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Rowan AB, Magnante AT, Urh N, Figueroa L. Cognitive Behavioral Therapy for Insomnia Self-Management Mobile Apps: A Review of Efficacy and Quality. J Clin Psychol Med Settings 2024; 31:537-549. [PMID: 38281307 DOI: 10.1007/s10880-023-09992-y] [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] [Accepted: 12/04/2023] [Indexed: 01/30/2024]
Abstract
Cognitive behavioral therapy for insomnia (CBT-I) is the recommended treatment for insomnia, yet multiple barriers limit utilization. Digital CBT-I may present a solution, though related reviews have focused on Internet-based delivery rather than app use. The high utilization of health apps and prevalence of sleep apps indicate the need to equip clinicians with app-specific research. Toward this end, we reviewed efficacy and quality data on self-management CBT-I smartphone apps, revealing efficacy research on eleven apps, five of which were publicly available. While preliminary, these efficacy studies showed consistent positive findings. When examining quantitative quality indicators for the five publicly available apps, two had consistent data. Overall, two apps, CBTi Coach and Insomnia Coach, had positive, empirical findings across all efficacy and quality assessment approaches. We provide recommendations to guide clinician decision making regarding CBT-I self-management apps based on the literature and publicly available methods of app evaluations.
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Affiliation(s)
- Anderson B Rowan
- College of Health and Behavioral Sciences, Regent University, 1000 Regent University Drive, Virginia Beach, VA, 23464, USA.
| | - Anna T Magnante
- W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nicole Urh
- College of Health and Behavioral Sciences, Regent University, 1000 Regent University Drive, Virginia Beach, VA, 23464, USA
| | - Lynette Figueroa
- College of Health and Behavioral Sciences, Regent University, 1000 Regent University Drive, Virginia Beach, VA, 23464, USA
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Liang F, Yang X, Peng W, Zhen S, Cao W, Li Q, Xiao Z, Gong M, Wang Y, Gu D. Applications of digital health approaches for cardiometabolic diseases prevention and management in the Western Pacific region. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 43:100817. [PMID: 38456090 PMCID: PMC10920052 DOI: 10.1016/j.lanwpc.2023.100817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/04/2023] [Accepted: 05/23/2023] [Indexed: 03/09/2024]
Abstract
Cardiometabolic diseases (CMDs) are the major types of non-communicable diseases, contributing to huge disease burdens in the Western Pacific region (WPR). The use of digital health (dHealth) technologies, such as wearable gadgets, mobile apps, and artificial intelligence (AI), facilitates interventions for CMDs prevention and treatment. Currently, most studies on dHealth and CMDs in WPR were conducted in a few high- and middle-income countries like Australia, China, Japan, the Republic of Korea, and New Zealand. Evidence indicated that dHealth services promoted early prevention by behavior interventions, and AI-based innovation brought automated diagnosis and clinical decision-support. dHealth brought facilitators for the doctor-patient interplay in the effectiveness, experience, and communication skills during healthcare services, with rapidly development during the pandemic of coronavirus disease 2019. In the future, the improvement of dHealth services in WPR needs to gain more policy support, enhance technology innovation and privacy protection, and perform cost-effectiveness research.
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Affiliation(s)
- Fengchao Liang
- School of Public Health and Emergency Management, Southern University of Science and Technology, 1088 Xueyuan Avenue, Shenzhen 518055, People's Republic of China
| | - Xueli Yang
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, 22 Qixiangtai Rd, Tianjin 300070, People's Republic of China
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, 22 Qixiangtai Rd, Tianjin 300070, People's Republic of China
| | - Wen Peng
- Nutrition and Health Promotion Center, Department of Public Health, Medical College, Qinghai University, 251 Ningda Road, Xining City 810016, People's Republic of China
- Qinghai Provincial Key Laboratory of Prevention and Control of Glucolipid Metabolic Diseases with Traditional Chinese Medicine, Xining 810008, People's Republic of China
| | - Shihan Zhen
- School of Public Health and Emergency Management, Southern University of Science and Technology, 1088 Xueyuan Avenue, Shenzhen 518055, People's Republic of China
| | - Wenzhe Cao
- School of Public Health and Emergency Management, Southern University of Science and Technology, 1088 Xueyuan Avenue, Shenzhen 518055, People's Republic of China
| | - Qian Li
- School of Public Health and Emergency Management, Southern University of Science and Technology, 1088 Xueyuan Avenue, Shenzhen 518055, People's Republic of China
| | - Zhiyi Xiao
- School of Public Health and Emergency Management, Southern University of Science and Technology, 1088 Xueyuan Avenue, Shenzhen 518055, People's Republic of China
| | - Mengchun Gong
- Institute of Health Management, Southern Medical University, No. 1023-1063, Shatai South Road, Guangzhou 510515, People's Republic of China
| | - Youfa Wang
- The First Affiliated Hospital of Xi'an Jiaotong University Public Health Institute, Global Health Institute, School of Public Health, International Obesity and Metabolic Disease Research Center, Xi'an Jiaotong University, Xi'an 710061, People's Republic of China
| | - Dongfeng Gu
- School of Public Health and Emergency Management, Southern University of Science and Technology, 1088 Xueyuan Avenue, Shenzhen 518055, People's Republic of China
- School of Medicine, Southern University of Science and Technology, 1088 Xueyuan Avenue, Shenzhen 518055, People's Republic of China
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Thorshov TC, Øverby CT, Hansen DD, Bong WK, Skifjeld K, Hurlen P, Dammen T, Moen A, Hrubos-Strøm H. Experience with the use of a digital sleep diary in symptom management by individuals with insomnia -a pilot mixed method study. Sleep Med X 2023; 6:100093. [PMID: 38162592 PMCID: PMC10757200 DOI: 10.1016/j.sleepx.2023.100093] [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: 07/07/2023] [Revised: 11/01/2023] [Accepted: 11/08/2023] [Indexed: 01/03/2024] Open
Abstract
Background Insomnia is the most common sleep disorder. The recommended treatment is cognitive behavioural therapy for insomnia (CBTi). A sleep diary is a core tool in CBTi. We have developed a digital sleep diary with a standardised feedback function. Aim To study feasibility of the digital sleep diary in participants of the Akershus Sleep Apnea (ASAP) cohorts with difficulties falling asleep or maintaining sleep. To describe sleep diary engagement and explore experiences with the digital sleep diary with potential influences in insomnia symptom management. Material and methods Twenty participants were recruited from the ASAP. All filled out a digital sleep diary up to 12 weeks. Treatment options provided were a self-help book (N = 11) or electroencephalography neurofeedback (N = 9) in addition to the sleep diary standardised feedback function. We collected quantitative data from the sleep diary reports and we sub-divided insomnia by sleep onset insomnia and non-sleep onset insomnia. Finally, we performed qualitative interviews. Results The median number of entries to the sleep diary was 81 (25th quartile: 26, 75th quartile 84). In the qualitative analysis, we identified two main themes; "structure and overview" and "usability and digital features". Conclusion The sleep diary was found to be feasible when distributed in combination with a self-help book or electroencephalography neurofeedback. The qualitative results emphasised the importance of a timely graphical overview and visualisations of self-recorded sleep.
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Affiliation(s)
- Thea Christine Thorshov
- Division of Surgery, Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway
| | - Caroline Tonje Øverby
- Division of Surgery, Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway
| | - Diana Dobran Hansen
- Division of Surgery, Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway
| | - Way Kiat Bong
- Faculty of Technology, Art and Design, Department of Computer Science, Human-Computer Interaction and Universal Design of ICT, Oslo Metropolitan University, Oslo, Norway
| | | | - Petter Hurlen
- Division of Clinical Informatics, Department of Diagnostics and Technology, Akershus University Hospital, Lørenskog, Norway
| | - Toril Dammen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway
- Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Anne Moen
- Faculty of Medicine, Institute of Health and Society, Department of Nursing Science, University of Oslo, Norway
| | - Harald Hrubos-Strøm
- Division of Surgery, Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway
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Marx W, Manger SH, Blencowe M, Murray G, Ho FYY, Lawn S, Blumenthal JA, Schuch F, Stubbs B, Ruusunen A, Desyibelew HD, Dinan TG, Jacka F, Ravindran A, Berk M, O'Neil A. Clinical guidelines for the use of lifestyle-based mental health care in major depressive disorder: World Federation of Societies for Biological Psychiatry (WFSBP) and Australasian Society of Lifestyle Medicine (ASLM) taskforce. World J Biol Psychiatry 2023; 24:333-386. [PMID: 36202135 PMCID: PMC10972571 DOI: 10.1080/15622975.2022.2112074] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/24/2022] [Accepted: 08/07/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The primary objectives of these international guidelines were to provide a global audience of clinicians with (a) a series of evidence-based recommendations for the provision of lifestyle-based mental health care in clinical practice for adults with Major Depressive Disorder (MDD) and (b) a series of implementation considerations that may be applicable across a range of settings. METHODS Recommendations and associated evidence-based gradings were based on a series of systematic literature searches of published research as well as the clinical expertise of taskforce members. The focus of the guidelines was eight lifestyle domains: physical activity and exercise, smoking cessation, work-directed interventions, mindfulness-based and stress management therapies, diet, sleep, loneliness and social support, and green space interaction. The following electronic bibliographic databases were searched for articles published prior to June 2020: PubMed, EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register), CINAHL, PsycINFO. Evidence grading was based on the level of evidence specific to MDD and risk of bias, in accordance with the World Federation of Societies for Biological Psychiatry criteria. RESULTS Nine recommendations were formed. The recommendations with the highest ratings to improve MDD were the use of physical activity and exercise, relaxation techniques, work-directed interventions, sleep, and mindfulness-based therapies (Grade 2). Interventions related to diet and green space were recommended, but with a lower strength of evidence (Grade 3). Recommendations regarding smoking cessation and loneliness and social support were based on expert opinion. Key implementation considerations included the need for input from allied health professionals and support networks to implement this type of approach, the importance of partnering such recommendations with behaviour change support, and the need to deliver interventions using a biopsychosocial-cultural framework. CONCLUSIONS Lifestyle-based interventions are recommended as a foundational component of mental health care in clinical practice for adults with Major Depressive Disorder, where other evidence-based therapies can be added or used in combination. The findings and recommendations of these guidelines support the need for further research to address existing gaps in efficacy and implementation research, especially for emerging lifestyle-based approaches (e.g. green space, loneliness and social support interventions) where data are limited. Further work is also needed to develop innovative approaches for delivery and models of care, and to support the training of health professionals regarding lifestyle-based mental health care.
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Affiliation(s)
- Wolfgang Marx
- Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Sam H Manger
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
- Australasian Society of Lifestyle Medicine, Melbourne, Australia
| | - Mark Blencowe
- Australasian Society of Lifestyle Medicine, Melbourne, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Fiona Yan-Yee Ho
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR
| | - Sharon Lawn
- Lived Experience Australia Ltd, Adelaide, Australia
- Flinders University, College of Medicine and Public Health, Adelaide, Australia
| | - James A. Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham NC 27710
| | - Felipe Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Anu Ruusunen
- Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
| | - Hanna Demelash Desyibelew
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | | | - Felice Jacka
- Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Arun Ravindran
- Department of Psychiatry & Institute of Medical Sciences, University of Toronto. Centre for Addiction and Mental Health, Toronto, Canada
| | - Michael Berk
- Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Adrienne O'Neil
- Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
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Simon L, Reimann J, Steubl LS, Stach M, Spiegelhalder K, Sander LB, Baumeister H, Messner EM, Terhorst Y. Help for insomnia from the app store? A standardized rating of mobile health applications claiming to target insomnia. J Sleep Res 2023; 32:e13642. [PMID: 35624078 DOI: 10.1111/jsr.13642] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 03/27/2022] [Accepted: 05/04/2022] [Indexed: 02/03/2023]
Abstract
A large number of mobile health applications claiming to target insomnia are available in commercial app stores. However, limited information on the quality of these mobile health applications exists. The present study aimed to systematically search the European Google Play and Apple App Store for mobile health applications targeting insomnia, and evaluate the quality, content, evidence base and potential therapeutic benefit. Eligible mobile health applications were evaluated by two independent reviewers using the Mobile Application Rating Scale-German, which ranges from 1 - inadequate to 5 - excellent. Of 2236 identified mobile health applications, 53 were included in this study. Most mobile health applications (68%) had a moderate overall quality. Concerning the four main subscales of the Mobile Application Rating Scale-German, functionality was rated highest (M = 4.01, SD = 0.52), followed by information quality (M = 3.49, SD = 0.72), aesthetics (M = 3.31, SD = 1.04) and engagement (M = 3.02, SD = 1.03). While scientific evidence was identified for 10 mobile health applications (19%), only one study employed a randomized controlled design. Fifty mobile health applications featured sleep hygiene/psychoeducation (94%), 27 cognitive therapy (51%), 26 relaxation methods (49%), 24 stimulus control (45%), 16 sleep restriction (30%) and 24 sleep diaries (45%). Mobile health applications may have the potential to improve the care of insomnia. Yet, data on the effectiveness of mobile health applications are scarce, and this study indicates a large variance in the quality of the mobile health applications. Thus, independent information platforms are needed to provide healthcare seekers and providers with reliable information on the quality and content of mobile health applications.
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Affiliation(s)
- Laura Simon
- Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Josephin Reimann
- Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Lena Sophia Steubl
- Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Michael Stach
- Institute of Databases and Information Systems, Ulm University, Ulm, Germany
| | - Kai Spiegelhalder
- Faculty of Medicine, Department of Psychiatry and Psychotherapy, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Lasse Bosse Sander
- Institute of Psychology, Department of Rehabilitation Psychology and Psychotherapy, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Harald Baumeister
- Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Eva-Maria Messner
- Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Yannik Terhorst
- Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
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Nuo M, Fang H, Wang T, Liang J, He Y, Han H, Lei J. Understanding the research on tracking, diagnosing, and intervening in sleep disorders using mHealth apps: Bibliometric analysis and systematic reviews. Digit Health 2023; 9:20552076231165967. [PMID: 37051563 PMCID: PMC10084565 DOI: 10.1177/20552076231165967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 04/14/2023] Open
Abstract
Objectives In solving the global challenge of sleep disorders, Mobile Health app is one of the important means to monitor, diagnose, and intervene in sleep disorders. This study aims to (1) summarize the status and trends of research in this field; (2) assess the production and usage of sleep mHealth apps; (3) calculate the conversion rate of grants that the proportion of newly developed apps from being funded and developed to published on application stores. Methods Using bibliometric and content analysis methods, based on "Research Paper-Product Output-Product Application" chain and considering the "Research Grants" of articles, we conducted a systematic review of eight databases, to identify relevant studies over the last decade. Results Over the past decade, 1399 authors published 313 papers in 182 journals and conferences. The number of publications increased with an average annual growth of 41.6%. The current focus area is research using cognitive behavioral therapy to intervene in sleep. Sleep-staging tracking is a shortcoming of this field. A total 368 sleep mHealth apps (233 newly developed and 135 existing) were examined in 313 papers; 323 grants supported 178 articles (56.9%). Only 12 of the newly developed apps are used in the real world, resulting in a 9% grant conversion rate. Conclusions In the last decade, the field of tracking, diagnosing, and intervening in sleep disorders using mHealth apps has shown a trend of rapid development. However, the conversion rate of products from being funded and developed for use by end-users is low.
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Affiliation(s)
- Mingfu Nuo
- Institute of Medical Technology, Health Science Center, Peking University, Beijing, China
| | - Hongjuan Fang
- Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tong Wang
- Department of Medical Informatics, School of Public Health, Jilin University, Changchun, China
| | - Jun Liang
- IT Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- School of Public Health, Zhejiang University, Hangzhou, China
- Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yunfan He
- School of Public Health, Zhejiang University, Hangzhou, China
| | - Hongbin Han
- Institute of Medical Technology, Health Science Center, Peking University, Beijing, China
- Department of Radiology, Peking University Third Hospital, Health Science Center, Peking University, Beijing, China
| | - Jianbo Lei
- Institute of Medical Technology, Health Science Center, Peking University, Beijing, China
- Center for Medical Informatics, Health Science Center, Peking University, Beijing, China
- School of Medical Informatics and Engineering, Southwest Medical University, Luzhou, China
- Jianbo Lei, Institute of Medical Technology, Health Science Center, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, China.
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Ghaben SJ, Mat Ludin AF, Mohamad Ali N, Beng Gan K, Singh DKA. A framework for design and usability testing of telerehabilitation system for adults with chronic diseases: A panoramic scoping review. Digit Health 2023; 9:20552076231191014. [PMID: 37599901 PMCID: PMC10437210 DOI: 10.1177/20552076231191014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023] Open
Abstract
Objective This scoping review aimed to identify the design and usability testing of a telerehabilitation (TR) system, and its characteristics and functionalities that are best-suited for rehabilitating adults with chronic diseases. Methods Searches were conducted in PubMed, EBSCO, Web of Science, and Cochrane library for studies published between January 2017 and December 2022. We followed the Joanna Briggs Institute guidelines and the framework by Arksey and O'Malley. Screening was undertaken by two reviewers, and data extraction was undertaken by the first author. Then, the data were further reviewed and discussed thoroughly with the team members. Results A total of 31 results were identified, with the core criteria of developing and testing a telerehabilitation system, including a mobile app for cardiovascular diseases, cancer, diabetes, and chronic respiratory disorders. All developed systems resulted from multidisciplinary teams and employed mixed-methods research. We proposed the "input-process-output" framework that identified phases of both system design and usability testing. Through system design, we reported the use of user-centered design, iterative design, users' needs and characteristics, theory underpinning development, and the expert panel in 64%, 75%, 86%, 82%, and 71% of the studies, respectively. We recorded the application of moderated usability testing, unmoderated testing (1), and unmoderated testing (2) in 74%, 63%, and 15% of the studies, respectively. The identified design and testing activities produced a matured system, a high-fidelity prototype, and a released system in 81.5%, 15%, and 3.5%, respectively. Conclusion This review provides a framework for TR system design and testing for a wide range of chronic diseases that require prolonged management through remote monitoring using a mobile app. The identified "input-process-output" framework highlights the inputs, design, development, and improvement as components of the system design. It also identifies the "moderated-unmoderated" model for conducting usability testing. This review illustrates characteristics and functionalities of the TR systems and healthcare professional roles.
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Affiliation(s)
- Suad J Ghaben
- Faculty of Health Sciences, Physiotherapy Programme & Center for Healthy Ageing & Wellness, (H-CARE), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Department of Physiotherapy, Faculty of Applied Medical Sciences, Al Azhar University, Gaza, Palestine
| | - Arimi Fitri Mat Ludin
- Faculty of Health Sciences, Biomedical Science Programme & Center for Healthy Ageing and Wellness (H=CARE), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nazlena Mohamad Ali
- Institute of Visual Informatics (IVI), Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Kok Beng Gan
- Department of Electrical, Electronic and Systems Engineering, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Devinder Kaur Ajit Singh
- Faculty of Health Sciences, Physiotherapy Programme & Center for Healthy Ageing & Wellness, (H-CARE), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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8
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Arroyo AC, Zawadzki MJ. The Implementation of Behavior Change Techniques in mHealth Apps for Sleep: Systematic Review. JMIR Mhealth Uhealth 2022; 10:e33527. [PMID: 35377327 PMCID: PMC9132368 DOI: 10.2196/33527] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/21/2021] [Accepted: 01/07/2022] [Indexed: 01/19/2023] Open
Abstract
Background Mobile health (mHealth) apps targeting health behaviors using behavior change techniques (BCTs) have been successful in promoting healthy behaviors; however, their efficacy with sleep is unclear. Some work has shown success in promoting sleep through mHealth, whereas there have been reports that sleep apps can be adverse and lead to unhealthy obsessions with achieving perfect sleep. Objective This study aims to report and describe the use of BCTs in mHealth apps for sleep with the following research questions: How many BCTs are used on average in sleep apps, and does this relate to their effectiveness on sleep outcomes? Are there specific BCTs used more or less often in sleep apps, and does this relate to their effectiveness on sleep outcomes? Does the effect of mHealth app interventions on sleep change when distinguishing between dimension and measurement of sleep? Methods We conducted a systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to review articles on mHealth app interventions for sleep published between 2010 and 2020. Results A total of 12 studies met the eligibility criteria. Most studies reported positive sleep outcomes, and there were no negative effects reported. Sleep quality was the most common dimension of sleep targeted. Subjective measures of sleep were used across all apps, whereas objective measures were often assessed but rarely reported as part of results. The average number of BCTs used was 7.67 (SD 2.32; range 3-11) of 16. Of the 12 studies, the most commonly used BCTs were feedback and monitoring (n=11, 92%), shaping knowledge (n=11, 92%), goals and planning (n=10, 83%), and antecedents (n=10, 83%), whereas the least common were scheduled consequences (n=0, 0%), self-belief (n=0, 0%), and covert learning (n=0, 0%). Most apps used a similar set of BCTs that unfortunately did not allow us to distinguish which BCTs were present when studies reported more positive outcomes. Conclusions Our study describes the peer-reviewed literature on sleep apps and provides a foundation for further examination and optimization of BCTs used in mHealth apps for sleep. We found strong evidence that mHealth apps are effective in improving sleep, and the potential reasons for the lack of adverse sleep outcome reporting are discussed. We found evidence that the type of BCTs used in mHealth apps for sleep differed from other health outcomes, although more research is needed to understand how BCTs can be implemented effectively to improve sleep using mHealth and the mechanisms of action through which they are effective (eg, self-efficacy, social norms, and attitudes).
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Affiliation(s)
- Amber Carmen Arroyo
- Department of Psychological Sciences, University of California, Merced, CA, United States
| | - Matthew J Zawadzki
- Department of Psychological Sciences, University of California, Merced, CA, United States
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Reynaud E, Pottelette J, Rabot J, Rolling J, Royant-Parola S, Hartley S, Coutelle R, Schröder CM. Differential effects of COVID-related lockdown on sleep-wake rhythms in adults with autism spectrum disorder compared to the general population. Autism Res 2022; 15:945-956. [PMID: 35234355 PMCID: PMC9073973 DOI: 10.1002/aur.2692] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 12/25/2022]
Abstract
COVID‐related lockdown led to a radical modification of daily activities and routines which are known to affect sleep. Compared to the general population, participants with autism may be particularly vulnerable to the repercussions of lockdown on sleep, given their intrinsic inflexible adherence to routines and the high overall prevalence of sleep disturbances in this population. The study is a French nation‐wide online survey assessing sleep–wake rhythms and behaviors known to affect sleep (daily screen time, daylight exposure, and physical activity), before and during COVID‐related lockdown. Respondents were 207 adults with autism (56% female) and 1652 adults of the general population (77% female), with a mean age 35.3 years (SD 11.3). Before lockdown, the adults with autism displayed on average later bedtime and waking hours, lower sleep quality, more evening screen time, less exposure to daylight, and less exercise (all p < 0.01). Lockdown affected all studied measures of sleep and related exposures in a similar way in both groups: poorer self‐rated sleep quality as well as a less regular and delayed sleep–wake rhythm, longer screen time in the evening and less exposure to daylight (all p < 0.001). Adults with autism displayed significantly higher levels of sleep and circadian rhythm disturbances and less favorable daily routines known to regulate sleep. While the effect of confinement on sleep and sleep related behaviors was similar in both groups, the results highlight that the pre‐existing shift in circadian rhythms and lifestyles in adults with ASD further deteriorated during lockdown.
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Affiliation(s)
- Eve Reynaud
- UPR3212 - Institute of cellular and intergrative Neurosciences, CNRS UPR3212-Institute of Cellular and Integrative Neurosciences, Strasbourg, France
| | - Julien Pottelette
- UPR3212 - Institute of cellular and intergrative Neurosciences, CNRS UPR3212-Institute of Cellular and Integrative Neurosciences, Strasbourg, France.,Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, Strasbourg, France.,Expert Centre for High-Functioning Autism, Fondation FondaMental, Strasbourg, France.,Autism Ressource Centre 67, Strasbourg, France
| | - Juliette Rabot
- UPR3212 - Institute of cellular and intergrative Neurosciences, CNRS UPR3212-Institute of Cellular and Integrative Neurosciences, Strasbourg, France.,Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, Strasbourg, France.,Expert Centre for High-Functioning Autism, Fondation FondaMental, Strasbourg, France.,Autism Ressource Centre 67, Strasbourg, France
| | - Julie Rolling
- UPR3212 - Institute of cellular and intergrative Neurosciences, CNRS UPR3212-Institute of Cellular and Integrative Neurosciences, Strasbourg, France.,Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, Strasbourg, France
| | | | - Sarah Hartley
- Réseau Morphée, Paris, France.,Physiologie et Explorations fonctionnelles, APHP Hospital Raymond Poincaré Paris, Garches, France
| | - Romain Coutelle
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, Strasbourg, France.,Expert Centre for High-Functioning Autism, Fondation FondaMental, Strasbourg, France.,Autism Ressource Centre 67, Strasbourg, France
| | - Carmen M Schröder
- UPR3212 - Institute of cellular and intergrative Neurosciences, CNRS UPR3212-Institute of Cellular and Integrative Neurosciences, Strasbourg, France.,Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, Strasbourg, France.,Expert Centre for High-Functioning Autism, Fondation FondaMental, Strasbourg, France
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Towards Understanding the Usability Attributes of AI-Enabled eHealth Mobile Applications. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2021:5313027. [PMID: 34970424 PMCID: PMC8714331 DOI: 10.1155/2021/5313027] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/30/2021] [Accepted: 11/16/2021] [Indexed: 12/28/2022]
Abstract
Mobile application (app) use is increasingly becoming an essential part of our daily lives. Due to their significant usefulness, people rely on them to perform multiple tasks seamlessly in almost all aspects of everyday life. Similarly, there has been immense progress in artificial intelligence (AI) technology, especially deep learning, computer vision, natural language processing, and robotics. These technologies are now actively being implemented in smartphone apps and healthcare, providing multiple healthcare services. However, several factors affect the usefulness of mobile healthcare apps, and usability is an important one. There are various healthcare apps developed for each specific task, and the success of these apps depends on their performance. This study presents a systematic review of the existing apps and discusses their usability attributes. It highlights the usability models, outlines, and guidelines proposed in previous research for designing apps with improved usability characteristics. Thirty-nine research articles were reviewed and examined to identify the usability attributes, framework, and app design conducted. The results showed that satisfaction, efficiency, and learnability are the most important usability attributes to consider when designing eHealth mobile apps. Surprisingly, other significant attributes for healthcare apps, such as privacy and security, were not among the most indicated attributes in the studies.
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