asked to provide responses to three surveys during their time in the program-at baseline, 12-weeks and 6-months, which included questions documenting demographic information, general satisfaction with the program, and a participants' level of "global distress" through use of the Clinical Outcomes Routine Evaluation System (CORE-10)-a validated brief 10-item assessment and outcome measurement tool used to assess conditions including anxiety, depression, physical problems, and risk to self. Results and Conclusions: This data set did not include a large enough sample of participants to reach statistical significance. Nevertheless, the study provides some preliminary analysis, and identifies opportunities for the future analysis and research.
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Affiliation(s)
- Jasmine M Noble
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Wesley Vuong
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Shireen Surood
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Liana Urichuk
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Andrew J Greenshaw
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Vincent I O Agyapong
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
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17
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Duan S, Wang H, Wilson A, Qiu J, Chen G, He Y, Wang Y, Ou J, Chen R. Developing a Text Messaging Intervention to Reduce Deliberate Self-Harm in Chinese Adolescents: Qualitative Study. JMIR Mhealth Uhealth 2020; 8:e16963. [PMID: 32392173 PMCID: PMC7317623 DOI: 10.2196/16963] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/19/2020] [Accepted: 03/01/2020] [Indexed: 01/27/2023] Open
Abstract
Background Deliberate self-harm is common during adolescence and can have detrimental consequences for the well-being of adolescents. Although it is sometimes difficult to engage adolescents in traditional psychotherapies for deliberate self-harm, SMS text messaging has been shown to be promising for cost-effective and low-intensity interventions. Objective This study aimed to investigate the views of Chinese adolescents with deliberate self-harm about SMS text messaging interventions in order to develop an acceptable and culturally competent intervention for adolescents with deliberate self-harm. Methods Semistructured interviews were conducted with 23 adolescents who had experience with deliberate self-harm. The transcripts of the interviews were analyzed using thematic analysis. Results Four themes were identified: beneficial perception of receiving messages, short frequency and duration of messages, caring content in messages, and specific times for sending messages. Most of the participants perceived SMS text messaging interventions to be beneficial. The key factors that emerged for the content of the intervention included encouragement and company, feeling like a virtual friend, providing coping strategies, and individualized messages. In addition, the preferred frequency and duration of the SMS text messaging intervention were identified. Conclusions Our study will help in the development of a culturally appropriate SMS text messaging intervention for adolescents with deliberate self-harm. It has the potential to decrease deliberate self-harm instances by providing acceptable support for adolescents with deliberate self-harm who may be reluctant to seek face-to-face psychotherapies.
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Affiliation(s)
- Suqian Duan
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Haoran Wang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Amanda Wilson
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
| | - Jiexi Qiu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Guanmei Chen
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuqiong He
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuanyuan Wang
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
| | - Jianjun Ou
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Runsen Chen
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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18
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Kornfield R, Zhang R, Nicholas J, Schueller SM, Cambo SA, Mohr DC, Reddy M. "Energy is a Finite Resource": Designing Technology to Support Individuals across Fluctuating Symptoms of Depression. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2020; 2020:10.1145/3313831.3376309. [PMID: 33585841 PMCID: PMC7877799 DOI: 10.1145/3313831.3376309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
While the HCI field increasingly examines how digital tools can support individuals in managing mental health conditions, it remains unclear how these tools can accommodate these conditions' temporal aspects. Based on weekly interviews with five individuals with depression, conducted over six weeks, this study identifies design opportunities and challenges related to extending technology-based support across fluctuating symptoms. Our findings suggest that participants perceive events and contexts in daily life to have marked impact on their symptoms. Results also illustrate that ebbs and flows in symptoms profoundly affect how individuals practice depression self-management. While digital tools often aim to reach individuals while they feel depressed, we suggest they should also engage individuals when they are less symptomatic, leveraging their energy and motivation to build habits, establish plans and goals, and generate and organize content to prepare for symptom onset.
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Affiliation(s)
| | | | - Jennifer Nicholas
- Northwestern University Chicago, IL, USA
- University of Melbourne Melbourne, Australia
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19
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McCall T, Schwartz TA, Khairat S. The Acceptability of Text Messaging to Help African American Women Manage Anxiety and Depression: Cross-Sectional Survey Study. JMIR Ment Health 2020; 7:e15801. [PMID: 31909720 PMCID: PMC7055826 DOI: 10.2196/15801] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/28/2019] [Accepted: 11/16/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The rates of mental illness among African American women are comparable with the general population; however, they significantly underutilize mental health services compared with their white counterparts. Previous studies revealed that interventions delivered via text messaging are effective and can be used to increase access to services and resources. More insight into whether or not this modality is acceptable for use to deliver mental health care to help African American women manage anxiety and depression is needed. OBJECTIVE This exploratory study aimed to gain insight into the acceptability of using text messaging to help African American women manage anxiety and depression. METHODS A self-administered Web-based survey was launched in June 2018 and closed in August 2018. Eligible participants were African American women (18 years or older) who reside in the United States. Participants were recruited through convenience sampling (eg, email sent via listservs and social media posts). Respondents were provided an anonymous link to the questionnaire. The survey consisted of 53 questions on the following subjects: sociodemographic characteristics, attitudes toward seeking professional psychological help, mobile phone use, and acceptability of using a mobile phone to receive mental health care. RESULTS The results of this exploratory study (N=101) showed that fewer than half of respondents endorsed the use of text messaging to communicate with a professional to receive help to manage anxiety (49/101, 48.5%) and depression (43/101, 42.6%). Approximately 51.4% (52/101) agreed that having the option to use text messaging to communicate with a professional if they are dealing with anxiety would be helpful. Similarly, 48.5% (49/101) agreed that having the option to use text messaging to communicate with a professional if they are dealing with depression would be helpful. Among participants who agreed that text messaging would be helpful, more than 80% noted being comfortable with its use to receive help for managing anxiety (approximately 86%, 45/52) and depression (approximately 82%, 40/49; highly significant positive association, all P<.001). More than 50% of respondents (56/101, 55.4%) indicated having concerns about using text messaging. No statistically significant associations were found between age and agreement with the use of text messaging to communicate with a professional to receive help for managing anxiety (P=.26) or depression (P=.27). CONCLUSIONS The use of text messaging was not highly endorsed by African American women as an acceptable mode of communication with a professional to help them manage anxiety or depression. Concerns around privacy, confidentiality, and the impersonal feel of communicating about sensitive issues via text messages must be addressed for this modality to be a viable option. The findings of this study demonstrated the need for further research into the use of mobile technology to provide this population with more accessible and convenient options for mental health care.
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Affiliation(s)
- Terika McCall
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Todd A Schwartz
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Saif Khairat
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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20
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Silverman-Lloyd LG, Dominguez Cortez J, Godage SK, Valenzuela Araujo D, Rivera T, Polk S, DeCamp LR. Immigrant Latino parents demonstrated high interactivity with pediatric primary care text messaging intervention. Mhealth 2020; 6:45. [PMID: 33209916 PMCID: PMC7656102 DOI: 10.21037/mhealth.2020.01.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 01/16/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The majority of Latino immigrants have been shown to have a mobile phone. Cellular phones offer a low-cost method of reaching larger populations and have the potential for increased tailoring and interactivity. This supports the development of mHealth interventions to address healthcare disparities in this population. In this study we sought to evaluate the feasibility and acceptability of interactive Spanish-language text messages sent throughout a child's first year of life in a low-income, limited-English proficient (LEP) Latino population to support families in accessing and using pediatric primary care more effectively. METHODS Participants (n=79) received interactive text messages over a period of 12 months as a part of a multi-modal mHealth intervention conducted at an urban academic pediatric primary care practice. Inclusion criteria were: singleton infant <2 months of age, enrollment in public health insurance, parent age >18, parent preferred healthcare language of Spanish, and at least one household cellular phone. Interactive text messages were designed to promote increased healthcare engagement and prompted participant responses through preprogramed algorithms. Text message sequences included clinic appointment reminders, support for obtaining medicine and completing referral appointments, monitoring of illness care needs and use, and parent support program reminders. Descriptive analyses were used to examine text message volume, usability, and participant response to text sequences. RESULTS Among participants, mean parent age was 30.1 years (SD: 6.1 years); mean years in the US was 7.5 years (SD: 5.1 years). 63.3% of parents had less than a high school education and 84.8% of parents had possible/high likelihood of limited health literacy. Participants completed the majority of sequences with appointment reminder sequences having the quickest response time. The top quartile of responders completed 88.3% of sequences; lower educational attainment was associated with lower text message sequence completion. Participants rated the program positively, especially the appointment reminders. CONCLUSIONS LEP Latino parents successfully engaged with interactive Spanish-language text sequences and parent acceptability was high. This study demonstrates feasibility for interventions employing this technology. Text message interventions may be a feasible approach to reduce healthcare disparities and costs for vulnerable populations.
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Affiliation(s)
- Luke G. Silverman-Lloyd
- University of California, Berkeley-University of California, San Francisco Joint Medical Program, Berkeley, CA, USA
| | - Jose Dominguez Cortez
- Johns Hopkins Center for Health/Salud and Opportunity for Latinos, Baltimore, MD, USA
| | | | | | - Tatiahna Rivera
- Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Sarah Polk
- Johns Hopkins Center for Health/Salud and Opportunity for Latinos, Baltimore, MD, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lisa Ross DeCamp
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, USA
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21
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Ramos G, Chavira DA. Use of Technology to Provide Mental Health Care for Racial and Ethnic Minorities: Evidence, Promise, and Challenges. COGNITIVE AND BEHAVIORAL PRACTICE 2019. [DOI: 10.1016/j.cbpra.2019.10.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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22
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Kaonga NN, Morgan J. Common themes and emerging trends for the use of technology to support mental health and psychosocial well-being in limited resource settings: A review of the literature. Psychiatry Res 2019; 281:112594. [PMID: 31605874 DOI: 10.1016/j.psychres.2019.112594] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 09/29/2019] [Accepted: 09/29/2019] [Indexed: 12/19/2022]
Abstract
There are significant disparities in access to mental health care. With the burgeoning of technologies for health, digital tools have been leveraged within mental health and psychosocial support programming (eMental health). A review of the literature was conducted to understand and identify how eMental health has been used in resource-limited settings in general. PubMed, Ovid Medline and Web of Science were searched. Six-hundred and thirty full-text articles were identified and assessed for eligibility; of those, 67 articles met the inclusion criteria and were analyzed. The most common mental health use cases were for depression (n = 25) and general mental health and well-being (n = 21). Roughly one-third used a website or Internet-enabled intervention (n = 23) and nearly one-third used an SMS intervention (n = 22). Technology was applied to enhance service delivery (n = 32), behavior change communication (n = 26) and data collection (n = 8), and specifically dealt with adherence (n = 7), ecological momentary assessments (n = 7), well-being promotion (n = 5), education (n = 8), telemedicine (n = 28), machine learning (n = 5) and games (n = 2). Emerging trends identified wearables, predictive analytics, robots and virtual reality as promising areas. eMental health interventions that leverage low-tech tools can introduce, strengthen and expand mental health and psychosocial support services and can be a starting point for future, advanced tools.
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Affiliation(s)
- Nadi Nina Kaonga
- HealthEnabled, Cape Town, South Africa; Tufts University School of Medicine, Boston, MA, United States; Maine Medical Center, Portland, ME, United States.
| | - Jonathan Morgan
- Regional Psychosocial Support Initiative (REPSSI), Cape Town, South Africa.
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23
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Urizar GG, Caliboso M, Gearhart C, Yim IS, Dunkel Schetter C. Process Evaluation of a Stress Management Program for Low-Income Pregnant Women: The SMART Moms/Mamás LÍSTAS Project. HEALTH EDUCATION & BEHAVIOR 2019; 46:930-941. [PMID: 31390900 DOI: 10.1177/1090198119860559] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background. The SMART Moms/Mamás LÍSTAS Project was a randomized control trial that tested the efficacy of a prenatal stress management program in reducing stress and cortisol levels among low-income women. The current study is a process evaluation of the stress management program (intervention arm of the original randomized controlled trial) and assessed whether implementation fidelity factors (i.e., intervention delivery, receipt, and enactment) were associated with lower stress (perceived stress, salivary cortisol), improved negative and positive mood states (Positive and Negative Affect Schedule), and increased confidence to use relaxation and coping skills. Method. Fifty-five low-income pregnant women (71% Latina, 76% annual income <$20,000) attended weekly group-based sessions over an 8-week period in which a clinically trained researcher taught relaxation and coping skills. Process evaluation measures were obtained via participant self-report and videotaped class sessions that were coded for delivery, receipt, and enactment of the intervention to determine which implementation factors were associated with changes in program outcomes (stress, mood, confidence) over the 8-week period. Results. Women in stress management showed a significant reduction in their stress and cortisol levels (p < .001), improvements in negative and positive mood states (p < .001) and were more confident in using relaxation and coping skills postintervention (74%). The implementation factors of delivery (i.e., instructor adherence to intervention content; p = .03) and enactment (i.e., participant use of intervention skills; p = .02) were most associated with improvements in program outcomes. Conclusion. These findings highlight that implementation factors should be considered when delivering stress management interventions in underserved communities.
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Affiliation(s)
- Guido G Urizar
- California State University, Long Beach, Long Beach, CA, USA
| | | | | | - Ilona S Yim
- University of California, Irvine, Irvine, CA, USA
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24
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Forsythe AM, Venter C. Behavioral Economics, Motivating Psycho-Education Improvements: A Mobile Technology Initiative in South Africa. Front Psychol 2019; 10:1560. [PMID: 31354576 PMCID: PMC6635590 DOI: 10.3389/fpsyg.2019.01560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 06/20/2019] [Indexed: 11/13/2022] Open
Abstract
Here we report on a health behavioral support project, using incentivized behavior on a mobile platform through M4JAM. This was a proof of concept study to support further developments, more specifically targeted at the management of tuberculosis and human immunodeficiency virus. The study reported here examines the impact of financial rewards and app toward improving mental health outcomes in South Africa. A total of 136 participants were recruited from a database and dichotomized into self-determined and heteronomous groups based on self-report scores. Overall the findings reported here highlight that personal financial incentives have a role in motivating behavior. The findings are discussed in light of the usefulness of an incentivized mobile platform in real-world practice to encourage mental health improvements in low- to middle-income countries.
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Affiliation(s)
- Alexandra Mary Forsythe
- Centre for Psychological Research, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Catherine Venter
- School of Psychology, University of Liverpool, Liverpool, United Kingdom
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Marko-Holguin M, Cordel SL, Van Voorhees BW, Fogel J, Sykes E, Fitzgibbon M, Glassgow AE. A Two-Way Interactive Text Messaging Application for Low-Income Patients with Chronic Medical Conditions: Design-Thinking Development Approach. JMIR Mhealth Uhealth 2019; 7:e11833. [PMID: 31042152 PMCID: PMC6658312 DOI: 10.2196/11833] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 01/18/2019] [Accepted: 01/30/2019] [Indexed: 12/02/2022] Open
Abstract
Background Two-way interactive text messaging between patient and community health workers (CHWs) through mobile phone SMS (short message service) text messaging is a form of digital health that can potentially enhance patient engagement in young adults and families that have a child with chronic medical conditions such as diabetes mellitus, sickle cell disease, and asthma. These patients have complex needs, and a user-centered way can be useful for designing a tool to address their needs. Objective The aim of this study was to utilize the user-centered approach of design thinking to develop a two-way interactive communication SMS text messaging tool for communication between patients or caregivers and CHWs. Methods We applied a design thinking methodology for development of the SMS text messaging tool. We collected qualitative data from 127 patients/caregivers and 13 CHWs, health care professionals, and experts. In total, 4 iterative phases were used to design the final prototype. Results The design thinking process led to the final SMS text messaging tool that was transformed from a one-dimensional, template-driven prototype (phases 1 and 2) into a dynamic, interactive, and individually tailored tool (phases 3 and 4). The individualized components consider social factors that influence patients’ ability to engage such as transportation issues and appointment reminders. SMS text messaging components also include operational factors to support staff such as patient contact lists, SMS text messaging templates, and technology chat support. Conclusions Design thinking can develop a tool to meet the engagement needs of patients with complex health care needs and be user-friendly for health care staff.
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Affiliation(s)
- Monika Marko-Holguin
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Stephanie Luz Cordel
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States.,All Voices Consulting, LLC, Phoenix, AZ, United States
| | | | - Joshua Fogel
- Department of Business Management, Brooklyn College, Brooklyn, NY, United States
| | - Emily Sykes
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Marian Fitzgibbon
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Anne Elizabeth Glassgow
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
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Tailored Text Message Prompts to Increase Therapy Homework Adherence: A Single-Case Randomised Controlled Study. BEHAVIOUR CHANGE 2019. [DOI: 10.1017/bec.2019.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Psychotherapy homework completion is associated with positive treatment outcomes, but many patients show low adherence to prescribed assignments. Whether text-message prompts are effective in increasing adherence to assignments is unknown.Aims:To evaluate whether tailored daily text-message prompts can increase homework adherence in a stress/anxiety treatment.Method:This study used a randomised controlled single-case alternating treatment design with parallel replication in seven participants. Participants received a five-week relaxation program for stress and anxiety with daily exercises. The intervention consisted of daily text messages tailored for each participant. Phases with or without text messages were randomly alternated over the study course. Randomisation tests were used to statistically analyse differences in mean number of completed relaxation exercises between phases.Results:There was a significant (combinedp= .018) effect of daily text messages on homework adherence across participants with weak to medium effect size improvements. No negative effects of daily text messages were identified.Conclusions:Tailored text messages can marginally improve adherence to assignments for patients in CBT. Further studies may investigate how text messages can be made relevant for more patients and whether text messages can be used to increase homework quality rather than quantity.
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Cummings JR, Gaydos LM, Mensa-Kwao A, Song M, Blake SC. Perspectives on caregiver-focused MHealth Technologies to improve mental health treatment for low-income youth with ADHD. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2019; 4:6-16. [PMID: 31106258 PMCID: PMC6519954 DOI: 10.1007/s41347-018-0066-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To examine stakeholder perspectives regarding: (1) whether mobile health (MHealth) tools can improve the mental health (MH) treatment process for low-income youth with ADHD in safety net settings; and (2) what functions would be helpful to improve the treatment process. METHODS This study analyzed qualitative data from a larger project that collected information from key stakeholders at four safety-net clinics across Georgia. We conducted five focus groups with caregivers who had a Medicaid-insured child receiving treatment for ADHD, and 17 semi-structured interviews with clinic administrators and providers. Stakeholders shared their perspectives on strategies to improve the MH treatment process, including the use of mHealth tools. Caregivers also completed a brief survey about technology use. We present findings from a thematic analysis of the qualitative data and descriptive findings from the survey. RESULTS Participants in each group of stakeholders expressed interest in mHealth tools that would: (1) deliver reminders for caregivers (including appointment and medication refill reminders); (2) help caregivers obtain information about ADHD symptoms and treatment options; (3) help caregivers track information about their child's symptoms and treatment progress; and (4) facilitate communication between caregivers and providers. While more than three-fourths of caregivers had a smartphone, providers and administrators expressed concern that access to mHealth technologies may be inconsistent if low-income families are unable to pay cellular phone bills. CONCLUSIONS Caregivers, clinic administrators, and providers were supportive of enhanced mHealth technologies to improve MH care for this population.
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Affiliation(s)
- Janet R. Cummings
- Department of Health Policy and Management, Rollins School of Public Health, Emory University
| | - Laura M. Gaydos
- Department of Health Policy and Management, Rollins School of Public Health, Emory University
| | - Augustina Mensa-Kwao
- Department of Behavioral Health Sciences and Health Education, Rollins School of Public Health, Emory University
| | - Minna Song
- Department of Behavioral Health Sciences and Health Education, Rollins School of Public Health, Emory University
| | - Sarah C. Blake
- Department of Health Policy and Management, Rollins School of Public Health, Emory University
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Laoch A, Holmes CM. Serving Transgender Clients in the Digital Age. JOURNAL OF LGBT ISSUES IN COUNSELING 2019. [DOI: 10.1080/15538605.2018.1488233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ari Laoch
- Mental Health & Wellness, Health Brigade, Richmond, Virginia, USA
| | - Courtney M. Holmes
- Department of Rehabilitation Counseling, Virginia Commonwealth University, Richmond, Virginia, USA
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Smartphone Applications for Mindfulness Interventions with Suicidality in Asian Older Adults: A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122810. [PMID: 30544738 PMCID: PMC6313610 DOI: 10.3390/ijerph15122810] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 11/16/2022]
Abstract
Elderly suicide is a rising concern. Despite the advent of mobile technology, there remained a gap in the evidence base as to whether smartphone applications could be used for mindfulness intervention for suicidality in Asian older adults. This paper aimed to review recent research relevant to smartphone applications that could be used in providing mindfulness interventions for suicidality to Asian older adults. The inclusion criteria for this review were papers published in peer-reviewed journals from 2008 to 2018 with the usage of specific search terms, namely, ‘smartphone application’, ‘mobile application’, and ‘mindfulness’, assessed against the inclusion criteria and screened by an experienced Asian clinician to be of clinical utility for mindfulness intervention for suicidality with Asian older adults. Initial search on databases yielded 236 results. A total of 35 full text papers that fit the inclusion criteria were assessed for eligibility and 10 papers were included in the current review. This review highlighted the paucity of rigorous empirically validated research into effective smartphone applications that can be used for mindfulness interventions for suicidality with Asian older adults.
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Effectiveness of Resilience Teaching via Short Message Service on Stress of Mothers of Educable Mentally Retarded Children. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2018. [DOI: 10.5812/ijpbs.59966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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García Y, Ferrás C, Rocha Á, Aguilera A. Design and acceptability of a psychosocial text messaging intervention for victims of gender-based violence. Health Informatics J 2018; 25:1588-1594. [PMID: 30113247 DOI: 10.1177/1460458218792688] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mobile phones can produce detailed and personalized data to help diagnose, treat, prevent or rehabilitate women who are victims of gender violence. We sent automatic text messages, based on cognitive-behavioural therapy, to female victims of gender violence to assess the feasibility of the medium for mental health intervention. During the 28-day intervention period, each woman received four automatic text messages every day on a pre-established schedule. We evaluated symptoms of depression using the Personal Health Questionnaire-9. The Personal Health Questionnaire-9 decreased from an average of 14.8 at the beginning of the intervention, to 6.1 at the end of the text messaging period. All of the women reported that they liked receiving the messages, they found them useful and they felt that the messages had improved their health. Text messages are acceptable to women users who are recipients of public health and social services. Future research should focus more on the evaluation of the results and on how the specific content and aspects of text messaging improve health outcomes.
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Lam JA, Kahler CW. A randomized crossover trial to test the effects of positive psychology intervention delivered by text messaging. THE JOURNAL OF POSITIVE PSYCHOLOGY 2018. [DOI: 10.1080/17439760.2017.1315649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Jeffrey A. Lam
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Christopher W. Kahler
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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Choo CC, Burton AA. Smartphone Apps for Mindfulness Interventions for Suicidality in Asian Youths: Literature Review. JMIR Mhealth Uhealth 2018; 6:e139. [PMID: 29880468 PMCID: PMC6013712 DOI: 10.2196/mhealth.8304] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/13/2017] [Accepted: 11/16/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The advent of mobile technology has ushered in an era in which smartphone apps can be used as interventions for suicidality. OBJECTIVE We aimed to review recent research that is relevant to smartphone apps that can be used for mindfulness interventions for suicidality in Asian youths. METHODS The inclusion criteria for this review were: papers published in peer-reviewed journals from 2007 to 2017 with usage of search terms (namely "smartphone application" and "mindfulness") and screened by an experienced Asian clinician to be of clinical utility for mindfulness interventions for suicidality with Asian youths. RESULTS The initial search of databases yielded 375 results. Fourteen full text papers that fit the inclusion criteria were assessed for eligibility and 10 papers were included in the current review. CONCLUSIONS This review highlighted the paucity of evidence-based and empirically validated research into effective smartphone apps that can be used for mindfulness interventions for suicidality with Asian youths.
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Affiliation(s)
| | - André Ad Burton
- School of Psychology, Curtin University, Western Australia, Australia
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Aguilera A, Ramos Z, Sistiva D, Wang Y, Alegria M. Homework completion via telephone and in-person Cognitive Behavioral Therapy among Latinos. COGNITIVE THERAPY AND RESEARCH 2018; 42:340-347. [PMID: 29725144 PMCID: PMC5927598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Homework completion in cognitive behavioral therapy (CBT) for depression is an integral ingredient in treatment that often goes unreported. Furthermore, many studies of homework completion focus on patient adherence without considering the therapists' role in reviewing and reinforcing this behavior. No studies to date have assessed the relationship between homework variables and outcomes among Latinos receiving CBT for depression. Since this population has often been difficult to engage in CBT, this study aims to assess whether homework completion and therapist review of homework are related to improved outcomes in a CBT intervention (telephone or in person) for Latinos with depression. We found that higher homework completion was significantly related to lower depression scores at the end of final treatment (as measured by PHQ-9) (B = -1.38, p < 0.01). However, the significant association of homework with depression went away when clinician review of homework was included in a subsequent step of the model (B = -0.42, p = 0.45). The number of times a clinician actively reviewed homework was still significantly related to a decrease in PHQ-9 when controlling for demographic factors (B = -1.23, p < 0.01). This study found that homework is a predictor of improved outcomes in CBT for depression but highlights the role of therapists reviewing homework as a predictor of lower depression symptoms among Spanish speaking Latinos from low socioeconomic backgrounds.
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Affiliation(s)
- Adrian Aguilera
- University of California, Berkeley, School of Social Welfare, 120 Haviland Hall, Berkeley, CA, MC7400, USA
- University of California, San Francisco, Department of Psychiatry, San Francisco, CA
| | - Zorangeli Ramos
- University of California, Berkeley, School of Social Welfare, 120 Haviland Hall, Berkeley, CA, MC7400, USA
| | - Diana Sistiva
- University of California, Berkeley, School of Social Welfare, 120 Haviland Hall, Berkeley, CA, MC7400, USA
| | - Ye Wang
- Massachusetts General Hospital, Disparities Research Unit, Boston, MA
| | - Margarita Alegria
- Massachusetts General Hospital, Disparities Research Unit, Boston, MA
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Adkins EC, Zalta AK, Boley RA, Glover A, Karnik NS, Schueller SM. Exploring the potential of technology-based mental health services for homeless youth: A qualitative study. Psychol Serv 2018; 14:238-245. [PMID: 28481610 DOI: 10.1037/ser0000120] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Homelessness has serious consequences for youth that heighten the need for mental health services; however, these individuals face significant barriers to access. New models of intervention delivery are required to improve the dissemination of mental health interventions that tailor these services to the unique challenges faced by homeless youth. The purpose of this study was to better understand homeless youths' use of technology, mental health experiences and needs, and willingness to engage with technology-supported mental health interventions to help guide the development of future youth-facing technology-supported interventions. Five focus groups were conducted with 24 homeless youth (62.5% female) in an urban shelter. Youth were 18- to 20-years-old with current periods of homelessness ranging from 6 days to 4 years. Transcripts of these focus groups were coded to identify themes. Homeless youth reported using mobile phones frequently for communication, music, and social media. They indicated a lack of trust and a history of poor relationships with mental health providers despite recognizing the need for general support as well as help for specific mental health problems. Although initial feelings toward technology that share information with a provider were mixed, they reported an acceptance of tracking and sharing information under certain circumstances. Based on these results, we provide recommendations for the development of mental health interventions for this population focusing on technology-based treatment options. (PsycINFO Database Record
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Affiliation(s)
- Elizabeth C Adkins
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University
| | - Alyson K Zalta
- Department of Behavioral Sciences and Psychiatry, Rush University Medical Center
| | - Randy A Boley
- Department of Psychiatry, Rush University Medical Center
| | - Angela Glover
- Department of Psychiatry, Rush University Medical Center
| | | | - Stephen M Schueller
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University
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Choo CC, Burton AAD. Mobile Phone Apps for Behavioral Interventions for At-Risk Drinkers in Australia: Literature Review. JMIR Mhealth Uhealth 2018; 6:e18. [PMID: 29439946 PMCID: PMC5829458 DOI: 10.2196/mhealth.6832] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 06/07/2017] [Accepted: 10/09/2017] [Indexed: 01/02/2023] Open
Abstract
Background The mobile technology era has ushered in the use of mobile phone apps for behavioral intervention for at-risk drinkers. Objective Our objective was to review recent research relevant to mobile phone apps that can be used for behavioral intervention for at-risk drinkers in Australia. Methods The inclusion criteria for this review were articles published in peer-reviewed journals from 2001 to 2017 with use of the search terms “smartphone application,” “alcohol,” “substance,” “behavioural intervention,” “electronic health,” and “mobile health.” Results In total, we identified 103 abstracts, screened 90 articles, and assessed 50 full-text articles that fit the inclusion criteria for eligibility. We included 19 articles in this review. Conclusions This review highlighted the paucity of evidence-based and empirically validated research into effective mobile phone apps that can be used for behavioral interventions with at-risk drinkers in Australia.
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Affiliation(s)
- Carol C Choo
- College of Healthcare Sciences, James Cook University, Singapore, Singapore
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Implementing Group CBT for Depression Among Latinos in a Primary Care Clinic. COGNITIVE AND BEHAVIORAL PRACTICE 2018; 25:135-144. [PMID: 29606848 DOI: 10.1016/j.cbpra.2017.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Depression in low-income Latino populations can be treated using group cognitive behavioral therapy (GCBT). However, effective delivery of GCBT for depression in primary care settings is often impeded by high dropout rates and poor homework adherence. In this study, we describe the structure, processes, and outcomes (including attendance, homework completion, and symptom measures) of GCBT for Spanish-speaking Latino patients with depression in an urban public sector primary care setting. For this study, 96 Latino patients in a primary care clinic participated in at least 1 session of GCBT. Although depressive symptoms among these patients, as measured by the PHQ-9, significantly decreased during treatment, attendance and homework completion were limited. Even with a strategy in place to allow patients to continue in treatment after missing several sessions, 23% of patients dropped out of therapy following their initial session, and approximately half of all patients completed less than 50% (or 8) therapy sessions. Homework was only completed 23% of the time it was checked. Greater session attendance prospectively predicted lower depressive symptoms over time. We discuss potential strategies to increase engagement, treatment effects, and symptom reduction for depression in primary care settings.
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Aguilera A, Ramos Z, Sistiva D, Wang Y, Alegria M. Homework Completion via Telephone and In-Person Cognitive Behavioral Therapy Among Latinos. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-017-9884-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bhat A, Mao J, Unutzer J, Reed S, Unger J. Text messaging to support a perinatal collaborative care model for depression: A multi-methods inquiry. Gen Hosp Psychiatry 2018; 52:14-20. [PMID: 29494854 PMCID: PMC5936469 DOI: 10.1016/j.genhosppsych.2018.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/08/2018] [Accepted: 01/17/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Mental health care integrated into obstetric settings improves access to perinatal depression treatments. Digital interactions such as text messaging between patient and provider can further improve access. We describe the use of text messaging within a perinatal Collaborative Care (CC) program, and explore the association of text messaging content with perinatal depression outcomes. METHODS We analyzed data from an open treatment trial of perinatal CC in a rural obstetric clinic. Twenty five women with Patient Health Questionnaire-9 score of ≥10 enrolled in CC, and used text messaging to communicate with their Care Manager(CM). We used surveys and focus groups to assessacceptability of text messaging with surveys and focus groups. We calculated the number of text messages exchanged, and analyzed content to understand usage patterns. We explored association between text messaging content and depression outcomes. RESULTS CMs initiated 85.4% messages, and patients responded to 86.9% messages. CMs used text messaging for appointment reminders, and patients used it to obtain obstetric and parenting information. CMs had concerns about the likelihood of boundary violations. Patients appreciated the asynchronous nature of text messaging. CONCLUSION Text messaging is feasible and acceptable within a perinatal CC program. We need further research into the effectiveness of text messaging content, and response protocols.
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Affiliation(s)
- Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.
| | - Johnny Mao
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Jurgen Unutzer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Susan Reed
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Jennifer Unger
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA,Department of Global Health, University of Washington, Seattle, WA
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Yen S, Ranney ML, Tezanos KM, Chuong A, Kahler CW, Solomon JB, Spirito A. Skills to Enhance Positivity in Suicidal Adolescents: Results From an Open Development Trial. Behav Modif 2017; 43:202-221. [PMID: 29258328 DOI: 10.1177/0145445517748559] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
"Skills to Enhance Positivity" (STEP) is a two-part positive affect program designed to decrease recurrent suicidal behavior in adolescents hospitalized due to suicide risk. Here, we describe the initial pilot phase in which the intervention was developed and modified based on a sample of 20 adolescent participants, aged 12 to 18 years old ( Mage = 15.9, SD = 1.5). STEP consisted of an in-person phase (four sessions) and a remote delivery phase (text messaging and phone calls). The inpatient sessions focused on psychoeducation of positive affect, mindfulness meditation, gratitude, and savoring. The remote delivery phase comprised of weekly phone calls and daily text messages to enhance mood monitoring and skills practice reminders. Average session attendance was 81%, and mean daily response rate to text messages was 73.6%, demonstrating high engagement. STEP was described as good or excellent by over 90% of parents and 100% of adolescents. Only one participant had a suicide attempt, and five were readmitted for suicidality in the following 6 months, fewer than comparable naturalistic studies. Although preliminary results are promising, larger randomized trials are needed to determine the efficacy of STEP in reducing suicidal behaviors.
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Grutzmacher SK, Munger AL, Speirs KE, Zemeir LA, Richard KC, Worthington L. Feasibility of bidirectional text messages in evaluating a text-based nutrition education program for low-income parents: Results from the Text2BHealthy program. EVALUATION AND PROGRAM PLANNING 2017; 64:90-94. [PMID: 28578291 DOI: 10.1016/j.evalprogplan.2017.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 03/14/2017] [Accepted: 04/13/2017] [Indexed: 06/07/2023]
Abstract
Text messages are increasingly used in the delivery of health education programs. One appealing aspect of this approach is the possibility of remotely collecting participant data to use in program tailoring or evaluation. The purpose of the present study is to test the feasibility of using text messages to collect participant data. Using data from 33 texted evaluation questions sent through the Text2BHealthy nutrition education program for low-income parents (n=108-1521) response rates under different incentive and prompting strategies were examined. Response rates are generally low across a pilot year and three program years, ranging from 10-55%. While incentives seemed to be ineffective at improving response rates, results indicate that prompting participants to respond may increase response rates. Individuals who respond to an initial question are highly likely to respond to a follow-up question (88-99%) and to report positive behaviors (68-100%). Responses received through text may be unrepresentative and positively biased. Text messages may be a supplemental data collection strategy in nutrition education programs, but low response rates and response bias undermine data quality.
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Affiliation(s)
| | - Ashley L Munger
- California State University, Los Angeles, Los Angeles, CA, United States.
| | | | - Lindsey A Zemeir
- University of Maryland, College Park, Columbia, MD, United States.
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Bruehlman-Senecal E, Aguilera A, Schueller SM. Mobile Phone-Based Mood Ratings Prospectively Predict Psychotherapy Attendance. Behav Ther 2017; 48:614-623. [PMID: 28711112 PMCID: PMC5512460 DOI: 10.1016/j.beth.2017.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 12/13/2016] [Accepted: 01/02/2017] [Indexed: 11/15/2022]
Abstract
Psychotherapy nonattendance is a costly and pervasive problem. While prior research has identified stable patient-level predictors of attendance, far less is known about dynamic (i.e., time-varying) factors. Identifying dynamic predictors can clarify how clinical states relate to psychotherapy attendance and inform effective "just-in-time" interventions to promote attendance. The present study examines whether daily mood, as measured by responses to automated mobile phone-based text messages, prospectively predicts attendance in group cognitive-behavioral therapy (CBT) for depression. Fifty-six Spanish-speaking Latino patients with elevated depressive symptoms (46 women, mean age=50.92years, SD=10.90years), enrolled in a manualized program of group CBT, received daily automated mood-monitoring text messages. Patients' daily mood ratings, message response rate, and delay in responding were recorded. Patients' self-reported mood the day prior to a scheduled psychotherapy session significantly predicted attendance, even after controlling for patients' prior attendance history and age (OR=1.33, 95% CI [1.04, 1.70], p=.02). Positive mood corresponded to a greater likelihood of attendance. Our results demonstrate the clinical utility of automated mood-monitoring text messages in predicting attendance. These results underscore the value of text messaging, and other mobile technologies, as adjuncts to psychotherapy. Future work should explore the use of such monitoring to guide interventions to increase attendance, and ultimately the efficacy of psychotherapy.
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Affiliation(s)
| | - Adrian Aguilera
- University of California, Berkeley, School of Social Welfare; University of California, San Francisco, San Francisco General Hospital.
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Abaza H, Marschollek M. mHealth Application Areas and Technology Combinations*. A Comparison of Literature from High and Low/Middle Income Countries. Methods Inf Med 2017; 56:e105-e122. [PMID: 28925418 PMCID: PMC6291822 DOI: 10.3414/me17-05-0003] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/25/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND With the continuous and enormous spread of mobile technologies, mHealth has evolved as a new subfield of eHealth. While eHealth is broadly focused on information and communication technologies, mHealth seeks to explore more into mobile devices and wireless communication. Since mobile phone penetration has exceeded other infrastructure in low and middle-income countries (LMICs), mHealth is seen as a promising component to provide pervasive and patient-centered care. OBJECTIVES The aim of our research work for this paper is to examine the mHealth literature to identify application areas, target diseases, and mHealth service and technology types that are most appropriate for LMICs. METHODS Based on the 2011 WHO mHealth report, a combination of search terms, all including the word "mHealth", was identified. A literature review was conducted by searching the PubMed and IEEE Xplore databases. Articles were included if they were published in English, covered an mHealth solution/ intervention, involved the use of a mobile communication device, and included a pilot evaluation study. Articles were excluded if they did not provide sufficient detail on the solution covered or did not focus on clinical efficacy/effectiveness. Cross-referencing was also performed on included articles. RESULTS 842 articles were retrieved and analyzed, 255 of which met the inclusion criteria. North America had the highest number of applications (n=74) followed by Europe (n=50), Asia (n=44), Africa (n=25), and Australia (n=9). The Middle East (n=5) and South America (n=3) had the least number of studies. The majority of solutions addressed diabetes (n=51), obesity (n=25), CVDs (n=24), HIV (n=18), mental health (n=16), health behaviors (n=16), and maternal and child's health (MCH) (n=11). Fewer solutions addressed asthma (n=7), cancer (n=5), family health planning (n=5), TB (n=3), malaria (n=2), chronic obtrusive pulmonary disease (COPD) (n=2), vision care (n=2), and dermatology (n=2). Other solutions targeted stroke, dental health, hepatitis vaccination, cold and flu, ED prescribed antibiotics, iodine deficiency, and liver transplantation (n=1 each). The remainder of solutions (n=14) did not focus on a certain disease. Most applications fell in the areas of health monitoring and surveillance (n=93) and health promotion and raising awareness (n=88). Fewer solutions addressed the areas of communication and reporting (n=11), data collection (n=6), telemedicine (n=5), emergency medical care (n=3), point of care support (n=2), and decision support (n=2). The majority of solutions used SMS messaging (n=94) or mobile apps (n=71). Fewer used IVR/phone calls (n=8), mobile website/email (n=5), videoconferencing (n=2), MMS (n=2), or video (n=1) or voice messages (n=1). Studies were mostly RCTs, with the majority suffering from small sample sizes and short study durations. Problems addressed by solutions included travel distance for reporting, self-management and disease monitoring, and treatment/medication adherence. CONCLUSIONS SMS and app solutions are the most common forms of mHealth applications. SMS solutions are prevalent in both high and LMICs while app solutions are mostly used in high income countries. Common application areas include health promotion and raising awareness using SMS and health monitoring and surveillance using mobile apps. Remaining application areas are rarely addressed. Diabetes is the most commonly targeted medical condition, yet remains deficient in LMICs.
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Affiliation(s)
- Haitham Abaza
- Peter L. Reichertz Institute for Medical Informatics, Hannover Medical School, Hannover, Germany
| | - Michael Marschollek
- Peter L. Reichertz Institute for Medical Informatics, Hannover Medical School, Hannover, Germany
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Hassan ZM. Mobile phone text messaging to improve knowledge and practice of diabetic foot care in a developing country: Feasibility and outcomes. Int J Nurs Pract 2017. [DOI: 10.1111/ijn.12546] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chen RY, Feltes JR, Tzeng WS, Lu ZY, Pan M, Zhao N, Talkin R, Javaherian K, Glowinski A, Ross W. Phone-Based Interventions in Adolescent Psychiatry: A Perspective and Proof of Concept Pilot Study With a Focus on Depression and Autism. JMIR Res Protoc 2017; 6:e114. [PMID: 28623183 PMCID: PMC5493787 DOI: 10.2196/resprot.7245] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 04/05/2017] [Accepted: 04/24/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Telemedicine has emerged as an innovative platform to diagnose and treat psychiatric disorders in a cost-effective fashion. Previous studies have laid the functional framework for monitoring and treating child psychiatric disorders electronically using videoconferencing, mobile phones (smartphones), and Web-based apps. However, phone call and text message (short message service, SMS) interventions in adolescent psychiatry are less studied than other electronic platforms. Further investigations on the development of these interventions are needed. OBJECTIVE The aim of this paper was to explore the utility of text message interventions in adolescent psychiatry and describe a user feedback-driven iterative design process for text message systems. METHODS We developed automated text message interventions using a platform for both depression (EpxDepression) and autism spectrum disorder (ASD; EpxAutism) and conducted 2 pilot studies for each intervention (N=3 and N=6, respectively). The interventions were prescribed by and accessible to the patients' healthcare providers. EpxDepression and EpxAutism utilized an automated system to triage patients into 1 of 3 risk categories based on their text responses and alerted providers directly via phone and an online interface when patients met provider-specified risk criteria. Rapid text-based feedback from participants and interviews with providers allowed for quick iterative cycles to improve interventions. RESULTS Patients using EpxDepression had high weekly response rates (100% over 2 to 4 months), but exhibited message fatigue with daily prompts with mean (SD) overall response rates of 66.3% (21.6%) and 64.7% (8.2%) for mood and sleep questionnaires, respectively. In contrast, parents using EpxAutism displayed both high weekly and overall response rates (100% and 85%, respectively, over 1 to 4 months) that did not decay significantly with time. Monthly participant feedback surveys for EpxDepression (7 surveys) and EpxAutism (18 surveys) preliminarily indicated that for both interventions, daily messages constituted the "perfect amount" of contact and that EpxAutism, but not EpxDepression, improved patient communication with providers. Notably, EpxDepression detected thoughts of self-harm in patients before their case managers or caregivers were aware of such ideation. CONCLUSIONS Text-message interventions in adolescent psychiatry can provide a cost-effective and engaging method to track symptoms, behavior, and ideation over time. Following the collection of pilot data and feedback from providers and patients, larger studies are already underway to validate the clinical utility of EpxDepression and EpxAutism. TRIAL REGISTRATION Clinicaltrials.gov NCT03002311; https://clinicaltrials.gov/ct2/show/NCT03002311 (Archived by WebCite at http://www.webcitation.org/6qQtlCIS0).
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Affiliation(s)
- Robert Yuzen Chen
- Washington University School of Medicine, St. Louis, MO, United States
| | | | | | - Zoe Yunzhu Lu
- Washington University School of Medicine, St. Louis, MO, United States
| | - Michael Pan
- Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Nan Zhao
- Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Rebecca Talkin
- Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Kavon Javaherian
- Washington University School of Medicine, St. Louis, MO, United States
| | - Anne Glowinski
- Washington University School of Medicine, Department of Psychiatry, Division of Child and Adolescent Psychiatry, St. Louis, MO, United States
| | - Will Ross
- Washington University School of Medicine, St. Louis, MO, United States
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Tang W, Kreindler D. Supporting Homework Compliance in Cognitive Behavioural Therapy: Essential Features of Mobile Apps. JMIR Ment Health 2017; 4:e20. [PMID: 28596145 PMCID: PMC5481663 DOI: 10.2196/mental.5283] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 06/02/2016] [Accepted: 02/15/2017] [Indexed: 11/16/2022] Open
Abstract
Cognitive behavioral therapy (CBT) is one of the most effective psychotherapy modalities used to treat depression and anxiety disorders. Homework is an integral component of CBT, but homework compliance in CBT remains problematic in real-life practice. The popularization of the mobile phone with app capabilities (smartphone) presents a unique opportunity to enhance CBT homework compliance; however, there are no guidelines for designing mobile phone apps created for this purpose. Existing literature suggests 6 essential features of an optimal mobile app for maximizing CBT homework compliance: (1) therapy congruency, (2) fostering learning, (3) guiding therapy, (4) connection building, (5) emphasis on completion, and (6) population specificity. We expect that a well-designed mobile app incorporating these features should result in improved homework compliance and better outcomes for its users.
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Affiliation(s)
- Wei Tang
- Discipline of Psychiatry, Department of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - David Kreindler
- Division of Youth Psychiatry, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Centre for Mobile Computing in Mental Health, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Schueller SM, Aguilera A, Mohr DC. Ecological momentary interventions for depression and anxiety. Depress Anxiety 2017; 34:540-545. [PMID: 28494123 DOI: 10.1002/da.22649] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/08/2017] [Accepted: 11/11/2017] [Indexed: 12/19/2022] Open
Abstract
Ecological momentary interventions (EMIs) are becoming more popular and more powerful resources for the treatment and prevention of depression and anxiety due to advances in technological capacity and analytic sophistication. Previous work has demonstrated that EMIs can be effective at reducing symptoms of depression and anxiety as well as related outcomes of stress and at increasing positive psychological functioning. In this review, we highlight the differences between EMIs and other forms of treatment due to the nature of EMIs to be deeply integrated into the fabric of people's day-to-day lives. EMIs require unique considerations in their design, deployment, and evaluation. Furthermore, given that EMIs have been advanced by changes in technologies and that the use of behavioral intervention technologies for mental health has been increasing, we discuss how technologies and analytics might usher in a new era of EMIs. Future EMIs might reduce user burden and increase intervention personalization and sophistication by leveraging digital sensors and advances in natural language processing and machine learning. Thus, although current EMIs are effective, the EMIs of the future might be more engaging, responsive, and adaptable to different people and different contexts.
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Affiliation(s)
- Stephen M Schueller
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Adrian Aguilera
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA.,Department of Psychiatry, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA
| | - David C Mohr
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
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Aguilera A, Bruehlman-Senecal E, Demasi O, Avila P. Automated Text Messaging as an Adjunct to Cognitive Behavioral Therapy for Depression: A Clinical Trial. J Med Internet Res 2017; 19:e148. [PMID: 28483742 PMCID: PMC5440738 DOI: 10.2196/jmir.6914] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 02/10/2017] [Accepted: 03/13/2017] [Indexed: 11/16/2022] Open
Abstract
Background Cognitive Behavioral Therapy (CBT) for depression is efficacious, but effectiveness is limited when implemented in low-income settings due to engagement difficulties including nonadherence with skill-building homework and early discontinuation of treatment. Automated messaging can be used in clinical settings to increase dosage of depression treatment and encourage sustained engagement with psychotherapy. Objectives The aim of this study was to test whether a text messaging adjunct (mood monitoring text messages, treatment-related text messages, and a clinician dashboard to display patient data) increases engagement and improves clinical outcomes in a group CBT treatment for depression. Specifically, we aim to assess whether the text messaging adjunct led to an increase in group therapy sessions attended, an increase in duration of therapy attended, and reductions in Patient Health Questionnaire-9 item (PHQ-9) symptoms compared with the control condition of standard group CBT in a sample of low-income Spanish speaking Latino patients. Methods Patients in an outpatient behavioral health clinic were assigned to standard group CBT for depression (control condition; n=40) or the same treatment with the addition of a text messaging adjunct (n=45). The adjunct consisted of a daily mood monitoring message, a daily message reiterating the theme of that week’s content, and medication and appointment reminders. Mood data and qualitative responses were sent to a Web-based platform (HealthySMS) for review by the therapist and displayed in session as a tool for teaching CBT skills. Results Intent-to-treat analyses on therapy attendance during 16 sessions of weekly therapy found that patients assigned to the text messaging adjunct stayed in therapy significantly longer (median of 13.5 weeks before dropping out) than patients assigned to the control condition (median of 3 weeks before dropping out; Wilcoxon-Mann-Whitney z=−2.21, P=.03). Patients assigned to the text messaging adjunct also generally attended more sessions (median=6 sessions) during this period than patients assigned to the control condition (median =2.5 sessions), but the effect was not significant (Wilcoxon-Mann-Whitney z=−1.65, P=.10). Both patients assigned to the text messaging adjunct (B=−.29, 95% CI −0.38 to −0.19, z=−5.80, P<.001) and patients assigned to the control conditions (B=−.20, 95% CI −0.32 to −0.07, z=−3.12, P=.002) experienced significant decreases in depressive symptom severity over the course of treatment; however, the conditions did not significantly differ in their degree of symptom reduction. Conclusions This study provides support for automated text messaging as a tool to sustain engagement in CBT for depression over time. There were no differences in depression outcomes between conditions, but this may be influenced by low follow-up rates of patients who dropped out of treatment.
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Affiliation(s)
- Adrian Aguilera
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, United States.,Zuckerberg San Francisco General Hospital, Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Emma Bruehlman-Senecal
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, United States
| | - Orianna Demasi
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, Berkeley, CA, United States
| | - Patricia Avila
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, United States.,Zuckerberg San Francisco General Hospital, Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
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Kraft S, Wolf M, Klein T, Becker T, Bauer S, Puschner B. Text Message Feedback to Support Mindfulness Practice in People With Depressive Symptoms: A Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2017; 5:e59. [PMID: 28465278 PMCID: PMC5434251 DOI: 10.2196/mhealth.7095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/15/2017] [Accepted: 02/27/2017] [Indexed: 11/22/2022] Open
Abstract
Background It has been shown that mindfulness practice can be helpful in preventing relapse from depression. However, practicing mindfulness regularly at home is often a challenge for people with depression. Mobile phone text messaging (short message service, SMS) may be a feasible approach to assist regular mindfulness home practice. Objective The aim of this study was to evaluate the feasibility of text message–based feedback to support mindfulness practice in people with depressive symptoms after inpatient psychiatric treatment. Methods Participants received a manualized group introduction to three mindfulness exercises during inpatient treatment and were randomized at hospital discharge. All participants were asked to practice the exercises daily during the 4-month follow-up period. Only participants allocated to the intervention group received reinforcing feedback via mobile phone text messages after reporting their mindfulness practice via text message. Participation rates and satisfaction with the interventions were evaluated, and effects on relevant outcomes were explored. Results Of the 176 eligible inpatients invited to participate, 65.9% (116/176) attended the introductory mindfulness group at least once, 33.0% (58/176) were willing to participate in the study, and 41 were randomized. The majority 85% (35/41) of these participants completed the study. Among the participants allocated to the intervention group (n=21), 81% (17/21) used the text message support at least once. The average number of text messages sent during the intervention period was 14 (SD 21, range 0-91). Satisfaction rates were high. Preliminary analyses of the effects of the intervention yielded mixed results. Conclusions Findings indicate that text messaging following inpatient treatment is feasible for some, but not for all people with depressive symptoms. Modest use of the text messaging intervention and its mixed effects imply that dose and ingredients of the intervention should be increased for this group of patients in a future full-size RCT. Such a larger study should also include a process evaluation to investigate moderators of the effect of mindfulness practice and text message feedback on clinical outcome. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 58808893; http://www.controlled-trials.com/ISRCTN58808893 (Archived by Webcite at http://www.webcitation.org/6pmrDRnGt)
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Affiliation(s)
- Susanne Kraft
- Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Günzburg, Germany
| | - Markus Wolf
- Clinical Psychology and Psychotherapy Research, Institute of Psychology, University of Zurich, Zurich, Switzerland
| | - Thomas Klein
- Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Günzburg, Germany
| | - Thomas Becker
- Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Günzburg, Germany
| | - Stephanie Bauer
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Bernd Puschner
- Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Günzburg, Germany
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Mermelstein H, Guzman E, Rabinowitz T, Krupinski E, Hilty D. The Application of Technology to Health: The Evolution of Telephone to Telemedicine and Telepsychiatry: A Historical Review and Look at Human Factors. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s41347-017-0010-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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