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Cascini F, Pantovic A, Al-Ajlouni YA, Puleo V, De Maio L, Ricciardi W. Health data sharing attitudes towards primary and secondary use of data: a systematic review. EClinicalMedicine 2024; 71:102551. [PMID: 38533128 PMCID: PMC10963197 DOI: 10.1016/j.eclinm.2024.102551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/28/2024] Open
Abstract
Background To receive the best care, people share their health data (HD) with their health practitioners (known as sharing HD for primary purposes). However, during the past two decades, sharing for other (i.e., secondary) purposes has become of great importance in numerous fields, including public health, personalized medicine, research, and development. We aimed to conduct the first comprehensive overview of all studies that investigated people's HD sharing attitudes-along with associated barriers/motivators and significant influencing factors-for all data types and across both primary and secondary uses. Methods We searched PubMed, MEDLINE, PsycINFO, Web of Science, EMBASE, and CINAHL for relevant studies published in English between database inception and February 28, 2023, using a predefined set of keywords. Studies were included, regardless of their design, if they reported outcomes related to attitudes towards sharing HD. We extracted key data from the included studies, including the type of HD involved and findings related to: HD sharing attitudes (either in general or depending on type of data/user); barriers/motivators/benefits/concerns of the study participants; and sociodemographic and other variables that could impact HD sharing behaviour. The qualitative synthesis was conducted by dividing the studies according to the data type (resulting in five subgroups) as well as the purpose the data sharing was focused on (primary, secondary or both). The Newcastle-Ottawa Scale (NOS) was used to assess the quality of non-randomised studies. This work was registered with PROSPERO, CRD42023413822. Findings Of 2109 studies identified through our search, 116 were included in the qualitative synthesis, yielding a total of 228,501 participants and various types of HD represented: person-generated HD (n = 17 studies and 10,771 participants), personal HD in general (n = 69 studies and 117,054 participants), Biobank data (n = 7 studies and 27,073 participants), genomic data (n = 13 studies and 54,716 participants), and miscellaneous data (n = 10 studies and 18,887 participants). The majority of studies had a moderate level of quality (83 [71.6%] of 116 studies), but varying levels of quality were observed across the included studies. Overall, studies suggest that sharing intentions for primary purposes were observed to be high regardless of data type, and it was higher than sharing intentions for secondary purposes. Sharing for secondary purposes yielded variable findings, where both the highest and the lowest intention rates were observed in the case of studies that explored sharing biobank data (98% and 10%, respectively). Several influencing factors on sharing intentions were identified, such as the type of data recipient, data, consent. Further, concerns related to data sharing that were found to be mutual for all data types included privacy, security, and data access/control, while the perceived benefits included those related to improvements in healthcare. Findings regarding attitudes towards sharing varied significantly across sociodemographic factors and depended on data type and type of use. In most cases, these findings were derived from single studies and therefore warrant confirmations from additional studies. Interpretation Sharing health data is a complex issue that is influenced by various factors (the type of health data, the intended use, the data recipient, among others) and these insights could be used to overcome barriers, address people's concerns, and focus on spreading awareness about the data sharing process and benefits. Funding None.
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Affiliation(s)
- Fidelia Cascini
- Department of Life Sciences and Public Health, Section of Hygiene and Public Health, Università Cattolica del Sacro Cuore, L. go Francesco Vito 1, Rome, 00168, Italy
- Directorate General for the Digitisation of the Health Information System and Statistics, Ministry of Health, Italy
| | - Ana Pantovic
- Faculty of Biology, University of Belgrade, Belgrade, Serbia
| | | | - Valeria Puleo
- Department of Life Sciences and Public Health, Section of Hygiene and Public Health, Università Cattolica del Sacro Cuore, L. go Francesco Vito 1, Rome, 00168, Italy
| | - Lucia De Maio
- Department of Life Sciences and Public Health, Section of Hygiene and Public Health, Università Cattolica del Sacro Cuore, L. go Francesco Vito 1, Rome, 00168, Italy
| | - Walter Ricciardi
- Department of Life Sciences and Public Health, Section of Hygiene and Public Health, Università Cattolica del Sacro Cuore, L. go Francesco Vito 1, Rome, 00168, Italy
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Sarkar S, Gaur M, Chen LK, Garg M, Srivastava B. A review of the explainability and safety of conversational agents for mental health to identify avenues for improvement. Front Artif Intell 2023; 6:1229805. [PMID: 37899961 PMCID: PMC10601652 DOI: 10.3389/frai.2023.1229805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/29/2023] [Indexed: 10/31/2023] Open
Abstract
Virtual Mental Health Assistants (VMHAs) continuously evolve to support the overloaded global healthcare system, which receives approximately 60 million primary care visits and 6 million emergency room visits annually. These systems, developed by clinical psychologists, psychiatrists, and AI researchers, are designed to aid in Cognitive Behavioral Therapy (CBT). The main focus of VMHAs is to provide relevant information to mental health professionals (MHPs) and engage in meaningful conversations to support individuals with mental health conditions. However, certain gaps prevent VMHAs from fully delivering on their promise during active communications. One of the gaps is their inability to explain their decisions to patients and MHPs, making conversations less trustworthy. Additionally, VMHAs can be vulnerable in providing unsafe responses to patient queries, further undermining their reliability. In this review, we assess the current state of VMHAs on the grounds of user-level explainability and safety, a set of desired properties for the broader adoption of VMHAs. This includes the examination of ChatGPT, a conversation agent developed on AI-driven models: GPT3.5 and GPT-4, that has been proposed for use in providing mental health services. By harnessing the collaborative and impactful contributions of AI, natural language processing, and the mental health professionals (MHPs) community, the review identifies opportunities for technological progress in VMHAs to ensure their capabilities include explainable and safe behaviors. It also emphasizes the importance of measures to guarantee that these advancements align with the promise of fostering trustworthy conversations.
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Affiliation(s)
- Surjodeep Sarkar
- Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore County, Baltimore, MD, United States
| | - Manas Gaur
- Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore County, Baltimore, MD, United States
| | - Lujie Karen Chen
- Department of Information Systems, University of Maryland, Baltimore County, Baltimore, MD, United States
| | - Muskan Garg
- Department of AI & Informatics, Mayo Clinic, Rochester, MN, United States
| | - Biplav Srivastava
- AI Institute, University of South Carolina, Columbia, SC, United States
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Lipschitz JM, Pike CK, Hogan TP, Murphy SA, Burdick KE. The engagement problem: A review of engagement with digital mental health interventions and recommendations for a path forward. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2023; 10:119-135. [PMID: 38390026 PMCID: PMC10883589 DOI: 10.1007/s40501-023-00297-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 02/24/2024]
Abstract
Purpose of the review Digital mental health interventions (DMHIs) are an effective and accessible means of addressing the unprecedented levels of mental illness worldwide. Currently, however, patient engagement with DMHIs in real-world settings is often insufficient to see clinical benefit. In order to realize the potential of DMHIs, there is a need to better understand what drives patient engagement. Recent findings We discuss takeaways from the existing literature related to patient engagement with DMHIs and highlight gaps to be addressed through further research. Findings suggest that engagement is influenced by patient-, intervention- and systems-level factors. At the patient-level, variables such as sex, education, personality traits, race, ethnicity, age and symptom severity appear to be associated with engagement. At the intervention-level, integrating human support, gamification, financial incentives and persuasive technology features may improve engagement. Finally, although systems-level factors have not been widely explored, the existing evidence suggests that achieving engagement will require addressing organizational and social barriers and drawing on the field of implementation science. Summary Future research clarifying the patient-, intervention- and systems-level factors that drive engagement will be essential. Additionally, to facilitate improved understanding of DMHI engagement, we propose the following: (a) widespread adoption of a minimum necessary 5-element engagement reporting framework; (b) broader application of alternative clinical trial designs; and (c) directed efforts to build upon an initial parsimonious conceptual model of DMHI engagement.
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Affiliation(s)
- Jessica M Lipschitz
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Chelsea K Pike
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA
- Peter O'Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX
| | | | - Katherine E Burdick
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
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4
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Cummings P, Petitclerc A, Moskowitz J, Tandon D, Zhang Y, MacNeill LA, Alshurafa N, Krogh-Jespersen S, Hamil JL, Nili A, Berken J, Grobman W, Rangarajan A, Wakschlag L. Feasibility of Passive ECG Bio-sensing and EMA Emotion Reporting Technologies and Acceptability of Just-in-Time Content in a Well-being Intervention, Considerations for Scalability and Improved Uptake. AFFECTIVE SCIENCE 2022; 3:849-861. [PMID: 36277315 PMCID: PMC9579642 DOI: 10.1007/s42761-022-00147-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/13/2022] [Indexed: 11/24/2022]
Abstract
Researchers increasingly use passive sensing data and frequent self-report to implement personalized mobile health (mHealth) interventions. Yet, we know that certain populations may find these technical protocols burdensome and intervention uptake as well as treatment efficacy may be affected as a result. In the present study, we predicted feasibility (participant adherence to protocol) and acceptability (participant engagement with intervention content) as a function of baseline sociodemographic, mental health, and well-being characteristics of 99 women randomized in the personalized preventive intervention Wellness-for-Two (W-4-2), a randomized trial evaluating stress-related alterations during pregnancy and their effect on infant neurodevelopmental trajectories. The W-4-2 study used ecological momentary assessment (EMA) and wearable electrocardiograph (ECG) sensors to detect physiological stress and personalize the intervention. Participant adherence to protocols was 67% for EMAs and 52% for ECG bio-sensors. Higher baseline negative affect significantly predicted lower adherence to both protocols. Women assigned to the intervention group engaged on average with 42% of content they received. Women with higher annual household income were more likely to engage with more of the intervention content. Researchers should carefully consider tailoring of the intensity of technical intervention protocols to reduce fatigue, especially among participants with higher baseline negative affect, which may improve intervention uptake and efficacy findings at scale.
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Affiliation(s)
- P. Cummings
- Department of Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL USA
| | - A. Petitclerc
- Laval University School of Psychology, 2325 Rue des Bibliothèques, QC, Québec G1V 0A6 Canada
| | - J. Moskowitz
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, IL USA
| | - D. Tandon
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, IL USA
| | - Y. Zhang
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Institute for Innovations in Developmental Sciences, Chicago, IL USA
| | - L. A. MacNeill
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Institute for Innovations in Developmental Sciences, Chicago, IL USA
| | - N. Alshurafa
- Department of Preventive Medicine, Northwestern Feinberg School of Medicine, Chicago, IL USA
| | - S. Krogh-Jespersen
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Institute for Innovations in Developmental Sciences, Chicago, IL USA
| | - J. L. Hamil
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, IL USA
| | - A. Nili
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Institute for Innovations in Developmental Sciences, Chicago, IL USA
| | - J. Berken
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - W. Grobman
- Department of Obstetrics & Gynecology, Northwestern Feinberg School of Medicine, Chicago, IL USA
| | - A. Rangarajan
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - L. Wakschlag
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Institute for Innovations in Developmental Sciences, Chicago, IL USA
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Ng A, Wei B, Jain J, Ward EA, Tandon SD, Moskowitz JT, Krogh-Jespersen S, Wakschlag LS, Alshurafa N. Predicting the Next-Day Perceived and Physiological Stress of Pregnant Women by Using Machine Learning and Explainability: Algorithm Development and Validation. JMIR Mhealth Uhealth 2022; 10:e33850. [PMID: 35917157 PMCID: PMC9382551 DOI: 10.2196/33850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 02/02/2022] [Accepted: 05/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background Cognitive behavioral therapy–based interventions are effective in reducing prenatal stress, which can have severe adverse health effects on mothers and newborns if unaddressed. Predicting next-day physiological or perceived stress can help to inform and enable pre-emptive interventions for a likely physiologically and perceptibly stressful day. Machine learning models are useful tools that can be developed to predict next-day physiological and perceived stress by using data collected from the previous day. Such models can improve our understanding of the specific factors that predict physiological and perceived stress and allow researchers to develop systems that collect selected features for assessment in clinical trials to minimize the burden of data collection. Objective The aim of this study was to build and evaluate a machine-learned model that predicts next-day physiological and perceived stress by using sensor-based, ecological momentary assessment (EMA)–based, and intervention-based features and to explain the prediction results. Methods We enrolled pregnant women into a prospective proof-of-concept study and collected electrocardiography, EMA, and cognitive behavioral therapy intervention data over 12 weeks. We used the data to train and evaluate 6 machine learning models to predict next-day physiological and perceived stress. After selecting the best performing model, Shapley Additive Explanations were used to identify the feature importance and explainability of each feature. Results A total of 16 pregnant women enrolled in the study. Overall, 4157.18 hours of data were collected, and participants answered 2838 EMAs. After applying feature selection, 8 and 10 features were found to positively predict next-day physiological and perceived stress, respectively. A random forest classifier performed the best in predicting next-day physiological stress (F1 score of 0.84) and next-day perceived stress (F1 score of 0.74) by using all features. Although any subset of sensor-based, EMA-based, or intervention-based features could reliably predict next-day physiological stress, EMA-based features were necessary to predict next-day perceived stress. The analysis of explainability metrics showed that the prolonged duration of physiological stress was highly predictive of next-day physiological stress and that physiological stress and perceived stress were temporally divergent. Conclusions In this study, we were able to build interpretable machine learning models to predict next-day physiological and perceived stress, and we identified unique features that were highly predictive of next-day stress that can help to reduce the burden of data collection.
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Affiliation(s)
- Ada Ng
- McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - Boyang Wei
- McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - Jayalakshmi Jain
- McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - Erin A Ward
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - S Darius Tandon
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Judith T Moskowitz
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | | | - Lauren S Wakschlag
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Nabil Alshurafa
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Rubeis G. iHealth: The ethics of artificial intelligence and big data in mental healthcare. Internet Interv 2022; 28:100518. [PMID: 35257003 PMCID: PMC8897624 DOI: 10.1016/j.invent.2022.100518] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/11/2022] [Accepted: 02/24/2022] [Indexed: 01/13/2023] Open
Abstract
The concept of intelligent health (iHealth) in mental healthcare integrates artificial intelligence (AI) and Big Data analytics. This article is an attempt to outline ethical aspects linked to iHealth by focussing on three crucial elements that have been defined in the literature: self-monitoring, ecological momentary assessment (EMA), and data mining. The material for the analysis was obtained by a database search. Studies and reviews providing outcome data for each of the three elements were analyzed. An ethical framing of the results was conducted that shows the chances and challenges of iHealth. The synergy between self-monitoring, EMA, and data mining might enable the prevention of mental illness, the prediction of its onset, the personalization of treatment, and the participation of patients in the treatment process. Challenges arise when it comes to the autonomy of users, privacy and data security of users, and potential bias.
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7
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Brown R, Sillence E, Coventry L, Simpson E, Gibbs J, Tariq S, C. Durrant A, Lloyd K. Understanding the attitudes and experiences of people living with potentially stigmatised long-term health conditions with respect to collecting and sharing health and lifestyle data. Digit Health 2022; 8:20552076221089798. [PMID: 35463624 PMCID: PMC9019355 DOI: 10.1177/20552076221089798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/16/2022] [Indexed: 11/17/2022] Open
Abstract
Background The emerging landscape of patient-generated data (PGData) provides an opportunity to collect large quantities of information that can be used to develop our understanding of different health conditions and potentially improve the quality of life for those living with long-term health condition (LTHCs). If the potential benefits of PGData are to be realised, we need a better understanding of the psychological barriers and facilitators to the collection and beneficial sharing of health and lifestyle data. Due to the understudied role that stigma plays in sharing PGData, we explore the attitudes and experiences of those living with potentially stigmatised LTHCs with respect to collecting and sharing health and lifestyle data. Methods This study used semi-structured interviews and a card sorting task to explore the attitudes and experiences of people living with potentially stigmatised LTHCs. Fourteen adult participants who reported having a range of conditions were recruited in England. Template analysis was used to analyse interview transcripts and descriptive statistics were used for the card sorting task. Results The findings present four overarching themes: Preferences for collecting health and lifestyle data, Importance of anonymity, Expected use of data, and Sources of emotional support. Participants illustrated a general willingness to share health and lifestyle data; however, there were some notable differences in sharing experiences, varying both by information type and recipient group. Overall, participants did not identify health-related stigma as a barrier to collecting or sharing their personal health and lifestyle data. Conclusions We outline a number of preferences that participants feel would encourage them to collect and share data more readily, which may be considered when developing data sharing tools for the future.
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Affiliation(s)
- Richard Brown
- Department of Psychology, Northumbria University, Newcastle, UK
| | | | - Lynne Coventry
- Department of Psychology, Northumbria University, Newcastle, UK
| | - Emma Simpson
- The NHS Business Services Authority, Newcastle, UK
| | - Jo Gibbs
- Institute for Global Health, University College London, London, UK
| | - Shema Tariq
- Institute for Global Health, University College London, London, UK
| | | | - Karen Lloyd
- Institute for Global Health, University College London, London, UK
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Simpson E, Brown R, Sillence E, Coventry L, Lloyd K, Gibbs J, Tariq S, Durrant AC. Understanding the Barriers and Facilitators to Sharing Patient-Generated Health Data Using Digital Technology for People Living With Long-Term Health Conditions: A Narrative Review. Front Public Health 2021; 9:641424. [PMID: 34888271 PMCID: PMC8650083 DOI: 10.3389/fpubh.2021.641424] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
Using digital technology to share patient-generated health data has the potential to improve the self-management of multiple long-term health conditions. Sharing these data can allow patients to receive additional support from healthcare professionals and peer communities, as well as enhance their understanding of their own health. A deeper understanding of the concerns raised by those living with long-term health conditions when considering whether to share health data via digital technology may help to facilitate effective data sharing practices in the future. The aim of this review is to identify whether trust, identity, privacy and security concerns present barriers to the successful sharing of patient-generated data using digital technology by those living with long-term health conditions. We also address the impact of stigma on concerns surrounding sharing health data with others. Searches of CINAHL, PsychInfo and Web of Knowledge were conducted in December 2019 and again in October 2020 producing 2,581 results. An iterative review process resulted in a final dataset of 23 peer-reviewed articles. A thorough analysis of the selected articles found that issues surrounding trust, identity, privacy and security clearly present barriers to the sharing of patient-generated data across multiple sharing contexts. The presence of enacted stigma also acts as a barrier to sharing across multiple settings. We found that the majority of literature focuses on clinical settings with relatively little attention being given to sharing with third parties. Finally, we suggest the need for more solution-based research to overcome the discussed barriers to sharing.
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Affiliation(s)
- Emma Simpson
- The NHS Business Services Authority, Newcastle upon Tyne, United Kingdom
| | - Richard Brown
- Department of Psychology, Northumbria University Newcastle, Newcastle upon Tyne, United Kingdom
| | - Elizabeth Sillence
- Department of Psychology, Northumbria University Newcastle, Newcastle upon Tyne, United Kingdom
| | - Lynne Coventry
- Department of Psychology, Northumbria University Newcastle, Newcastle upon Tyne, United Kingdom
| | - Karen Lloyd
- Institute for Global Health, University College London, London, United Kingdom
| | - Jo Gibbs
- Institute for Global Health, University College London, London, United Kingdom
| | - Shema Tariq
- Institute for Global Health, University College London, London, United Kingdom
| | - Abigail C Durrant
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
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Borghouts J, Eikey E, Mark G, De Leon C, Schueller SM, Schneider M, Stadnick N, Zheng K, Mukamel D, Sorkin DH. Barriers to and Facilitators of User Engagement With Digital Mental Health Interventions: Systematic Review. J Med Internet Res 2021; 23:e24387. [PMID: 33759801 PMCID: PMC8074985 DOI: 10.2196/24387] [Citation(s) in RCA: 275] [Impact Index Per Article: 91.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/24/2020] [Accepted: 02/08/2021] [Indexed: 01/14/2023] Open
Abstract
Background Digital mental health interventions (DMHIs), which deliver mental health support via technologies such as mobile apps, can increase access to mental health support, and many studies have demonstrated their effectiveness in improving symptoms. However, user engagement varies, with regard to a user’s uptake and sustained interactions with these interventions. Objective This systematic review aims to identify common barriers and facilitators that influence user engagement with DMHIs. Methods A systematic search was conducted in the SCOPUS, PubMed, PsycINFO, Web of Science, and Cochrane Library databases. Empirical studies that report qualitative and/or quantitative data were included. Results A total of 208 articles met the inclusion criteria. The included articles used a variety of methodologies, including interviews, surveys, focus groups, workshops, field studies, and analysis of user reviews. Factors extracted for coding were related to the end user, the program or content offered by the intervention, and the technology and implementation environment. Common barriers included severe mental health issues that hampered engagement, technical issues, and a lack of personalization. Common facilitators were social connectedness facilitated by the intervention, increased insight into health, and a feeling of being in control of one’s own health. Conclusions Although previous research suggests that DMHIs can be useful in supporting mental health, contextual factors are important determinants of whether users actually engage with these interventions. The factors identified in this review can provide guidance when evaluating DMHIs to help explain and understand user engagement and can inform the design and development of new digital interventions.
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Affiliation(s)
| | - Elizabeth Eikey
- University of California San Diego, San Diego, CA, United States
| | - Gloria Mark
- University of California Irvine, Irvine, CA, United States
| | | | | | | | - Nicole Stadnick
- University of California San Diego, San Diego, CA, United States
| | - Kai Zheng
- University of California Irvine, Irvine, CA, United States
| | - Dana Mukamel
- University of California Irvine, Irvine, CA, United States
| | - Dara H Sorkin
- University of California Irvine, Irvine, CA, United States
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Emerson MR, Harsh Caspari J, Notice M, Watanabe-Galloway S, Dinkel D, Kabayundo J. Mental health mobile app use: Considerations for serving underserved patients in integrated primary care settings. Gen Hosp Psychiatry 2021; 69:67-75. [PMID: 33571926 DOI: 10.1016/j.genhosppsych.2021.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/10/2021] [Accepted: 01/13/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Margaret R Emerson
- University of Nebraska Medical Center College of Nursing, Omaha, NE, United States of America.
| | - Jennifer Harsh Caspari
- University of Nebraska Medical Center College of Medicine, Omaha, NE, United States of America
| | - Maxine Notice
- University of Central Missouri, School of Human Service, Warrensburg, MO, United States of America
| | | | - Danae Dinkel
- University of Nebraska Omaha, School of Health & Kinesiology, Omaha, NE, United States of America
| | - Josiane Kabayundo
- University of Nebraska Medical Center College of Public Health, Omaha, NE, United States of America
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Heidel A, Hagist C. Potential Benefits and Risks Resulting From the Introduction of Health Apps and Wearables Into the German Statutory Health Care System: Scoping Review. JMIR Mhealth Uhealth 2020; 8:e16444. [PMID: 32965231 PMCID: PMC7542416 DOI: 10.2196/16444] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 05/26/2020] [Accepted: 08/18/2020] [Indexed: 12/16/2022] Open
Abstract
Background Germany is the first country worldwide that has introduced a digital care act as an incentive system to enhance the use of digital health devices, namely health apps and wearables, among its population. The act allows physicians to prescribe statutory financed and previously certified health apps and wearables to patients. This initiative has the potential to improve treatment quality through better disease management and monitoring. Objective The aim of this paper was to outline the key concepts related to the potential risks and benefits discussed in the current literature about health apps and wearables. Furthermore, this study aimed to answer the research question: Which risks and benefits may result from the implementation of the digital care act in Germany? Methods We conducted the scoping study by searching the databases PubMed, Google Scholar, and JMIR using the keywords health apps and wearables. We discussed 55 of 136 identified articles published in the English language from 2015 to March 2019 in this paper using a qualitative thematic analysis approach. Results We identified four key themes within the articles: Effectivity of health apps and wearables to improve health; users of health apps and wearables; the potential of bring-your-own, self-tracked data; and concerns and data privacy risks. Within these themes, we identified three main stages of benefits for the German health care system: Usage of health apps and wearables; continuing to use health apps and wearables; and sharing bring-your-own; self-tracked data with different agents in the health care sector. Conclusions The digital care act could lead to an improvement in treatment quality through better patient monitoring, disease management, personalized therapy, and better health education. However, physicians should play an active role in recommending
and supervising health app use to reach digital-illiterate or health-illiterate people. Age must not be an exclusion criterion. Yet, concerns about data privacy and security are very strong in Germany. Transparency about data processing should be provided at all times for continuing success of the digital care act in Germany.
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Affiliation(s)
- Alexandra Heidel
- Chair of Economic and Social Policy, WHU - Otto Beisheim School of Management, Vallendar, Germany
| | - Christian Hagist
- Chair of Economic and Social Policy, WHU - Otto Beisheim School of Management, Vallendar, Germany
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Abstract
OBJECTIVES To survey international regulatory frameworks that serve to protect privacy of personal data as a human right as well as to review the literature regarding privacy protections and data ownership in mobile health (mHealth) technologies between January 1, 2016 and June 1, 2019 in order to identify common themes. METHODS We performed a review of relevant literature available in English published between January 1, 2016 and June 1, 2019 from databases including PubMed, Google Scholar, and Web of Science, as well as relevant legislative background material. Articles out of scope (as detailed below) were eliminated. We categorized the remaining pool of articles and discrete themes were identified, specifically: concerns around data transmission and storage, including data ownership and the ability to re-identify previously de-identified data; issues with user consent (including the availability of appropriate privacy policies) and access control; and the changing culture and variable global attitudes toward privacy of health data. RESULTS Recent literature demonstrates that the security of mHealth data storage and transmission remains of wide concern, and aggregated data that were previously considered "de-identified" have now been demonstrated to be re-identifiable. Consumer-informed consent may be lacking with regard to mHealth applications due to the absence of a privacy policy and/or to text that is too complex and lengthy for most users to comprehend. The literature surveyed emphasizes improved access control strategies. This survey also illustrates a wide variety of global user perceptions regarding health data privacy. CONCLUSION The international regulatory framework that serves to protect privacy of personal data as a human right is diverse. Given the challenges legislators face to keep up with rapidly advancing technology, we introduce the concept of a "healthcare fiduciary" to serve the best interest of data subjects in the current environment.
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Affiliation(s)
- Hannah K. Galvin
- Cambridge Health Alliance, Cambridge, MA, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - Paul R. DeMuro
- Chief Legal Officer Health and Wellness, Royal Palm Companies, Miami, Florida
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Lorenz N, Sander C, Ivanova G, Hegerl U. Temporal Associations of Daily Changes in Sleep and Depression Core Symptoms in Patients Suffering From Major Depressive Disorder: Idiographic Time-Series Analysis. JMIR Ment Health 2020; 7:e17071. [PMID: 32324147 PMCID: PMC7206522 DOI: 10.2196/17071] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/04/2020] [Accepted: 03/25/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There is a strong link between sleep and major depression; however, the causal relationship remains unclear. In particular, it is unknown whether changes in depression core symptoms precede or follow changes in sleep, and whether a longer or shorter sleep duration is related to improvements of depression core symptoms. OBJECTIVE The aim of this study was to investigate temporal associations between sleep and depression in patients suffering from major depressive disorder using an idiographic research approach. METHODS Time-series data of daily sleep assessments (time in bed and total sleep time) and self-rated depression core symptoms for an average of 173 days per patient were analyzed in 22 patients diagnosed with recurrent major depressive disorder using a vector autoregression model. Granger causality tests were conducted to test for possible causality. Impulse response analysis and forecast error variance decomposition were performed to quantify the temporal mutual impact of sleep and depression. RESULTS Overall, 11 positive and 5 negative associations were identified between time in bed/total sleep time and depression core symptoms. Granger analysis showed that time in bed/total sleep time caused depression core symptoms in 9 associations, whereas this temporal order was reversed for the other 7 associations. Most of the variance (10%) concerning depression core symptoms could be explained by time in bed. Changes in sleep or depressive symptoms of 1 SD had the greatest impact on the other variable in the following 2 to 4 days. CONCLUSIONS Longer rather than shorter bedtimes were associated with more depression core symptoms. However, the temporal orders of the associations were heterogeneous.
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Affiliation(s)
- Noah Lorenz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Leipzig University, Leipzig, Germany.,Research Centre of the German Depression Foundation, Leipzig, Germany
| | - Christian Sander
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Leipzig University, Leipzig, Germany.,Research Centre of the German Depression Foundation, Leipzig, Germany
| | | | - Ulrich Hegerl
- Research Centre of the German Depression Foundation, Leipzig, Germany.,Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe-Universität Frankfurt, Frankfurt, Germany
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