Smartphone delivery of a hope intervention: Another way to flourish

Application of Positive Psychology in Digital Interventions for Children, Adolescents, and Young Adults: Systematic Review and Meta-Analysis of Controlled Trials

BACKGROUND

The rising prevalence of mental health issues in children, adolescents, and young adults has become an escalating public health issue, impacting approximately 10%-20% of young people on a global scale. Positive psychology interventions (PPIs) can act as powerful mental health promotion tools to reach wide-ranging audiences that might otherwise be challenging to access. This increased access would enable prevention of mental disorders and promotion of widespread well-being by enhancing self-efficacy, thereby supporting the achievement of tangible objectives.

OBJECTIVE

We aimed to conduct a comprehensive synthesis of all randomized controlled trials and controlled trials involving children, adolescents, and young adults, encompassing both clinical and nonclinical populations, to comprehensively evaluate the effectiveness of digital PPIs in this age group.

METHODS

After a literature search in 9 electronic databases until January 12, 2023, and gray literature until April 2023, we carried out a systematic review of 35 articles, of which 18 (51%) provided data for the meta-analysis. We included randomized controlled trials and controlled trials mainly based on web-based, digital, or smartphone-based interventions using a positive psychology framework as the main component. Studies included participants with a mean age of <35 years. Outcomes of PPIs were classified into indicators of well-being (compassion, life satisfaction, optimism, happiness, resilience, emotion regulation and emotion awareness, hope, mindfulness, purpose, quality of life, gratitude, empathy, forgiveness, motivation, and kindness) and ill-being (depression, anxiety, stress, loneliness, and burnout). PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used for the selection of studies and data extraction. Quality assessment was performed following the CONSORT (Consolidated Standards of Reporting Trials) guidelines.

RESULTS

For well-being outcomes, meta-analytic results showed that PPIs augmented the feeling of purpose, gratitude, and hope (Hedges g=0.555), compassion (Hedges g=0.447), positive coping behaviors (Hedges g=0.421), body image-related outcomes (Hedges g=0.238), and positive mindset predisposition (Hedges g=0.304). For ill-being outcomes, PPIs reduced cognitive biases (Hedges g=-0.637), negative emotions and mood (Hedges g=-0.369), and stress levels (Hedges g=-0.342). Of note, larger effect sizes were found when a waiting list control group was considered versus a digital control group. A funnel plot showed no publication bias. Meta-regression analyses showed that PPIs tended to show a larger effect size on well-being outcomes in studies including young adults, whereas no specific effect was found for ill-being outcomes.

CONCLUSIONS

Revised evidence suggests that PPIs benefit young people's well-being and mitigate ill-being symptoms. Digital platforms offer a unique way to address their mental health challenges, although not without limitations. Future research should explore how they work for the needs of the young population and further examine what specific PPIs or combination of interventions is most beneficial with respect to other digital control groups.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42023420092; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=420092.

A qualitative study of university students' perspectives of hope during the COVID-19 pandemic

Background

Students in higher education commonly experience mental health problems. There is an ongoing need to explore potential intervention targets to focus on mental health promotion among students. Hopefulness may alleviate or be protective against various negative mental health conditions such as depression, anxiety, suicide, and trauma-related disorders.

Objective

To explore postsecondary students' meanings and experiences of hope during the COVID-19 pandemic and identify factors affecting hopefulness during crises.

Methods

Purposive sampling was used to recruit participants for online semi-structured interviews in a university located in Southwestern Ontario, Canada. Data were analyzed using thematic analysis.

Results

In total, 12 participants were interviewed, and 4 themes were generated: (1) hope is a complex concept with an associated set of behaviors, (2) cognitive framing of hope as a means of student resilience, (3) COVID-19 as an antagonist which amplifies preexisting student concerns and issues, and (4) the social and physical environments serve as barriers and enablers to hope and well-being. Hope was perceived as a positive mental trait, external events and the environment were reported to impact hope, and those who were generally more hopeful adjusted better mentally when unexpected circumstances arose.

Conclusions

Findings shed light on the interconnectedness and complex nature of hope, its sources, and enablers. Novel findings include the ways in which hope was affected during the COVID-19 pandemic. Recommendations for individual- and community-based interventions include targeting enablers to hopefulness by promoting social support systems, offering virtual extracurricular activities, and delivering alternative approaches to teaching and learning.

Promoting hope in minoritized and economically disadvantaged students

Minoritized and economically disadvantaged (MED) students encounter a host of detrimental factors within the academic setting (e.g., racism, classism, low expectations). In order for them to be successful, ways must be found to help them achieve academically despite their disadvantageous academic environments. Recent research indicates that hope theory might provide a pathway for MED students to have a higher chance at success. In this review, how hope has the potential to take on a special significance for MED students as well as how it can be leveraged to increase their odd of academic and life success is discussed. In addition, recent research centered around promoting hope in MED students, both formally and informally, is reviewed. Altogether, this review has implications for cultivating hope in schools.

Courage as Mediator between Positive Resources and General/Domain-Specific Well-Being Indices

Background: the current post-pandemic situation has exacerbated the effects already present due to the recent socio-economic crises belonging to the first two decades of this century: perception of instability, fears, concern for the future, underemployment, undignified work. This situation has negatively impacted life in general, career paths, and perceived quality of life, especially for new generations. Positive resources such as optimism and hope can have a positive effect in countering these effects which are impacting student academic satisfaction, life satisfaction, and flourishing. In the hypothesis, courage acts as a mediator for both domain-specific and general well-being, as perceived by college students. Methods: the research involved 410 Italian university students. Five rating scales were used: Visions About the Future, Courage Measure, Satisfaction with Life Scale (SWLS), the Flourishing Scale, and College Satisfaction Scale. Results: All research variables were significantly and positively correlated. The mediation model almost totally confirmed the hypotheses, as the relationship between optimism and academic satisfaction was totally mediated by courage. In other cases, optimism and hope had both a direct and an indirect effect, mediated by courage, on the life satisfaction, academic satisfaction, and flourishing of college students. Conclusions: the findings are discussed with recent theories and research on this topic, and suggestions are provided with practical implications for those involved in supporting the choice and construction of career paths.

Understanding what we know so far about young people's engagement with wellbeing apps. A scoping review and narrative synthesis

Background

Increased levels of wellbeing contribute to people being more productive, resilient, physically healthy and showing lower levels of mental illness. Using mobile apps to increase wellbeing in young people is becoming the method of choice. This study sought to critically appraise the current evidence base with regards to young people's (16–24 years of age) engagement with wellbeing apps.

Methods

A systematic review of the literature and narrative synthesis was conducted to investigate users’ characteristics and other potential engagement elements. A total of 11,245 titles, 160 abstracts and 68 full-text articles published between 2002 and 2021 were screened, of which 22 studies were included.

Results

Main themes/findings indicated that a user's engagement with wellbeing apps was dependant on the presence of strong identity elements, including motivation, mood and values; design elements such as meaningful rewards, short duration of studies and seamless automatic delivery with low contact with researchers; and being innovative and contextualised. The majority of the studies did not report outcomes by social determinants such as ethnicity, education and others.

Conclusion

This research reflects on the need to consider participants’ individuality when designing app mediated wellbeing interventions.

Mobile Apps That Promote Emotion Regulation, Positive Mental Health, and Well-being in the General Population: Systematic Review and Meta-analysis

BACKGROUND

Among the general public, there appears to be a growing need and interest in receiving digital mental health and well-being support. In response to this, mental health apps (MHapps) are becoming available for monitoring, managing, and promoting positive mental health and well-being. Thus far, evidence supports favorable outcomes when users engage with MHapps, yet there is a relative paucity of reviews on apps that support positive mental health and well-being.

OBJECTIVE

We aimed to systematically review the available research on MHapps that promote emotion regulation, positive mental health, and well-being in the general population aged 18-45 years. More specifically, the review aimed at providing a systematic description of the theoretical background and features of MHapps while evaluating any potential effectiveness.

METHODS

A comprehensive literature search of key databases, including MEDLINE (via Ovid), EMBASE (via Ovid), PsycINFO (via Ovid), Web of Science, and the Cochrane Register of Controlled Trials (CENTRAL), was performed until January 2021. Studies were included if they described standalone mental health and well-being apps for adults without a formal mental health diagnosis. The quality of all studies was assessed against the Mixed Methods Appraisal Tool. In addition, the Cochrane Risk-of-Bias tool (RoB-2) was used to assess randomized control trials (RCTs). Data were extracted using a modified extraction form from the Cochrane Handbook of Systematic Reviews. A narrative synthesis and meta-analysis were then undertaken to address the review aims.

RESULTS

In total, 3156 abstracts were identified. Of these, 52 publications describing 48 MHapps met the inclusion criteria. Together, the studies evaluated interventions across 15 countries. Thirty-nine RCTs were identified suggesting some support for the role of individual MHapps in improving and promoting mental health and well-being. Regarding the pooled effect, MHapps, when compared to controls, showed a small effect for reducing mental health symptoms (k=19, Hedges g=-0.24, 95% CI -0.34 to -0.14; P<.001) and improving well-being (k=13, g=0.17, 95% CI 0.05-0.29, P=.004), and a medium effect for emotion regulation (k=6, g=0.49, 95% CI 0.23-0.74, P<.001). There is also a wide knowledge base of creative and innovative ways to engage users in techniques such as mood monitoring and guided exercises. Studies were generally assessed to contribute unclear or a high risk of bias, or to be of medium to low methodological quality.

CONCLUSIONS

The emerging evidence for MHapps that promote positive mental health and well-being suggests promising outcomes. Despite a wide range of MHapps, few apps specifically promote emotion regulation. However, our findings may position emotion regulation as an important mechanism for inclusion in future MHapps. A fair proportion of the included studies were pilot or feasibility trials (k=17, 33%), and full-scale RCTs reported high attrition rates and nondiverse samples. Given the number and pace at which MHapps are being released, further robust research is warranted to inform the development and testing of evidence-based programs.

Acceptability, Engagement, and Exploratory Outcomes of an Emotional Well-being App: Mixed Methods Preliminary Evaluation and Descriptive Analysis

BACKGROUND

There is growing evidence suggesting that the emotional well-being of the public has been negatively affected in the past year. Consequently, demand for well-being support has increased. Although there is substantial empirical support for mental health apps that target diagnosed conditions, there is less research on emotional well-being apps. Among existing well-being apps, few studies have been conducted on apps that are based on lived experience and those that seek to enhance users' understanding of their emotional patterns. Thus, the acceptability of these novel apps requires further evaluation before upscaling.

OBJECTIVE

This evaluation aims to describe the acceptability, engagement, and preliminary outcomes of using an app (Paradym) designed to promote emotional well-being and positive mental health.

METHODS

This is a pre-post, mixed-methods, single-arm evaluation that is aggregated with digital analytics data. We anonymously collected real-world data on the demographics and well-being of the participants as well as the usability and acceptance of the app using validated questionnaires and open-ended questions. Participants tested the app for a minimum of 2 weeks before completing the follow-up measures. Google Analytics was used to record the level of app engagement. Chi-square and 2-tailed t tests were conducted to analyze quantitative data, and a thematic analysis approach was adopted for qualitative data.

RESULTS

A total of 115 participants completed baseline questionnaires, of which 79.1% (91/115) users downloaded the app. The sample was diverse in terms of ethnicity, including 43.4% (50/115) people who self-identified as belonging to minority ethnic groups. Most of the participants were female (78/115, 67.8%) and between the ages of 18 and 25 years (39/115, 33.9%). A total of 34 app users who completed questionnaires at baseline and follow-up provided valuable feedback to inform the future directions of Paradym. Favorable themes emerged describing the app's content, functionality, and underlying principles. Although usability feedback varied across items, a considerable number of participants (22/34, 64%) found that the app was easy to use. Google Analytics revealed that at least 79% (27/34) of people used the app daily. On the basis of preliminary observations, app users experience increased mental well-being. Post hoc analyses indicated that the reduction in depression scores (t₃₃=-2.16) and the increase in the well-being measures (t₃₃=2.87) were statistically significant. No adverse events were reported during the follow-up period.

CONCLUSIONS

The findings of this evaluation are encouraging and document positive preliminary evidence for the Paradym app.

The Role of Adolescents' Personal and Social Resources in Achieving Desired Emotional and Behavioral Outcomes during an Anxiety-Provoking Pandemic Outbreak

Considering adolescents' developmentally driven stressors and social needs, they may be particularly vulnerable to the anxiety associated with the public health and economic crises due to the COVID-19 pandemic. Furthermore, they may have difficulty following the mandated contagion prevention directives. The current study focused on the role of adolescents' positive personal resources (self-control, hope) and environmental resources (peer support) in two desired outcomes during the COVID-19 outbreak: wellbeing (i.e., maintaining/increasing positivity ratio) and contagion prevention behaviors (i.e., increasing handwashing). Path analysis was conducted using online survey data collected from a representative sample of 651 Israeli adolescents (ages 13-17). Positive resources were found to be both positively intercorrelated and negatively correlated with pandemic-related anxiety and positively with increased handwashing. Self-control correlated positively with social support, which, in turn, correlated positively with the positivity ratio (i.e., more positive than negative affects) and pandemic-related anxiety. Self-control and pandemic-related anxiety both correlated positively with increased prevention behavior. This study highlights the vital role of positive resources in achieving desired psychological and behavioral outcomes for adolescents during the anxiety-provoking pandemic. Beyond its theoretical innovation, this study offers practical value by focusing on malleable variables that could be the focus of dedicated interventions.

Digital epidemiological and citizen science methodology to capture prospective physical activity in free-living conditions: a SMART Platform study

OBJECTIVES

The purpose of this study was to develop a replicable methodology of mobile ecological momentary assessments (EMAs) to capture prospective physical activity (PA) within free-living social and physical contexts by leveraging citizen-owned smartphones running on both Android and iOS systems.

DESIGN

Data were obtained from the cross-sectional pilots of the SMART Platform, a citizen science and mobile health initiative.

SETTING

The cities of Regina and Saskatoon, Canada.

PARTICIPANTS

538 citizen scientists (≥18 years) provided PA data during eight consecutive days using a custom-built smartphone application, and after applying a rigid inclusion criteria, 89 were included in the final analysis.

OUTCOME MEASURES

EMAs enabled reporting of light, moderate, and vigorous PA, as well as physical and social contexts of PA. Retrospective PA was reported using International Physical Activity Questionnaire (IPAQ). For both measures, PA intensities were categorised into mean minutes of light and moderate-to-vigorous PA per day. Wilcoxon signed ranks tests and Spearman correlation procedures were conducted to compare PA intensities reported via EMAs and IPAQ.

RESULTS

Using EMAs, citizen scientists reported 140.91, 87.16 and 70.38 mean min/day of overall, light and moderate-to-vigorous PA, respectively, whereas using IPAQ they reported 194.39, 116.99 and 98.42 mean min/day of overall, light and moderate-to-vigorous PA, respectively. Overall (ρ=0.414, p<0.001), light (ρ=0.261, p=0.012) and moderate-to-vigorous PA (ρ=0.316, p=0.009) were fairly correlated between EMA and IPAQ. In comparison with EMAs, using IPAQ, citizen scientists reported significantly greater overall PA in active transportation (p=0.002) and recreation, sport and leisure-time domains (p=0.003).

CONCLUSIONS

This digital epidemiological and citizen science methodology adapted mobile EMAs to capture not only prospective PA, but also important physical and social contexts within which individuals accumulate PA. Ubiquitous tools can be leveraged via citizen science to capture accurate active living patterns of large populations in free-living conditions through innovative EMAs.

Once you choose hope: early adoption of green technology

Understanding why people differ in adopting green technologies is of paramount importance. Regardless of the current understanding of the factors affecting adoption, the overall willingness to adopt new green technologies is still low. The present paper argues that cognitive, goal-oriented hope potentially prompts the early adoption of green technologies. Unlike socio-economic factors that are difficult to change, hope and motivation levels may be altered by using policy tools and education. A theoretical model is proposed and empirically tested. Regression analysis with interactions of 238 self-administered questionnaires is presented. The results support the theoretical model, as personal motivation, environmental motivation, and hope exhibit a statistically significant contribution to the early adoption of green technologies. Furthermore, hope levels are found to have a significant moderating effect on the positive association between environmental motivation and early adoption. This study takes an initial step towards revealing the important role of hope in adopting green technologies.

Relationships among hope, psychological well-being and health-related quality of life in childhood cancer survivors

This cross-sectional study examined the level of hope among Hong Kong childhood cancer survivors and investigated the relationships among hope, depressive symptoms, self-esteem and health-related quality of life. We recruited 176 survivors aged 10-16 years who underwent medical follow-ups at the outpatient clinic. This study revealed that lower levels of hope were associated with an increase in depressive symptoms and reductions in self-esteem and health-related quality of life. Our results contribute to novel findings by demonstrating that hope may be a significant factor associated with health-related quality of life. This understanding could increase healthcare professionals' awareness about the psychological needs of childhood cancer survivors.